The Role of Intraoperative Proctosigmoidoscopy in Laparoscopic Pelvic Surgery

Ceana Nezhat, Seidman D, Daniel Seidman, Daniel S. Seidman, Farr Nezhat, Nezhat F, Camran Nezhat, Nezhat C
The Journal of the American Association of Gynecologic Laparoscopists · 2004 · vol. 11(1) , pp. 47–49 · doi:10.1016/s1074-3804(05)60009-6 · PMID:15104830 · W2129224064
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This paper examines the utility of intraoperative proctosigmoidoscopy during laparoscopic pelvic surgery to assess the integrity of the rectal anastomosis and the pelvic floor.

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Abstract

Study objectiveTo report the outcome of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel injury.DesignProspective patient database with retrospective chart review (Canadian Task Force classification II-3).SettingReferral practice and tertiary medical center.PatientsTwo hundred sixty-two women with rectosigmoid endometriosis and adhesions.InterventionsRigid sigmoidoscopy during laparoscopy. At the end of surgery, proctosigmoidoscopy was performed to evaluate intraluminal abnormality or rectosigmoid injury. The pelvis was then filled with isotonic fluid to observe laparoscopically for air leakage.Measurements and main resultsSigmoidoscopy was performed due to a lesion involving the rectum or sigmoid in 60.7%, large bowel in 11.1%, and posterior cul-de-sac in 28.2% of patients. During laparoscopy, endometriosis was found in 30.5%, adhesions in 20.2%, and both in 43.5%. Four women (1.5%) had bowel injury identified during sigmoidoscopy; all bowel injuries were treated by intracorporeal laparoscopic suturing. One incomplete repair was detected by sigmoidoscopy. In one woman (0.4%) a rectal polyp was detected.ConclusionBowel injury is one of the most serious complications of laparoscopy. Early detection and prompt intraoperative management are essential to prevent a potentially catastrophic outcome. Sigmoidoscopy is a relatively easy procedure and aids during laparoscopy in the diagnosis of bowel perforation and in assessment of bowel wall invasion and potential stricture caused by endometriosis. It is a safe procedure even when performed immediately after extensive laparoscopic surgical treatment of rectosigmoid endometriosis and adhesions.

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Condition tags

endometriosis

MeSH descriptors

Intraoperative Complications Laparoscopy Pelvis Sigmoidoscopy Adult Endometriosis Endometriosis Female Humans Intestines Intestines Intraoperative Complications Middle Aged Pelvis Rectal Diseases Rectal Diseases Sigmoid Diseases Sigmoid Diseases Tissue Adhesions Tissue Adhesions

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