Injury to the rectum during laparoscopic radical prostatectomy: is it a serious complication?
Introduction. Rectal injury is a serious intraoperative complication of radical prostatectomy (RP), with its reported incidence varying widely in the literature from 0 to 20.39%. Delayed diagnosis of rectal injury increases the risk of peritonitis, sepsis, and rectourethral fistula formation. The optimal strategy for prevention and management of this complication remains a matter of debate.Perlin D.V., Doronin A.B., Zipunnikov V.P., Shamkhalov Sh.N., Gorbach A.N., Khusainov M.Kh.
Aim. To analyze the causes of rectal injury during laparoscopic radical prostatectomy (LRP) and the efficiency of therapeutic measures based on the authors’ own experience in comparison with the published literature.
Materials and methods. A retrospective analysis was performed of 519 LRP procedures carried out at a single center between 2014 and 2023. Intraoperative rectal injury was identified in 3 patients (0.58%). In all cases, LRP was performed via an extraperitoneal approach. A bubble test was used for intraoperative diagnosis of rectal injury. All defects were closed with a two-layer suture using absorbable material. Postoperative management included antibiotic therapy, parenteral nutrition for 6-9 days, and prolonged bladder catheterization for 9-14 days.
Results. The length of the rectal defect ranged from 1.0 to 3.5 cm. There was no need for conversion to open surgery or colostomy. No surgical complications, suture failure, or signs of oncological disease progression were recorded during a follow-up period of 46-113 months.
Discussion. Intraoperative rectal injury during LRP is a rare complication. Timely intraoperative diagnosis, including the use of a bubble test, and immediate two-layer closure of the defect make it possible to minimize the risk of severe postoperative complications and rectourethral fistula formation.
Conclusion. Previous radiation therapy and prior surgery increase the risk of rectal injury, whereas intraoperative closure of the defect usually does not require colostomy and rarely results in complications. The role of preoperative bowel preparation and parenteral nutrition in preventing suture failure remains unclear.
Keywords
radical prostatectomy
iatrogenic rectal injury
intraoperative diagnosis
extraperitoneal approach
About the Authors
Corresponding author: D.V. Perlin – Ph.D., MD, Professor, Head of the Department of Urology, Volgograd State Medical University, Ministry of Health of Russia, Volgograd, Russia; Chief Physician, Volgograd Regional Uronephrological Center, Volzhsky, Russia; e-mail: dvperlin@mail.ruSimilar Articles
