Small intestine injury in laparoscopic-assisted vaginal hysterectomy

Study Objective. To review laparoscopic-assisted vaginal hysterectomy (LAVH) cases for instances of small intestine injury. Design. Retrospective review (Canadian Task Force Classification II-2). Setting. Tertiary care university hospital. Patients. Two thousand six hundred eighty-two women. Intervention. LAVH. Measurements and Main Results. Indications for hysterectomy were myomata uteri, adenomyosis, intractable menorrhagia, endometriosis, severe pelvic adhesions, cervical intraepithelial neoplasia, endometrial polyps, and hyperplasia. Small bowel injuries occurred in five women (1.9/1000), one (20%) of which was recognized postoperatively. Thermal injuries occurred in two patients, trocar injuries in two, and a dissection wound in one. Two-layer closure was performed for three patients, and partial resection with reanastomosis for two. All patients were discharged without sequelae. Conclusion. Small bowel injury during LAVH is not common. It may have unusual characteristics and devastating consequences if not recognized and treated promptly.