SURGICAL TECHNIQUES

Avoiding and repairing bowel injury in gynecologic surgery

Tips for avoiding the pitfalls in at-risk patients and injury-prone procedures, plus techniques for adhesiolysis, repair of serosal and small bowel injuries, and inspection of the bowel to rule out perforations.

Dr. Perkins is clinical instructor in obstetrics and gynecology, University of Mississippi Medical Center, Jackson, Miss, and Meharry Medical College School of Medicine, Nashville, Tenn. He practices at the Women’s Clinic, King’s Daughters Hospital, Greenville, Miss. Dr. Dent is assistant professor of surgery, Morehouse School of Medicine, and is a trauma surgeon at Grady Memorial Hospital, both in Atlanta, Ga. Dr. Perkins and Dr. Dent are members of the Society of Black Academic Surgeons. Both completed their training at Harlem Hospital Center in New York City.

This dreaded complication requires vigilance and skill to avoid, and adequate training and experience to manage and repair. In a perfect world, every gynecologist would be trained in techniques to prevent and repair inadvertent bowel injuries. Unfortunately, residency programs often do not provide such training.

Gynecologists routinely operate on patients with risk factors for bowel injury—obesity, endometriosis, multiple abdominal procedures, pelvic inflammatory disease, history of malignancy, and advanced age. A general surgeon is often called, however, for bowel repairs that can be performed by a gynecologist with sufficient training and experience. (There are instances, however, in which a general surgical consultation may not be readily available—another reason to master repair of bowel injuries encountered during gynecologic surgery.)