Our Summary

This research paper discusses injuries that can happen to the ureter (the tube that carries urine from your kidneys to your bladder) during surgery. Specifically, it looks at surgeries that are done either with an open incision (open colectomies) or using a small camera and small incisions (laparoscopic colectomies).

The researchers found that while there was initially an increase in ureter injuries when laparoscopic surgeries started to be used more frequently, this is no longer the case. They suggest that as surgeons have gained more experience with laparoscopic procedures, they’ve been able to avoid causing these injuries.

However, the paper notes that ureter injuries can be hard to detect during laparoscopic surgeries, and if they are not caught early, they can lead to serious problems, including loss of kidney function. To prevent this, many surgeons and gynecologists recommend using a ureteral catheterization as a protective measure. This involves placing a small tube into the ureter to help protect it during surgery.

If a ureter injury is not detected and treated during the initial surgery, it may require a second surgery, which could lead to increased health risks.

The researchers reviewed studies from 2003 to 2015 and focused on both prospective (forward-looking) and retrospective (backward-looking) studies that compared laparoscopic and open colectomies.

FAQs

  1. What are the risks of ureter injuries during laparoscopic colectomies?
  2. How can ureter injuries be prevented during surgery?
  3. What happens if a ureter injury is not detected and treated during the initial surgery?

Doctor’s Tip

Therefore, it is important for patients undergoing colectomy to discuss the risk of ureter injury with their surgeon and inquire about the use of protective measures such as ureteral catheterization. It is also crucial to follow up with your healthcare provider if you experience any symptoms such as abdominal pain, fever, or difficulty urinating after surgery. Early detection and treatment of ureter injuries can help prevent further complications and ensure a successful recovery.

Suitable For

Patients who are typically recommended for colectomy include those with:

  1. Colon cancer: Colectomy is often recommended as a treatment for colon cancer, particularly in cases where the cancer has spread beyond the colon.

  2. Inflammatory bowel disease: Patients with severe cases of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, may benefit from colectomy to alleviate symptoms and improve quality of life.

  3. Diverticulitis: Severe cases of diverticulitis, a condition in which small pockets in the colon become inflamed or infected, may require colectomy to remove the affected portion of the colon.

  4. Colon polyps: Large or precancerous colon polyps may necessitate colectomy to prevent the development of colon cancer.

  5. Bowel obstruction: Patients with a bowel obstruction, which can be caused by a variety of factors such as scar tissue, tumors, or severe constipation, may require colectomy to relieve the blockage.

  6. Familial adenomatous polyposis (FAP): Patients with FAP, a genetic condition characterized by the development of numerous colon polyps, may undergo colectomy to reduce their risk of developing colon cancer.

Overall, the decision to recommend colectomy for a patient is based on their individual medical history, the specific condition being treated, and the potential risks and benefits of the procedure.

Timeline

Before colectomy:

  • Patient undergoes pre-operative testing and evaluation to determine if colectomy is necessary
  • Patient may receive bowel preparation instructions to cleanse the colon before surgery
  • Surgery is scheduled and patient is admitted to the hospital
  • Patient undergoes colectomy procedure, either open or laparoscopic

After colectomy:

  • Patient is monitored in the hospital for complications and to ensure proper healing
  • Patient may experience pain, discomfort, and limited mobility in the days following surgery
  • Patient may require a temporary colostomy or ileostomy to divert stool while the colon heals
  • Patient begins the recovery process, including physical therapy and diet modifications
  • Patient is discharged from the hospital and continues to follow up with healthcare providers for monitoring and follow-up care.

What to Ask Your Doctor

  1. What are the potential risks and complications of colectomy surgery, including the risk of ureter injury?
  2. How experienced are you in performing laparoscopic colectomies, and what measures do you take to prevent ureter injuries during surgery?
  3. What are the signs and symptoms of a ureter injury that I should watch out for after surgery?
  4. How likely is it that a ureter injury could occur during my colectomy surgery?
  5. What steps will be taken to monitor and protect my ureter during the surgery?
  6. If a ureter injury does occur during surgery, what is the plan for detecting and treating it promptly?
  7. How often do you perform ureteral catheterization as a protective measure during colectomy surgery?
  8. What is the recovery process like if a ureter injury is detected and treated during or after surgery?
  9. Are there any specific lifestyle changes or precautions I should take post-surgery to prevent ureter injuries or complications?
  10. Can you provide any additional information or resources for me to learn more about ureter injuries and their prevention during colectomy surgery?

Reference

Authors: Liguori G, Dobrinja C, Pavan N, de Manzini N, Bucci S, Palmisano S, Trombetta C. Journal: Ann Ital Chir. 2016;87:446-455. PMID: 27842013