Our Summary

This study looks at ureteral injuries that can occur during abdominal or pelvic surgeries, specifically during both traditional and laparoscopic colectomies (surgery to remove part of the colon). These injuries have become more common over the past two decades, likely due to the increase in surgeries and the introduction of laparoscopic procedures.

The researchers reviewed previous studies (from 2003 to 2015) that compared injury rates from laparoscopic and traditional colectomies. They found that, initially, there was a moderate increase in ureteral injuries with laparoscopic surgeries. But as surgeons gained more experience with these procedures, the injury rate leveled out and was no higher than with traditional surgeries.

Detecting ureteral injuries during laparoscopic operations can be challenging, and symptoms can vary depending on the type of injury. If these injuries are not recognized and treated quickly, it can lead to serious health problems, including loss of kidney function. Many surgeons believe that using a preventive measure, like inserting a catheter into the ureter before surgery, can help reduce the risk of injury.

The study concludes that early detection and immediate repair of ureteral injuries during the same surgical procedure is highly desirable. If an injury is not recognized and treated during surgery, it may require a further procedure to divert urine flow and another surgery, which increases the risk of complications.

FAQs

  1. What are ureteral injuries and how do they occur during laparoscopic colectomies?
  2. How has the rate of ureteral injuries changed with the introduction of laparoscopic procedures?
  3. What measures can be taken to reduce the risk of ureteral injuries during laparoscopic surgeries?

Doctor’s Tip

Therefore, a helpful tip a doctor might tell a patient about laparoscopic colectomy is to discuss with their surgeon the steps they will take to prevent and detect ureteral injuries during the procedure. It is important for patients to be informed and ask questions about the surgical technique and measures that will be taken to minimize the risk of complications. Additionally, patients should be aware of the symptoms of ureteral injuries, such as flank pain, blood in the urine, or decreased urine output, and report any unusual symptoms to their healthcare provider immediately. Being proactive and informed can help ensure a successful outcome after laparoscopic colectomy surgery.

Suitable For

Typically, patients who are recommended for laparoscopic colectomy are those who have conditions such as colon cancer, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), diverticulitis, or severe constipation that have not responded to other treatments. Laparoscopic colectomy is often recommended for patients who are otherwise healthy and are able to tolerate surgery. It may also be recommended for patients who prefer a less invasive surgical option with faster recovery times compared to traditional open surgery.

Timeline

Before laparoscopic colectomy, a patient will typically undergo various tests and consultations to determine the need for surgery and to plan the procedure. They may also receive pre-operative instructions, such as fasting or bowel preparation.

During the laparoscopic colectomy procedure, the surgeon will make small incisions in the abdomen and insert a camera and surgical instruments to remove part of the colon. The surgery is minimally invasive compared to traditional open surgery, resulting in less pain, shorter hospital stays, and quicker recovery times.

After laparoscopic colectomy, the patient will likely experience some pain and discomfort, which can be managed with pain medication. They may need to stay in the hospital for a few days for monitoring and to ensure proper healing. The patient will also need to follow post-operative instructions, such as taking care of the incision sites, gradually resuming normal activities, and following a special diet.

Overall, laparoscopic colectomy offers many benefits for patients compared to traditional open surgery, including faster recovery times and reduced risk of complications. However, as with any surgical procedure, there are potential risks, such as ureteral injuries, that need to be carefully monitored and managed by the surgical team.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laparoscopic colectomy include:

  1. What are the potential risks and complications of a laparoscopic colectomy, including ureteral injuries?
  2. How experienced are you in performing laparoscopic colectomies, and what is your success rate in preventing and detecting ureteral injuries?
  3. What measures will be taken during the surgery to prevent ureteral injuries, such as using a catheter in the ureter?
  4. What symptoms should I watch for that may indicate a ureteral injury after surgery?
  5. How will ureteral injuries be detected and treated during the surgery, if necessary?
  6. What is the follow-up plan after the surgery to monitor for any potential complications, including ureteral injuries?
  7. What is the likelihood of needing additional surgeries or procedures if a ureteral injury is detected post-operatively?
  8. Are there any steps I can take before the surgery to reduce the risk of ureteral injuries?

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