Management of rectal injury during radical prostatectomy: Our experience and literature review
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v82i2.842Keywords:
Rectal injury, prostatectomy, treatmentAbstract
Objective: To evaluate the incidence, possible risk factors and management of rectal injury during radical prostatectomy.
Design, methodology or approach: Rectal injury is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited as most studies are based on relatively small series.
A total of 147 laparoscopic radical prostatectomies were retrospectively reviewed from January 2017 to April 2021. Four patients with rectal injury were found during the procedure.
Results: Of the total number of patients with rectal injury during the procedure, there was extraprostatic extension in the pre-surgery MRI in 50% of the patients. None had a history of previous RT. Primary closure was performed using two layers of suture in all cases. In one case (25%) an intraoperative colostomy was performed. One of the four patients (25%) developed a rectal fistula with secondary peritonitis for which he had to undergo another operation. The time on absolute diet varied from 0 days to 2 days and the time of antibiotic therapy differed in all patients.
Discussion: Rectal injury occurs in 0.1-1.8% of patients undergoing radical prostatectomy and significantly increases the morbidity of the procedure. Most rectal injuries occur during plane dissection maneuvers between the seminal vesicles, prostate, and rectum. To detect it, it is recommended to perform a digital rectal examination and insufflate air through the rectum intraoperatively. The risk factors for its appearance are previous RT, an advanced tumor and a low experience of the surgeon in the procedure. The interposition of tissue in rectal defects continues to generate controversy. Despite primary closure, there is a risk of rectal fistula, especially in cases of defects larger than 2 cm, previous RT, or tumor infiltration of the rectum.
Conclusions: Rectal injury is a rare but serious complication that can complicate the postoperative period of radical prostatectomy.
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