Accidental Puncture or Laceration in Colorectal Surgery

Kin, Cindy; Snyder, Karen E.; Kiran, Ravi P.; Remzi, Feza H.; Vogel, Jon D.

doi:10.1097/dcr.0b013e3182765c43

Cited by 21 publications

(10 citation statements)

References 10 publications

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“…A recent retrospective review of accidental punctures or lacerations during colorectal surgery revealed nine ureteral injuries in a series of 2897 colorectal operations. Interestingly, history of prior surgery was not associated with an increased incidence of extraintestinal organ injury [Kin et al 2013]. Vascular procedures may cause an intense inflammatory response around the ureters and result in either stricture or fistula as shown in Figure 1.…”

Section: General and Vascular Surgerymentioning

confidence: 99%

Management of iatrogenic ureteral injury

Burks

Santucci

2014

Therapeutic Advances in Urology

211

160

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Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries.

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Section: General and Vascular Surgerymentioning

confidence: 99%

Management of iatrogenic ureteral injury

Burks

Santucci

2014

Therapeutic Advances in Urology

211

160

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“… Denotes the codes 9982 (Accidental puncture or laceration during a procedure, not elsewhere classified) and E8700 (Accidental cut, puncture, perforation or haemorrhage during surgical operation) . …”

Section: Resultsmentioning

confidence: 99%

Reconciliation of international administrative coding systems for comparison of colorectal surgery outcome

et al. 2014

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“…In colorectal operations, serosal injuries or enterotomies are the most common accidental punctures or lacerations, and often occur in the course of adhesiolysis in reoperative surgery, but were found to be more a marker of surgical complexity than of surgical quality. 14,15 We may be able to use such markers to identify cases of greater complexity and, thus, perform risk adjustment to ultimately improve the accuracy of surgical quality metrics.…”

Section: Implications For Surgical Qualitymentioning

confidence: 99%

Complex and Reoperative Colorectal Surgery: Setting Expectations and Learning from Experience

Kin

2016

Clinics in Colon and Rectal Surgery

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Surgeons who perform colorectal operations are bound to face their share of complex and reoperative cases. For many, these challenging operations are what attracted us to the field. To maximize success and minimize complications in these circumstances, the surgeon must ensure adequate preoperative planning with good imaging and enlistment of help from other specialists, set expectations for the patient and operating room staff, and be aware of his or her own abilities. This issue of Clinics in Colon and Rectal Surgery is meant to serve as a resource so that surgeons and patients may benefit from the lessons learned by our expert contributors over years of experience. From a health systems and policy standpoint, it is important to recognize that these complex and reoperative cases confer a higher risk for morbidity and mortality when reporting quality outcomes, and to consider ways to optimize outcomes by concentrating the experience. Preoperative PreparationPreparation for the operation is often as important as the operation itself and consists of setting expectations for all parties involved-the surgeon and the surgical team, the patient, the operating room staff, and the nursing staff on the surgical ward. Failure to do this may result in significant delays, complications, poor delivery of care, and patient dissatisfaction. Imaging and Preoperative AssessmentOperative planning for complex and reoperative cases consists of obtaining high-quality imaging to reduce the risk of unplanned surgical findings. Other aspects of the workup include an assessment of the patient's risk for undergoing a general anesthetic and a major operation. Older patients are likely to undergo a full cardiopulmonary assessment to assess their readiness for a major operation based on the risk factor of age, and patients who are chronologically young yet frail due to their underlying illness should also undergo evaluation. Simple tools to measure a patient's frailty include gait speed, timed-up-and-go, and administration of screening questionnaires such as the Frail scale. 1-3 Assembling the Operating TeamMany complex and reoperative cases require a multidisciplinary approach, involving collaboration with other specialists including urologists, gynecologists, radiation oncologists, and plastic surgeons. The colorectal surgeon should function as the lead surgeon in these cases and coordinate the other players in the operative plan.Another consideration for a surgeon embarking on a difficult case is to ensure that an experienced colleague is available to help should the need arise. This is especially important for junior surgeons, but even very experienced senior surgeons will face particularly challenging cases where Keywords ► complex surgery ► reoperative surgery ► complications AbstractA range of topics are covered in this issue dedicated to complex and reoperative colorectal surgery, from radiation-induced surgical problems, to enterocutaneous fistulas and locally advanced or recurrent rectal cancer. Common themes include the importanc...

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Accidental Puncture or Laceration in Colorectal Surgery

Cited by 21 publications

References 10 publications

Management of iatrogenic ureteral injury

Management of iatrogenic ureteral injury

Reconciliation of international administrative coding systems for comparison of colorectal surgery outcome

Complex and Reoperative Colorectal Surgery: Setting Expectations and Learning from Experience

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