7400 Gastric Injury at Laparoscopy for Gynaecological Indications: A Systematic Review

Study ObjectiveTo identify causes of gastric injury at laparoscopy for gynaecological indications and determine optimal management.DesignA prospectively registered systematic review (PROSPERO CRD42021237999) was undertaken and performed according to PRISMA guidelines.SettingDatabases searched included Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), Medline, Embase, Web of Science, SCOPUS and Google Scholar from to January 2021.Patients or ParticipantsAll study types were included involving female patients of any age with gastric injuries undergoing laparoscopic surgery for any gynaecological indication.InterventionsLaparoscopic surgery for any gynaeoclogical indications.Measurements and Main Results6294 articles were screened from which 67 studies were selected for a full-text review. 28 articles satisfied inclusion criteria which contained 42 cases which were comprised of 7 observational studies (1 prospective, 6 retrospective) observational studies, 4 case series and 17 case reports. 93% (39/42) of reported injuries occurred at the time of laparoscopic entry where Veress entry technique was utilised in 74% of cases (31/42). Eighteen cases had entry point reported, with 33% (14/42) occurring at periumbilical entry point with 5% (2/42) occurring at Palmer's point. The commonest site of gastric injury was superficial, on the anterior stomach (n=8) or at the greater curvature (n=5). Of the reported aetiology, 21% (9/42) were anaesthetic related (i.e., inadvertent oesophageal intubation, prolonged or failed oxygenation). Of the patients with reported management (32/42), a similar proportion of patients were managed conservatively (n=11) when compared to laparotomy (n=13) or via laparoscopy (n=8). All injuries were detected intraoperatively with all patients recovering well with no reported long-term sequelaeConclusionThis review of the literature reveals that gastric injury at laparoscopy for gynaecological indications is a rare complication predominantly occurring during laparoscopic entry, most commonly at periumbilical entry point. When detected intraoperatively, conservative management or laparoscopic repair in the appropriate patient is often adequate with no apparent long term sequalae.