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German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

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Iatrogenic Bowel Injury Following Minimally Invasive Lateral Approach to the Lumbar Spine: A Retrospective Analysis of 3 Cases

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  • presenting/speaker Christian Fisahn - Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Chirurgische Klinik und Poliklinik, Bochum, Germany
  • Emre Yilmaz - Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Chirurgische Klinik und Poliklinik, Bochum, Germany
  • Martin Hoffmann - BG-Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Chirurgische Klinik und Poliklinik, Bochum, Germany
  • Jens R. Chapman - Swedish Hospital, Seattle, United States
  • Thomas A. Schildhauer - BG Universitätsklinikum Bergmannsheil, Ruhr Universität Bochum, Chirurgische Klinik und Poliklinik, Bochum, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocAB50-366

doi: 10.3205/19dkou462, urn:nbn:de:0183-19dkou4628

Published: October 22, 2019

© 2019 Fisahn et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives: Anterior approaches are often used during lumbar interbody fusion procedures. Visceral injuries (bowel injuries) are rare but represent a primary risk during anterior approaches to the lumbar spine. Left untreated, these injuries can result in significant complications. The aim of this study was to investigate the presentation and management of bowel injury cases following anterior approaches to the lumbar spine to raise the surgeon?s awareness of this rare complication.

Methods: All direct anterior, oblique anterior, and transpsoas lumbar interbody fusion surgeries performed at our institution between 2012 and 2017 were analyzed retrospectively. Charts were screened for cases requiring return to the operating room owing to a suspected bowel injury and details of the case were extracted for illustrative purposes.

Results and conclusion: A total of 775 anterior lumbar surgeries were conducted at a single tertiary care institution between July 2012 and June 2017. A total of 590 transpsoas lumbar interbody fusion (TPIF) surgeries were performed. Four patients, each having undergone TPIF, were suspected of bowel injury and underwent an exploratory laparotomy. At surgery, 3 patients were confirmed to have a bowel injury, giving a procedure-specific incidence of 0.51% and overall incidence of 0.39%. Among the 3 confirmed bowel injury cases, average delay between surgery and visceral injury diagnosis was 4.7 days (range 3-7 days).