Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia.
Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia.
J Minim Invasive Gynecol. 2022 Nov;29(11):1224-1230. doi: 10.1016/j.jmig.2022.09.058. Epub 2022 Sep 30.
This systematic review aims to identify causes of increased risk for and location and mechanism of gastric injury at laparoscopy for gynecologic indications and determine optimal management.
A prospectively registered systematic review (PROSPERO: CRD42021237999) was undertaken and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, Embase, Web of Science, SCOPUS, and Google Scholar from 1960 to 2021.
All study types were included involving female patients of any age with gastric injury at laparoscopy for gynecologic indication.
TABULATION, INTEGRATION, AND RESULTS: A total of 6294 articles were screened, from which 67 studies were selected for a full-text review. Twenty-eight articles were included, which contained 42 cases drawn from 7 observational studies, 4 case series, and 17 case reports. Of these, 93% (39/42) were at the time of laparoscopic entry, with Veress entry technique used in 79% of these cases (31/39). Eighteen cases reported an entry point, with 77% (14/18) occurring at the periumbilical entry point and 11% (2/18) occurring at Palmer's point. Of the cases with reported etiology for gastric distention or displacement, 64% (9/14) were owing to anesthetic cause. The most common sites of gastric injury were on the anterior stomach wall (n = 8) and the greater curvature (n = 5). Among patients with reported management (32/42), a similar proportion were managed conservatively (11) when compared with repair through laparotomy (13) or laparoscopy (8). All injuries were detected intraoperatively with no reported short-term sequelae.
This systematic review of the literature reveals that gastric injury at laparoscopy for gynecologic indications is a rare complication predominantly occurring during laparoscopic entry, most commonly at the periumbilical entry point. When detected intraoperatively, conservative management, laparoscopic, or open repair in the appropriate patient has been performed with no short-term sequelae. The limitations of this review include paucity of cases, detail, and timeline of publications.
本系统评价旨在确定妇科腹腔镜检查中胃损伤风险增加的原因、位置和机制，并确定最佳治疗方法。
根据系统评价和荟萃分析的首选报告项目，前瞻性注册了一项系统评价（PROSPERO：CRD42021237999），并按照该指南进行了研究。检索的数据库包括 Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、Medline、Embase、Web of Science、SCOPUS 和 Google Scholar，时间跨度为 1960 年至 2021 年。
所有研究类型均纳入研究对象为任何年龄的女性患者，因妇科原因行腹腔镜检查时发生胃损伤。
结果列表、整合与结果：共筛选出 6294 篇文章，其中 67 篇文章进行了全文审查。28 篇文章被纳入，其中 7 项观察性研究、4 项病例系列研究和 17 项病例报告共包含 42 例。这些研究中，93%（39/42）发生在腹腔镜进入时，其中 79%（31/39）采用 Veress 进入技术。18 例报告了进入点，其中 77%（14/18）发生在脐部进入点，11%（2/18）发生在 Palmer 点。在报道胃扩张或移位病因的病例中，64%（9/14）归因于麻醉原因。胃损伤最常见的部位是胃前壁（n=8）和胃大弯（n=5）。在报道治疗方法的患者中（32/42），与剖腹手术（13 例）或腹腔镜手术（8 例）相比，相似比例的患者采用保守治疗（11 例）。所有损伤均在术中发现，无短期不良后果报道。
本系统评价文献显示，妇科腹腔镜检查中胃损伤是一种罕见的并发症，主要发生在腹腔镜进入时，最常见于脐部进入点。当在术中发现时，根据患者的具体情况，采用保守治疗、腹腔镜或剖腹手术进行修复，均无短期不良后果。本综述的局限性包括病例数量少、发表的细节和时间线有限。
