Small bowel obstruction secondary to stapled laparoscopically assisted vaginal hysterectomy.

Background: This study analyzes the complication of small bowel obstruction following stapled division of the adnexa during laparoscopically assisted vaginal hysterectomy (LAVH).

Methods: We reviewed the records of three patients with small bowel obstruction following stapled LAVH. We then tested the proposed mechanisms of obstruction by firing endoscopic staplers across silicon tubing to simulate division of the adnexal structures. Staple shape, spillage, and closure were analyzed.

Results: Small bowel obstruction can result when a partially formed endoscopic staple hooks the small bowel. The problem can be traced to either spilled intraperitoneal staples or partially formed staples that adhere to part of the adnexal staple line. The mechanisms staple closure, spillage, and ability to hook small bowel were confirmed with a laboratory model.

Conclusions: Techniques for reducing the incidence of small bowel obstruction following stapled LAVH include minimizing staple spillage and careful inspection of the adnexal staple line for partially formed staples.