Comparative Study of Ureteral Injury After Laparoscopic or Laparotomy Rectal Surgery

Abstract

Background Despite the low incidence rate, ureteral injuries can lead to significant morbidity. Urinary organs can be injured during open or laparoscopic surgery. This study aimed to assess whether a ureteral injury exists between laparoscopic and open surgery over 20 years in Shiraz. Methods This is a retrospective study and 779 patients of rectal cancer were evaluated in Shiraz from 2000 to 2021 by collecting data from the patients' electronic charts. We evaluated the type of surgery, gender, age, body mass index (BMI), stage, appearance and size of the tumor, preoperative (chemo)-radio-therapy, recurrence, and metastasis. Ureteral injury was analyzed and urinary incontinence was recorded.Results A total number of 131 (22.2%) in laparoscopy surgeries and 42 (30.6%) in laparotomy surgeries had abdominoperineal (A-P) resection. The total number of 254 (43%) in laparoscopy surgeries and 61 (44.5%) of patients had low anterior resection in laparotomy surgeries. The incidence of ureteral injuries was 2.2% for open procedures and 1.5% for laparoscopic and 2.2% for conversion procedures. The rate of urinary incontinence was 65 (11.0%) in laparoscopy and 9 (6.6%) in laparotomy group. Conclusion It is concluded that the ureteral injury after laparotomy is more than laparoscopic surgeries. Although the number of side effects of these surgeries is low, it can be concluded that the possibility of damage to the ureter is less in laparoscopic surgery and that of damage to the nerves of the pelvic floor is more.