Abstract:

Objective

To summarize the management experience of radical prostatectomy complicated with rectal injury by extraperitoneal laparoscopic approach.

Methods

A retrospective analysis was made of the clinical data of 5 patients who underwent radical prostatectomy complicated with rectal injury through extraperitoneal laparoscopic approach in Shaoxing People's Hospital from January 2014 to October 2022.One patient was pathologically found to have prostate cancer after transurethral prostatectomy，and the other 4 patients were confirmed to have prostate cancer by perineal prostatectomy.The operation time was 1-2 weeks after the puncture.In 3 cases，rectal injury was found directly during the operation and primary rectal repair was performed，of which 2 cases，prophylactic colostomy was performed due to large rectal laceration，poor intestinal preparation and serious contamination of the operating field and 1 case only underwent rectal repair without prophylactic colostomy.Rectal injury was found in the 2 cases after operation，one underwent conservative treatment successfully，the other underwent colostomy，transanal rectourethral fistula repair 4 months later，and coloplasty 3 months later.

Results

All the 5 patients had good healing，no fecal urine，wound infection，pelvic abscess，sepsis，peritonitis，etc.Cystourethrography showed no contrast extravasation.

Conclusions

The rectal injury in radical prostatectomy by extrasperitoneal laparoscopy is most likely to occur in the apical part.The timely detection of rectal injury during the operation and the subsequent laparoscopic primary rectal repair are extremely important.Good preoperative intestinal preparation creates a good opportunity for primary rectal repair，without the need for preventive colostomy.

Key words: Extraperitoneal, Laparoscopic, Prostatectomy, Rectal injury