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

Rustagi, Tarush; Yılmaz, Emre; Alonso, Fernando; Schmidt, Cameron; Oskouian, Rod J.; Tubbs, R. Shane; Hopkins, Sarah; Schildhauer, Thomas A.; Fisahn, Christian

doi:10.1177/2192568218800045

Cited by 7 publications

(18 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…High clinical suspicion is of utmost importance to avoid devastating postoperative outcomes. While Rustagi et al [11] reported that abdominal pain, distention, and fever were the most common findings in cases of visceral injury, most of the patients in our study complained of nonspecific and vague symptoms and signs. Abdominal pain and fever are common events after a retroperitoneal approach and spinal fusion.…”

contrasting

confidence: 56%

“…Although bowel injury after LLIF is very rare, it is a potentially life-threatening complication. A few studies have documented a small number of cases of bowel perforation after LLIF [9][10][11][12]. Its exact incidence is not known.…”

Section: Discussionmentioning

confidence: 99%

“…Despite its minimally invasive nature, several approachrelated complications have been reported, including neurological injury, psoas muscle weakness, pseudohernia, and vascular injury [5]. Although the incidence of bowel injuries due to LLIF surgery is minimal, the injuries can be fatal in the absence of early diagnosis and treatment [6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…The authors have frequently utilized the LLIF approach for the treatment of various spinal conditions. Although several reports on bowel injury after the anterior approach to the spine have already been published in the literature [6][7][8][9][10][11][12], owing to the low incidence of such complications, we failed to realize the seriousness of this risk until we encountered two such cases. Therefore, we decided to perform a computed tomography (CT) scan of the abdomen and pelvis (APCT) for every patient and analyzed the incidence and risk factors for postoperative pneumoperitoneum and bowel injury.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bowel Injury and Insidious Pneumoperitoneum after Lateral Lumbar Interbody Fusion

et al. 2022

View full text Add to dashboard Cite

Retrospective review of prospectively collected cases. Purpose: To report bowel injury cases and determine the incidence and risk factors of insidious pneumoperitoneum after lateral lumbar interbody fusion (LLIF). Overview of Literature: Minimally invasive LLIF is considered a safe surgical approach with a low risk of complications. Visceral injury after LLIF is rare and, to our knowledge, no studies on pneumoperitoneum after LLIF have been performed. Bowel injury is a catastrophic complication, but the clinical signs may not be apparent. After we encountered two cases of bowel injury after LLIF, we decided to perform computed tomography of the abdomen and pelvis (APCT) after surgery for all patients who underwent LLIF. Methods: A total of 90 patients underwent APCT within 48 hours of surgery. Medical records were reviewed to determine each patient's age, sex, body mass index, medical and surgical histories, characteristics of LLIF procedures, and subjective symptoms and abnormal findings in the physical examination related to acute abdomen after surgery. Various parameters were compared between patients with and without pneumoperitoneum. Results: Bowel injuries were identified in the first two patients and five patients (5.5%) were diagnosed with pneumoperitoneum only on APCT. We found that the greater the number of fused segments, the higher the incidence of postoperative bowel injury and/or pneumoperitoneum. The incidence was significantly high when the L2-3 level was included in the LLIF surgery. Conclusions: Pneumoperitoneum after LLIF indicates damage to the peritoneum and the presence of bowel injury that may lead to peritonitis. However, it is difficult to distinguish pneumoperitoneum and/or bowel injury from general abdominal pain after surgery because patients may present with a wide range of symptoms. We recommend that APCT be routinely performed after LLIF surgery in order to promptly identify pneumoperitoneum and bowel injury.

show abstract

contrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bowel Injury and Insidious Pneumoperitoneum after Lateral Lumbar Interbody Fusion

et al. 2022

View full text Add to dashboard Cite

show abstract

“…For multiple series, the incidence of BPs attributed to XLIF/MI XLIF ranged between 0.03% to 12.5%; this left us questioning the true incidence of this surgical error [ Table 1 ]. [ 2 , 7 , 9 , 15 , 17 , 19 , 21 , 22 ] Specifically, BPs occurred in one case report, and with higher numbers of cases reported in other clinical series [ Table 1 ]. [ 2 , 5 , 7 , 9 , 15 , 17 , 19 , 21 , 22 ] In 2015, Balsano et al .…”

Section: Different Frequencies Of Bowel Perforations Reports For Xlif/mi Xlifmentioning

confidence: 99%

Perspective on the true incidence of bowel perforations occurring with extreme lateral lumbar interbody fusions. How should they be treated?

Epstein¹

2021

Surgical Neurology International

View full text Add to dashboard Cite

Background: What is the risk of bowel perforation (BP) with open or minimally invasive (MI) extreme lateral lumbar interbody fusion (XLIF)? What is the truth? Further, if peritoneal symptoms/signs arise following XLIF/MI XLIF, it is critical to obtain an emergent consultation with general surgery who can diagnose and treat a potential BP. Literature Review: In multiple series, the frequency of BP ranged markedly from 0.03% (i.e. 1 of 2998 patients), to 0.08% (11/13,004), to 0.5%, to 8.3% (1 in 12 patients), up to 12.5% (1 in 8 patients). BPs attributed to different causes carry high mortality rates varying from 11.1% to 23%. For the 11 (0.08%) BP occurring out of 13,004 patients undergoing XLIF in one series, there was one (9.09%) death due to uncontrolled sepsis. In another series, where 31 BP were identified for multiple lumbar surgical procedures identified through PubMed (1960–2016), including 10 (32.2%) for lateral lumbar surgery including XLIF, the overall mortality rate was 12.9% (4/31). Conclusion: The incidence of BPs occurring following XLIF/MI XLIF procedures ranged from 0.03% to 12.5% in various reports. What is the true incidence of these errors? Certainly, it is more critical that when spine surgeons’ patients develop acute peritoneal symptoms/signs following these procedures, they immediately consult general surgery to both diagnose, and treat potential BP in a timely fashion to avoid the high morbidity (87.1%) and mortality rates (12.9%) attributed to these perforations.

show abstract

Complications From Lateral Transpsoas Approaches to the Lumbar Spine

Glinski¹,

Ansari²,

Kolb³

et al. 2020

Surgical Anatomy of the Lateral Transpsoas Approach to the Lumbar Spine

View full text Add to dashboard Cite

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

Cited by 7 publications

References 50 publications

Bowel Injury and Insidious Pneumoperitoneum after Lateral Lumbar Interbody Fusion

Bowel Injury and Insidious Pneumoperitoneum after Lateral Lumbar Interbody Fusion

Perspective on the true incidence of bowel perforations occurring with extreme lateral lumbar interbody fusions. How should they be treated?

Complications From Lateral Transpsoas Approaches to the Lumbar Spine

Contact Info

Product

Resources

About