Vaginal Injury During Stapled Anastomosis

Abstract

We have witnessed the evolution of the stapler technology in the field of colorectal surgery within the last three decades. Improvements in technical innovations have allowed the surgeons to be able to create easier and safer stapled ultralow colorectal, coloanal, and ileal-pouch anal anastomosis. However, our innovative spirit of pushing the limits of low pelvic anastomosis on behalf of our patients has inevitably brought some complications with it. Vaginal injury during stapled anastomosis is a rare, but devastating complication, which can result in severe consequences if it is not recognized and appropriately addressed at the time of surgery. The most common reasons for this complication are patient-related factors such as narrow pelvis or reoperative pelvic surgery and more importantly lack of familiarity or respect for the pelvic anatomy and dissection by surgeons. In this chapter, we will share our experience on how to avoid vaginal injury, and when it happens how to fix this humbling and difficult complication.