Page 219 - Read Online

Page 8 of 13 Climent et al. Mini-invasive Surg 2018;2:45 I http://dx.doi.org/10.20517/2574-1225.2018.62

Figure 2. Colovesical fistula in a patient undergoing laparoscopic anterior resection. Air in the bladder in the absence of catheterisation

a result of thermal and/or ischemic injury, tension or local inflammatory damage of autonomic nerves is
[62]
well recognised . Special attention must be paid during dissection at the origin of the inferior mesenteric
artery, during the posterior mobilization of the rectum and lateral and anterior dissection of the rectum to
[63]
minimise risk of nerve injury .
Due to sympathetic and parasympathetic nerve damage, patients describe incomplete urination, frequency
of urination, interrupted urination, incontinence and low-flow urination. Urinary dysfunction may be
easily evaluated with the International Prostate Symptom Score, which includes assessment of urinary
symptoms and patient’s QOL. Utilizing this scoring system, data suggest 12.7% of patients suffer from
[62]
severe dysfunction after rectal resection .
For appropriate diagnosis and follow-up of urogenital dysfunction, The International Index of Erectile
Function form for men and the International Index of Female Sexual Function for women are valuable
[63]
and validated instruments to assess sexual dysfunction . Some studies have reported impotence in
20%-46% and ejaculatory disorders in 20%-60% of men, whereas in women symptoms include loss of
libido, vaginal moisture loss, orgasm loss and dyspareunia, being reported by 30% to 65% of patients after
LAR [62,63] . Damage of superior hypogastric plexus and hypogastric nerves causes bladder instability (loss of
relaxation) and retrograde ejaculation or loss of ejaculation in men, whereas damage of inferior hypogastric
[63]
plexus leads to difficulties in bladder emptying and impotence .
Stoma complications
Stoma complications could be associated with significant morbidity, which is highest in the first
[64]
5 years postoperatively . Some complications appear early in the postoperative course, such as fluid and
electrolyte imbalance, peristomal dermatitis or stoma retraction because the bowel is under tension, often
requiring stoma refashioning.

Parastomal hernias
There is a wide range of incidence of parastomal hernia, depending on the follow-up and the type of stoma.
An incidence of 6.2% has been described for loop ileostomies, while the incidence is higher for colostomies