ABSTRACT
Intraoperative bowel injuries are most likely to occur during entry into the abdominal cavity and during lysis of adhesions. If entering the abdomen through an old scar, the risk of injury is reduced if entry is gained just beyond the limit of the old scar. Sharp entry is preferred over use of an electrocoagulation device due to the clean, defined nature of a sharp injury. Thermal injuries are more difficult to detect and evaluate due to the potential for delayed tissue necrosis up to a few centimeters beyond the point of visible damage. When a significant thermal injury to the bowel occurs, a wide resection up to 3 to 5 cm from the edges of the injury with primary reanastomosis is recommended. Thin filmy intra-abdominal adhesions can be safely lysed using blunt dissection and the electrocautery devise. Thicker, less yielding adhesions require sharp dissection to avoid injury to the bowel.
