Comparative Study of Ureteral Injuries After Rectal Surgery Via Laparoscopy vs. Laparotomy

Background: Despite the low frequency rate, ureteral injuries can lead to significant morbidity. Urinary organs can be injured during open or laparoscopic surgery. This study aimed to assess differences in ureteral injury rates between laparoscopic and open surgery for rectal neoplasms. Methods: This retrospective study included 726 patients with rectal tumors in Shiraz, Iran, from 2000 to 2021. Data collected from the patients’ electronic charts included the type of surgery, gender, age, body mass index (BMI), stage, appearance and size of the tumor, preoperative chemoradiotherapy, recurrence, and metastasis. Ureteral injury and urinary incontinence occurrences were recorded. Results: Abdominoperineal (AP) resection was done via laparoscopy in 131 (22.2%) cases and laparotomy in 42 (30.9%) cases. Low anterior resection was performed by laparoscopy in 254 (43%) cases and laparotomy in 61 (44.8%) cases. The frequency of ureteral injuries was 2.2% for open procedures and 1.5% for laparoscopic procedures (P=0.837). The rate of urinary incontinence was 65 (11.0%) in the laparoscopy and 9 (6.6%) in the laparotomy group (P=0.169). Conclusion: The frequency of ureteral injury after laparotomy or laparoscopic surgeries was not significantly different. Although the number of side effects of these surgeries was low, it can be concluded that the possibility of damage to the ureter is less in laparoscopic surgery, while that of damage to the nerves of the pelvic floor is more.