Iatrogenic bowel injury in laparoscopic cholecystectomy in patients with a history of prior laparotomy: an analytical review

Introduction. Iatrogenic bowel injury during laparoscopic cholecystectomy (LC) is a rare but potentially life-threatening complication, with the risk markedly increased in patients with previous laparotomies due to dense intra-abdominal adhesions. The aim of this study was to analyze the incidence, clinical outcomes, and risk factors associated with such injuries and to develop practical recommendations for their prevention and management. Materials and methods of research. An analytical literature review was conducted covering the period from 2015 to 2025 using the PubMed, Google Scholar, and Embase databases. The analysis included systematic reviews, meta-analyses, national registries, and clinical guidelines from leading surgical societies (WSES, SAGES). Results. The overall incidence of iatrogenic bowel injury during LC ranges from 0,04 % to 0,3 %, while in patients with a history of laparotomy it increases to 0.1%–1%. The presence of adhesions elevates the risk of bowel injury during initial entry by 3–5 times. The timing of diagnosis is the key prognostic factor: when identified and corrected intraoperatively, mortality is close to zero; however, with delayed recognition (typically on postoperative days 2–5) due to peritonitis and sepsis, mortality may reach 20–30 %. Conclusion. To minimize the risk of bowel injury, surgeons should employ open (Hasson) entry or alternative trocar insertion sites, avoid blind Veress needle access, maintain a high index of surgical suspicion, and keep a low threshold for conversion to laparotomy in the presence of technical difficulties compromising visualization or safety.