Predicting Risk of Complications With Gynecologic Laparoscopic Surgery

Abstract

Objective: To determine the incidence and predictors of risk for operative complications, conversions to laparotomy, and postoperative admissions after laparoscopic procedures.Methods: We obtained demographic information on and medical histories of a consecutive series of 843 women who underwent laparoscopic surgery for all procedures other than tubal ligation at Brigham and Women's Hospital during 1994. All major complications after surgery were recorded. Major operative complications were defined as bowel, bladder, ureter, or vascular injuries or significant abdominal wall or other internal bleeding. Categorical analysis was used to compare differences in the rates of operative complications, conversions to laparotomy, and postoperative admissions after laparoscopy. We also estimated the influence of medical history and specific laparoscopic procedures on the risk of adverse complications after surgery.Results: Operative complications and conversion to laparotomy occurred in 1.9% and 4.7% of laparoscopic procedures, respectively. Complications included four bowel, two bladder, one ureteral, two vascular, and five abdominal wall injuries. There were 165 patients (19.6%) admitted postoperatively. Aside from the type of operative procedure, increasing age was the most important predictor of complications. Relative to all other operative procedures, women treated for endometriosis or ovarian cystectomy had generally low rates of operative complications, conversions to laparotomy, and postoperative admissions. In contrast, 12.5% of women undergoing laparoscopically assisted vaginal hysterectomy experienced operative injuries or abdominal bleeding and 90% were hospitalized postoperatively.Conclusion: Serious operative complications after gynecologic laparoscopy were rare in this patient population. The more complex laparoscopic procedures resulted in proportionately greater rates of operative complications, conversions to laparotomy, and postoperative admissions to the hospital. (Obstet Gynecol 1998;92:327-31.

Major vascular injury after laparoscopic tubal ligation

“…Literature regarding complications specifically related to laparoscopic tubal ligation is less extensive (11). Between 1977 and 1981 there were 29 deaths reported to the Centers for Disease Control after tubal sterilization, of which 3 were MVIs secondary to laparoscopic procedures (12).…”

Evaluation of laparoscopic management of gynecologic emergencies by residents

“…Although the associated factors that modify these parameters after elective laparoscopic gynecologic procedures have been studied previously [1,8], little is known about gynecologic emergencies [6]. At the time of the present study, no investigation had specifically addressed these associated factors across the entire spectrum of laparoscopic treatment of gynecologic emergencies.…”

Gynäkologisch-geburtshilfliche Notfälle − Komplikationen bei endoskopischen Eingriffen

“…1995 [34] 16.521 0,3 0,1 0, 6 Bateman et al 1996 [3] 2324 0,22 0,1 0, 8 Saidi et al 1996 [36] 452 10,3 -10,3 Härkki-Siren and Kurki. 1997 [12] 70.607 0,4 0,06 1,0 Chapron et al 1998 [8] 29.266 0,5 0,08 0,4-l,7 b Mac Cordick et al 1999 c [25] 743 2,9 2,6 3,0 Mirhashemiet al 1998 [29] 843 1, 9 1,8 8,4 Härkki-Siren et al 1999 [13] 32,205 0,4 0,06 1, 3 Quasarano et al 1999 c [33] 234 9,8 7,0 18,0 Leonard et al 2000 [22] 1033 3 Während der Anlage des Zugangs kommt es auch zu den meisten schwerwiegenden Komplikationen, vor allem zu akzidentellen Gefäßverletzungen. Erfreulicherweise sind Verletzungen großer Gefäße im Rahmen der Laparoskopie insgesamt selten und werden in der Literatur bei 0,04-0,1% aller laparoskopischer Eingriffe berichtet [26].…”