Neurologic complications in operations performed in the lithotomy position / 대한산부인과학회지

OBJECTIVE: Neurologic complication of extremity is well recognized as a potential complication of procedures performed on patients in the lithotomy position. The goal of this study was to evaluate the incidence and risk factors of this complication. MATERIALS AND METHODS: We retrospectively reviewed the perioperative courses of 322 patients who underwent 1 of 13 surgical procedures performed on patients in the lithotomy position at the A university medical center from 2003 to 2005 inclusive. Neurologic complication was defined as symptoms of paresthesia or dysesthesia (burning) with or without aching pain in the distribution of a extremity nerve or weakness of any extremity muscle, both during postoperative period. RESULTS: Neurologic complications of extremity developed in 5 patients (1.6%). Unilateral nerve affected in patients as follows: sciatic (four patients), radial (one patient). All patients complained motor weakness and paresthesia. 2 patients with suspicious muscle injury due to compartment syndrome had painful swelling. Symptoms were noted at operative day or first and second postoperative day. These symptoms resolved within 5 months in 4 of 5 patients. Multivariate risk factors for development of neurologic complication included perioperative blood transfusion (r=0.128, P<0.05) and duration in lithotomy (r=0.247, P<0.01) CONCLUSIONS: In our data, neurologic complications of extremity were infrequent complications that were noted very soon after surgery and anesthesia. Prognosis often was mild and resolved spontaneous, but they could be severe and associate with prolonged disability. The longer patients were positioned in the lithotomy positions, the greater the chance of development of a neurologic complication. The appropriate positioning and reduction of time in the lithotomy position may reduce the risk of neurologic complication.

Complications of gynecologic laparoscopy / 대한산부인과학회지

OBJECTIVE: to describe our experience and examine the frequency of gynecologic laparoscopy complication performed in a secondary care hospital. METHODS: We retrospectively studied 262 patients were treated by gynecologic laparoscopy (mean age 43 yrs). Period of study were from March 2003 through March 2005 in one teaching hospital. Data were analyzed using SPSS for windows software. Frequency and descriptive statistics were calculated. RESULTS: The overall number of complication in 262 laparoscopies was 16 (6.1%). 5 ureter injuries, 3 stump disruption, 2 troca site hematoma, 1 bladder injury, 1 small bowel injury, 1 post operative bowel obstruction, 1 leg neuropathy, 1 leg weakness, 1 massive bleeding. The complication rates were analysed by type of surgery. We evaluated correlation with variable factors. Our complication rates were higher to those reported in the literature and were significantly different by type of surgery. Complications were related to variable factors of blood transfusion and anesthetic time. CONCLUSION: The complication rate occurred at higher rates in our institution. All patients complications developed were treated and none sustained long-term morbidity. However, operative laparoscopy should be performed carefully. Early recognition of injuries, preferably intraoperatively, with immediate appropriate treatment is crucial. It is also important to be alert to early manifestations of complications in the postoperative observation period.

A case of spontaneous uterine perforation result from acute gangrenous myometritis in an old woman with IUD for 40 yrs / 대한산부인과학회지

Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidences of direct association between IUD use and pelvic inflammatory disease are rare, the frequency of inflammatory complications associated with the use of IUDs ranges from 2% to 8%. Gynecological surgeries on the account of purulent, inflammatory disease associated with IUD are 4-7%. We report one case with spontaneous perforation of uterus due to acute gangrenous myometritis in an old woman with IUD for 40 yrs in pelvic cavity, followed by a review of the literature.