Complications of Advanced Operative Laparoscopy: A Review of 452 Cases

To evaluate complications of advanced operative laparoscopy, operative and postoperative complications in 452 consecutive cases from January 1, 1991 to August 31, 1993 were evaluated. The series was divided into three time-segments of 8, 12, and 12 months. Common and serious complications were classified and reviewed. Complications developed during and after advanced operative laparoscopy in 47 (10.4%) patients in the series, of which 24 (5.3% of all cases, or 51% of total complications) were serious complications, such as hemorrhage, ureteral injuries and fistulas, and intestinal obstruction. Seventeen (3.8%) patients required further unplanned surgery for management of complications. During the initial learning period of 8 months, the rate of complications averaged 17.3%, decreasing to 7.7% and 10.1%, respectively, in the second and third periods of the series. There were no cases of death, postoperative ileus, thrombophlebitis, or pulmonary complication. We concluded that the overall incidence of complications in advanced operative laparoscopy is low. Serious complications may account for half of all complications. Surgical experience reduces the incidence of complications. Ovarian cystectomy produced the lowest rate of common complications and no serious ones. Laparoscopically assisted vaginal hysterectomy (LAVH) produced the highest rates of both common and serious complications.

Intestinal Obstruction and Bilateral Ureteral Injuries After Laparoscopic Oophorectomy in a Patient with Severe Endometriosis and a Large Endometrioma

A 44-year-old woman presented with right lower quadrant abdominal pain of three months' duration and history of previous Cesarean section and abdominal hysterectomy. Pelvic examination and vaginal sonography revealed a large unilocular mass. Laparoscopy findings included a fixed, large endometrioma severely attached to the pelvic peritoneum and intestines in the pelvic cavity, and significant adhesions in the upper part of the prior midline abdominal hysterectomy incision. Two days after laparoscopic bilateral adnexectomy, she was readmitted with small-bowel obstruction and underwent prompt adhesiolysis via laparotomy. Thirty-nine days later, she presented with massive urinary ascites. Evaluation revealed right ureteral stricture at the uterine artery level and complete ligation and resection of the left ureter at the pelvic brim near the infundibulopelvic ligament stump. Left ureteral reimplantation with psoas hitch and right ureterolysis were performed. We conclude that, in cases of severe endometriosis with significant ureteral and intestinal involvement, laparotomy should be considered.