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Intestinal obstruction and bilateral ureteral injuries after laparoscopic oophorectomy in a patient with severe endometriosis and a large endometrioma
Selected Scientific Abstracts
to implant the surgical membrane, and a subjective rating of the ease of implant were evaluated. If an adhesion was lysed at the implant site, the adhesion was scored using a standard system. The time spent in implantation was calculated for each implant site. The uterine sites had a smaller time spent in implantation than either the pelvic sidewall or cul-de-sac. Less time was spent in implanting the surgical membrane with staples than clips or sutures. There have been no reports of immediate or longterm postoperative complications attributable to the surgical membrane. Most patients were implanted with the intention of keeping the surgical membrane in place long-term. Five patients had second-looks; one had a filmy, avascular adhesion, while the remaining patients had no adhesion formation to the implant site, the surgical membrane and its edges or the anchoring devices. There were no postoperative complications in the latter patients. In conclusion, the surgical membrane is easily used at laparoscopy, with the most rapid fixation accomplished through the use of laparoscopic staples. Short and long term complications have been nil, while efficacy after laparoscopic implantation has been good in a limited secondlook 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 1MH Saidi, 2MF Sarosdy, 3pw Hollimon. 1Department of Ob/Gyn; 2Department of Urology; 3Department of Surgery; The University of Texas Health Science Center, San Antonio, San Antonio, TX.
Complications of Advanced Operative Laparoscopy: A Review of 452 Cases MH Saidi, TG Vancaillie, AJ White, RK Sadler, BD Akright, SA Farhart. Department Of Ob/Gyn, The Universityof Texas Health Science Center at San Antonio, San Antonio, TX.
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. C o m p l i c a t i o n s d e v e l o p e d during and after a d v a n c e d o p e r a t i v e l a p a r o s c o p y 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.
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 s o n o g r a p h y r e v e a l e d a large unilocular mass. L a p a r o s c o p y 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.
Laparoscopic Treatment of Benign Ovarian Dermoid Cysts M Saks, R Deckardt. Zentrum fuer Ambulatnte Gynaekologische Operationen und Laserchirurgie, Munich, Germany.
Forty-four women underwent laparoscopic surgery for treatment of 49 benign dermoid cysts in
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to implant the surgical membrane, and a subjective rating of the ease of implant were evaluated. If an adhesion was lysed at the implant site, the adhesion was scored using a standard system. The time spent in implantation was calculated for each implant site. The uterine sites had a smaller time spent in implantation than either the pelvic sidewall or cul-de-sac. Less time was spent in implanting the surgical membrane with staples than clips or sutures. There have been no reports of immediate or longterm postoperative complications attributable to the surgical membrane. Most patients were implanted with the intention of keeping the surgical membrane in place long-term. Five patients had second-looks; one had a filmy, avascular adhesion, while the remaining patients had no adhesion formation to the implant site, the surgical membrane and its edges or the anchoring devices. There were no postoperative complications in the latter patients. In conclusion, the surgical membrane is easily used at laparoscopy, with the most rapid fixation accomplished through the use of laparoscopic staples. Short and long term complications have been nil, while efficacy after laparoscopic implantation has been good in a limited secondlook 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 1MH Saidi, 2MF Sarosdy, 3pw Hollimon. 1Department of Ob/Gyn; 2Department of Urology; 3Department of Surgery; The University of Texas Health Science Center, San Antonio, San Antonio, TX.
Complications of Advanced Operative Laparoscopy: A Review of 452 Cases MH Saidi, TG Vancaillie, AJ White, RK Sadler, BD Akright, SA Farhart. Department Of Ob/Gyn, The Universityof Texas Health Science Center at San Antonio, San Antonio, TX.
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. C o m p l i c a t i o n s d e v e l o p e d during and after a d v a n c e d o p e r a t i v e l a p a r o s c o p y 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.
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 s o n o g r a p h y r e v e a l e d a large unilocular mass. L a p a r o s c o p y 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.
Laparoscopic Treatment of Benign Ovarian Dermoid Cysts M Saks, R Deckardt. Zentrum fuer Ambulatnte Gynaekologische Operationen und Laserchirurgie, Munich, Germany.
Forty-four women underwent laparoscopic surgery for treatment of 49 benign dermoid cysts in
$31