Complications of laparoscopy: a prospective multicentre observational study

BJOG: An International Journal of Obstetrics and Gynaecology - Tập 104 Số 5 - Trang 595-600 - 1997
Frank Willem Jansen1, Kitty Kapiteyn2, Trudy C.M. Trimbos-Kemper2, J. Hermans3, J. Baptist Trimbos2
1Department of Gynaecology, Leiden University Hospital, The Netherlands.
2Department of Gynaecology, Leiden University Hospital, Leiden, The Netherlands
3Medical Statistics, Leiden University Hospital, Leiden, The Netherlands

Tóm tắt

Objective To determine the incidence and describe the complications of laparoscopic procedures in The Netherlands.

Design A nationwide prospective multicentre observational study.

Methods Data on complications were registered from 1 January to 31 December 1994 by 72 hospitals. Any unexpected or unplanned event requiring intra‐operative or post‐operative intervention was defined as a complication. Complications were classified in two groups: approach and technique related complications. Complication rates were compared with these already published.

Results Of 25,764 laparoscopic procedures, 145 complications occurred (rate 5.7 per 1000 [%0]); two deaths occurred. In 84 women laparotomy was necessary (rate 3.3%0). In 83 cases (57%; 95% CI for approach = 49–65%) the complication was caused by the surgical approach; in 62 cases (43%) the technique was at fault. Haemorrhage of the epigastric vein and intestinal injury, often requiring laparotomy (90% of cases) were the most frequently observed complications. The complication rate was 2.7%0 for diagnostic laparoscopic procedures, 4.5%0 for sterilisation and 17.9%0 (χ2= 127; dF = 2; P <0.001) for operative laparoscopy. The highest incidence was registered for complications occurring during laparoscopic (assisted) hysterectomy. Stepwise logistic regression analysis showed that previous laparotomy and surgical experience were associated with complications requiring laparotomy.

Conclusions Most complications occurred during operative laparoscopic procedures (rate 17.9%0). Residents in training are required to learn diagnostic laparoscopy and sterilisation and this training programme results in a fall in the risk of the complications. However, operative laparoscopic procedures are still hazardous, especially laparoscopic hysterectomy. Women with a previous laparotomy are particularly at risk.

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Tài liệu tham khảo

10.1016/S0950-3552(05)80061-6

10.1016/0028-2243(81)90023-X

Querleu D, Complications of gynaecologic laparoscopic surgery—a French multicenter collaborative study, N Engl J Med, 328, 1355, 10.1056/NEJM199305063281817

10.1016/0301-2115(95)02279-1

Matthews DE, 1988, Using and Understanding Medical Statistics, Karger Basel, 141

10.1097/00006250-199310000-00044

10.1089/lps.1993.3.567

Grainger DA, 1990, Ureteral injuries at laparoscopy: insights into diagnosis, management and prevention, Obstet Gynecol, 75, 839

10.1016/S0002-9378(94)70382-5

10.1016/S0002-9378(11)91584-1

Harris WJ., 1992, Uterine dehiscence following laparoscopic myomectomy, Obstet Gynecol, 80, 545

Montz FJ, 1994, Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists, Obstet Gynecol, 84, 881

Cunanan RG, 1980, Complications of laparoscopic tubal sterilization, Obstet Gynecol, 55, 501

10.1016/S0002-9378(87)80269-7

Philips J, 1977, Laparoscopic procedures: a national survey for 1975, J Reprod Med, 18, 219

Bhiwandaiwala PP, 1985, Comparison of the safety of open and conventional laparoscopic sterilization, Obstet Gynecol, 66, 391

10.1097/00006250-197907000-00014

Bhiwandaiwala PP, 1982, A comparison of different laparoscopic sterilization occlusion techniques in 24,439 procedures, Am J Obstet Gynecol, 144, 319, 10.1016/0002-9378(82)90585-3

Philips JM., 1977, Complications in laparoscopy, Int J Gynaecol Obstet, 15, 157, 10.1002/j.1879-3479.1977.tb00668.x

See WA, 1993, Predictors of laparoscopic complications after formal training in laparoscopic surgery, JAMA, 270, 2689, 10.1001/jama.1993.03510220045032

Soderstrom RM, 1973, A critical evaluation of complications in laparoscopy, J Reprod Med, 10, 245

10.1016/0029-7844(94)00352-E

Nezhat C, 1992, Laparoscopic repair of ureter resected during operative laparoscopy, Obstet Gynecol, 80, 543

Lueken RP, 1992, Bowel injury at laparoscopic adhesiolysis—an absolute indication for laparotomy, Gynaecol Endosc, 1, 39

Nezhat FR, 1991, Comparison of direct insertion of disposable and standard reusable laparoscopic trocars and previous pneumoperitoneum with veress needle, Obstet Gynecol, 78, 148

10.1097/00006254-197507000-00001

10.1016/S0950-3552(89)80003-3

Semm K., 1977, Statistical survey of gynaecological laparoscopy/pelviscopy in Germany till 1977, Endoscopy, 2, 101

Riedel HH, 1989, The frequency distribution of various pelviscopic (laparoscopic) operations, including complications rates—statistics of the Federal Republic of Germany in the years 1983–1985, Zentrabl Gynakol, 3, 78

Yuzpe AA., 1990, Pneumoperitoneum, needle and troicart injuries in laparoscopy, J Reprod Med, 35, 485

Peterson HB, 1990, American Association of Gynecologic Laparoscopists' 1988. Membership survey on operative laparoscopy, J Reprod Med, 35, 587

Lehmann‐Willenbrock E, 1992, Pelvis‐ copy/laparoscopy and its complications in Germany 1949–1988, J Reprod Med, 37, 671

Chapron C, 1992, Complications de la coeliochirurgie gynécologique, J Gvnecol Obstet Biol Reprod, 21, 207

Lécuru F, 1996, Morbidity of routine gynaecological laparoscopy: a report of a series of 283 procedures, Gynaecol Endosc, 5, 79

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Thông tin xuất bản

BJOG: An International Journal of Obstetrics and Gynaecology

Tập 104 Số 5

595-600

Thông tin tác giả