Human Reproduction, Vol 13, 867-872, Copyright © 1998 by Oxford University Press
C Chapron, D Querleu, MA Bruhat, P Madelenat, H Fernandez, F Pierre and JB Dubuisson
A multicentre study was carried out in seven top French centres for
laparoscopic gynaecological surgery. This series covers a period of 9
years, in which 29,966 diagnostic and operative laparoscopic operations
were performed. The risk of complications has been assessed according to
the complexity of the laparoscopic procedure in question. The means of
diagnosis and treatment of the complications have been analysed, together
with the importance of the surgeon's degree of experience. The mortality
rate was 3.33 per 100,000 laparoscopies. The overall complication rate was
4.64 per 1000 laparoscopies (n = 139). The rate of complications requiring
laparotomy was 3.20 per 1000 (n = 96). The complication rate was
significantly correlated with the complexity of the laparoscopic procedure
(P = 0.0001). One in three complications (34.1%; n = 43) occurred while
setting up for laparoscopy, and one in four (28.6%) were not diagnosed
during the operation. As new indications for laparoscopic surgery in
gynaecology have appeared, there has been a parallel and statistically
significant increase in the rate of urological complications (P = 0.001).
Increased experience by the surgeons has had three consequences: a
statistically significant drop in the number of bowel injuries (P =
0.0003), a drop in the rate of complications requiring laparotomy for those
laparoscopic surgical procedures that are well defined (P = 0.01), and a
change in the way complications are treated, with a significant increase in
the proportion of incidents treated by laparoscopy (P = 0.0001).
REVIEWS
Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases
Service de Chirurgie Gynecologique, Clinique Universitaire Baudelocque, CHU Cochin Port-Royal, Paris, France.
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