A prospective multi-centre study of major complications experienced during excisional laparoscopic surgery for endometriosis.

OBJECTIVE: To clarify the rate of major intra-operative and post-operative complications experienced during excisional surgery for endometriosis. DESIGN: Prospective multi-centre observational study set in two University teaching hospitals and three private hospitals in Sydney, Australia. All consecutive subjects undergoing laparoscopic excisional surgery for minimal to severe endometriosis were recruited (790 subjects). Complications were recorded intra-operatively or post-operatively on a secure computerised patient database. Major intra- and post-operative complications i.e. inadvertent visceral or vascular injury or other complications directly related to surgery that either significantly prolonged the operating time, delayed discharge or necessitated re-admission. RESULTS: Seven hundred and ninety subjects were recruited over a 3-year period. Seven major complications were experienced (8.8/1000); four bowel injuries, one cystotomy, one ureteric transection, and one major vascular injury. All visceral or vascular injuries were diagnosed prior to completion of the surgery. No significant longterm sequelae were experienced. CONCLUSION: The incidence of major complications in this study of 8.8/1000 compares favourably with other similar reports. In view of the potential symptom relief obtained, the authors continue to believe the benefits of such surgery significantly outweigh the risks of subsequent operative-related morbidity.

Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry.

OBJECTIVE: To obtain consensus as to the optimal form of entry technique for access to the peritoneal cavity. DESIGN: A meta-analysis of all relevant English language studies of laparoscopic entry complications. MAIN OUTCOME MEASURES: Incidence of bowel and major vascular injuries. RESULTS: Bowel injuries occur in 0.7/1,000 and major vascular injuries in 0.4/1,000. The overall incidence of major injuries at time of entry is 1.1/1,000. The direct entry technique is associated with a significantly reduced major injury incidence of 0.5/1,000, when compared to both open and Veress entry produces (1.1 and 0.9/1,000 respectively, p = 0.0005). Entry-related bowel injuries are reported more often following general surgical laparoscopies than with gynaecological procedures (p = 0.001). No such difference is seen in the incidence of vascular injuries (p = 0.987). Open entry is statistically more likely to be associated with bowel injury than either Veress needle or direct entry However, open entry appears to minimise vascular injury at time of entry. CONCLUSIONS: There remains no clear evidence as to the optimal form of laparoscopic entry in the low-risk patient. However, direct entry may be an under-utilised and safe alternative to the Veress needle and open entry technique.