title: Major retroperitoneal vascular injuries during laparoscopic cholecystectomy and appendectomy.
abstract: BACKGROUND
  Serious complications may occur during laparoscopic surgery, as in any surgical procedure. Injuries of major retroperitoneal vascular structures are uncommon but important complications of laparoscopy.
  
  
  METHODS
  We report on 9 major vascular injuries in 8 patients in the course of 8 laparoscopic procedures between 1994 and 2002.
  
  
  RESULTS
  The primary operations were cholecystectomy in 7 patients and appendectomy in one patient. Six vascular injuries occurred during placement of the first umbilical trocar, two in the course of the insertion of a Veress needle, and one during the insertion of the second trocar. A laparotomy was performed immediately in all cases. Left common iliac arteries were injured in two patients, aorta in three patients, right common iliac vein in one patient, both right common iliac artery and vein in one patient, and inferior vena cava in one patient. Polytetrafluoroethylene (PTFE) graft interposition was employed in two common iliac arteries and a tubular PTFE graft in one aortic injury, and Dacron patchplasty in one common iliac artery injury. Two aortic, two common iliac vein, and an inferior vena cava injury were repaired primarily. There were also four visceral organ injuries, which were repaired primarily. The major retroperitoneal vascular complication rate was 0.07%. An average of 3.5 units of whole blood were transfused in each case and the average stay in hospital was 6.8 days. There was no mortality.
  
  
  CONCLUSIONS
  The surgeon's experience and knowledge are the essential factors for prevention of major vascular injuries during laparoscopic procedures. In case of an injury, immediate laparotomy must be performed to achieve hemostasis and a surgeon who is familiar with vascular surgery should employ the definitive treatment.
authors.affiliation: Department of General Surgery, School of Medicine, University of Istanbul, Istanbul, Turkey. rguloglu@yahoo.com
authors.forename: Recep
authors.initials: R
authors.lastname: Guloglu
authors.forename: Sukru
authors.initials: S
authors.lastname: Dilege
authors.forename: Murat
authors.initials: M
authors.lastname: Aksoy
authors.forename: Orhan
authors.initials: O
authors.lastname: Alimoglu
authors.forename: Nihat
authors.initials: N
authors.lastname: Yavuz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Mihmanli
authors.forename: Mustafa
authors.initials: M
authors.lastname: Gulmen
mesh_terms: D000293:Adolescent; D000328:Adult; D001012:Aorta, Abdominal / Q000293:injuries* / Q000601:surgery; D001062:Appendectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000293:injuries* / Q000601:surgery; D007084:Iliac Vein / Q000293:injuries* / Q000601:surgery; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000601:surgery
chemical_list: D011138:Polytetrafluoroethylene