title: Major complications of operative gynecologic laparoscopy in southern Taiwan: a follow-up study.
abstract: OBJECTIVE
  This follow-up study examined the major complications among 4307 operative gynecologic laparoscopies. The overall complication rate and each individual category were compared with those of our previous study period. The clinical outcome and salvage procedures were correlated with the time of recognition and the severity of initial procedures in the individual injury type.
  
  
  METHODS
  Retrospective, comparative study based on medical record reviewing (Canadian Task Force classification II-3).
  
  
  METHODS
  Tertiary teaching hospital, Chi Mei Foundation Hospital in southern Taiwan.
  
  
  METHODS
  Records of women (n = 4307) aged 40.5 +/- 11.7 years (mean +/- SD [95% CI 40.1-40.5]) who underwent operative gynecologic laparoscopies from January 2000 through February 2006 were reviewed in this study. The complications were compared with those of our previous study based on 1507 laparoscopies performed between December 1992 and November 1999 for follow-up comparison.
  
  
  METHODS
  Gynecologic laparoscopic surgeries.
  
  
  RESULTS
  Thirty-four complications occurred in 31 patients requiring repair procedures, 3 of whom had multiple complications, with an overall complication rate of 0.72% (31/4307). There were 13 bladder injuries (0.30%), 7 bowel injuries (0.16%), 3 cases of internal bleeding (0.07%), 4 vaginal stump hematomas or abscesses (0.09%), 3 ureteral injuries (0.07%), 3 major vessel injuries (0.07%), and 1 trocar site hematoma (0.02%). In addition, there were 125 (2.88%) postoperative blood transfusions without additional operative intervention. The major complication rate decreased compared with that of the previous study (0.72% [95% CI 0.51%-1.02%] vs 1.59% [95% CI 1.07%-2.36%]; p = .005). The overall complication rates were not significantly different between laparoscopic hysterectomy (LH) group and non-LH group. However, bladder injury happened more frequently in the LH group, whereas bowel injury was more common in the non-LH group. In addition, the severity of the original injury, timing of recognition, and accompanying salvage procedures correlated with the clinical outcomes.
  
  
  CONCLUSIONS
  The significantly decreased major complication rate, as compared with that of our previous study period, confirms the importance of experience accumulation and use of preventive maneuvers in reducing the complication rate. There were no significant differences among the individual injury category during these 2 study periods. The manifestations of bowel injury were highly variable and individualized. The accumulation of surgical experience with the aid of preventive maneuvers is helpful to reduce the complication rate significantly.
authors.affiliation: Department of Surgery, Chi Mei Foundation Hospital, Tainan, Taiwan.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Tian
authors.forename: Yue-Shan
authors.initials: YS
authors.lastname: Lin
authors.forename: Chin-Li
authors.initials: CL
authors.lastname: Lu
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Chia
authors.forename: Kuo-Feng
authors.initials: KF
authors.lastname: Huang
authors.forename: Tune-Yie
authors.initials: TY
authors.lastname: Shih
authors.forename: Kun-Hung
authors.initials: KH
authors.lastname: Shen
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Chung
authors.forename: Yung-Chieh
authors.initials: YC
authors.lastname: Tsai
authors.forename: Chien-Hsun
authors.initials: CH
authors.lastname: Chao
authors.forename: Ming-Ping
authors.initials: MP
authors.lastname: Wu
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013624:Taiwan