Laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection.
OBJECTIVE
To review the success and morbidity of laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection.


METHODS
Review of a prospective surgical database of all cases of laparoscopic major gynecologic surgery in  patients with prior laparotomy bowel resection. No cases were excluded. Bowel diagnoses and procedures were total colectomy for inflammatory bowel disease (4), partial colectomy for colon cancer (6), partial small bowel resection for obstruction (1), and Whipple for pancreatic cancer (2).  Two patients had 3 prior laparotomies, 8 patients had 2 prior laparotomies, and 3 patients had 1 prior laparotomy. All prior abdominal incisions were midline. Gynecologic diagnoses and procedures were laparoscopic cytoreduction for ovarian cancer (1), lsh/bso/staging for ovarian cancer (1),  lavh/bso/lymphadenectomy for endometrial cancer (4), and lavh/bso, lsh/bso, or bso for large ovarian mass (7). Median patient age was 57 years, median BMI was 31kg/m(2), and all patients had medical comorbidities.


RESULTS
All 13 laparoscopic gynecologic surgeries were  successful without trocar insertion injury, conversion to laparotomy, and without enterotomy. Abdominal adhesions were present in all cases. Median operative time was 2 hours, median blood loss was 100cc, and median hospital stay was 1 day. There were no postoperative complications.


CONCLUSIONS
Laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection is feasible for experienced laparoscopic surgeons.
Department of Obstetrics and Gynecology, Pennsylvania State University, PA, USA. jfanning1@hmc.psu.edu
James
J
Fanning
Rod
R
Hojat
Timothy
T
Deimling
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D013505:Digestive System Surgical Procedures; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome