[Laparoscopy: complications and evaluation of the risk in a series of 700 explorations].
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An unusual case of Richter's hernia on the 5th day after laparoscopy is presented. The complaints simulated a postoperative hematoma, but they became so intense that the expansion was surgically explored: a conservative procedure on the loop of small bowel was possible. To prevent this complication after laparoscopy careful shaking of the abdominal wall at removal of the instruments is necessary.
Although the complication rate for laparoscopic tubal sterilization is generally low, laparotomy is sometimes necessary to complete the sterilization or manage complications. To better characterize factors that predispose women to unintended laparotomy, we analyzed data from the Collaborative Review of Sterilization. Of the 5027 women undergoing laparoscopic tubal sterilization, 12 had unintended laparotomies to manage complications, whereas 39 women had unintended laparotomies because of technical inability to complete the laparoscopic procedure. Women with prior abdominal or pelvic surgery had an increased risk of unintended laparotomy (relative risk = 10.2, 95% confidence interval = 5.3 to 19.7). Women with a history of intrauterine device use or pelvic inflammatory disease had elevated risks that were not statistically significant (relative risk = 2.2 and 1.5, respectively). Comparative studies of alternative surgical approaches for tubal sterilization are needed to formulate recommendations for women who may be at increased risk of unintended laparotomy associated with the laparoscopic approach.
Female sterilization by laparoscopy has become widely accepted throughout the United States and Europe. The failure rate of this procedure is still speculative. In the course of 4200 operative sterilization, 32 failures have been identified and 31 of these have been subsequently evaluated. The most common finding was inadequate or superficial fulguration and resection. Operative errors such as round ligament fulguration were also more common than expected.
A retrospective study of 5346 cases of laparoscopic sterilization with special reference to early and late complications was undertaken. In the 6-year period from 1972 to 1978, 846 patients were sterilized by the elasticized silicone-ring technique and 4500 patients were sterilized by the electrocautery method. The electrocautery method was complicated by electrical burns in 13 cases (0.29%); 3 of these patients required bowel resections. Mechanical complications occurred in 1.6% of the Silastic-ring cases, but none of the patients required additional surgery. The Silastic-ring patients had greater postoperative abdominal pain than the electrocautery patients, but it usually abated within 48 hours. There were 15 cases of postoperative pelvic infection in the electrocautery group, and none in the Silastic-ring group. Bleeding from the mesosalpinx occurred in both groups and occurred more often with coincident suction D&C. Technical failure to perform the sterilization procedure was principally related to previous abdominal surgery. A substantial number of patients complained of menstrual irregularity and/or dysmenorrhea following these sterilization procedures. The majority of women reported unchanged or improved sexual relations. Improvement in sexual relations was reported by significantly more patients in the Silastic-ring group than in the electrocautery group.
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One hundred and forty-one women were planned to be sterilized by the Falope-ring technique after vaginal term delivery. Two pregnancies (1.55%) occurred during an average observation period of 43.2 months. Tearing of the mesosalpinx with bleeding requiring laparotomy occurred in 2 cases, and was the major operative complication seen. In 3 cases, laparotomy was performed because of reduced visual field caused by the enlarged uterus and in 2 cases because of technical problems with maintaining pneumoperitoneum. In 10 patients, hysterosalpingography was performed. In 2 cases leakage was demonstrated and these patients were readmitted to laparoscopic sterilization in the interval phase. One woman was admitted to the hospital with acute lower abdominal pain one year after sterilization; laparotomy showed the salpinx to be twisted three times around the ring. The Falope-ring technique is recommended as a safe, easy and quick method for sterilization in the puerperium.
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