Complications of major operative laparoscopy. A review of 452 cases

OBJECTIVE: To evaluate complications of operative laparoscopy. STUDY DESIGN: Operative and postoperative complications in 452 consecutive cases from January 1, 1991, to August 31, 1993, were evaluated. The series was divided into three time segments--8, 12 and 12 months. Common and serious complications were classified and reviewed. RESULTS: Complications developed during and after major operative laparoscopy in 47 (10.4%) patients in the series; 24 (5.3% of cases, or 51% of total complications) were serious, such as hemorrhage, ureteral injuries and fistulas, and intestinal obstruction. Seventeen (3.8%) patients required unplanned surgery for management of complications. During the initial learning period of eight months, the rate of complications averaged 17.3%, decreasing to 7.7% and 10.1%, respectively, in the second and third periods in the series. There were no cases of death, postoperative ileus, thrombophlebitis or pulmonary complications. CONCLUSION: The overall incidence of complications in major operative laparoscopy was 10.4%. Serious complications accounted for half the complications. Surgical experience reduced the incidence of complications. Ovarian cystectomy produced the lowest rate of common complications and no serious ones. Laparoscopically assisted vaginal hysterectomy had the highest rate of serious complications.