The removal of the uterus surgically, called a hysterectomy, is the second most common type of surgery performed in young to middle-aged women, according to The American Congress of Obstetricians and Gynecologists. The uterus can be removed through the abdominal wall or vaginally through relatively large incisions or with the use of a laparoscope, a tube with a camera at the end, to aid in visualizing the removal of the uterus through small incisions in the abdomen or vagina. The laparoscope-aided hysterectomy, called a laparoscopic hysterectomy, has a shorter recovery time with less pain but does have potential complications after the procedure.
Considerations
Dr. Ray Garry and colleagues, in a report published in the January 2004 issue of the "British Medical Journal," reported patients that undergo laparoscopic hysterectomy have almost twice the incidence of complications compared to traditional open abdominal hysterectomy. There was no difference in the incidence of complications from a laparoscopic vaginal hysterectomy compared to a traditional vaginal hysterectomy.
Types
The most frequent complication in a laparoscopic hysterectomy is postoperative bleeding which occurs in about three percent of patients, according to Dr. Katherine O'Hanlon and her group, in a 2007 article published in the "Journal of the Society of Laparoendoscopic Surgeons." Injury to the urinary tract system, usually the bladder, occurred with nearly the same frequency. Other complications seen in the postoperative period were blood clots, infection and adhesions.
Symptoms
Bleeding from the vagina or surgical incisions, fullness in the abdomen, weakness and lightheadedness are symptoms of postoperative bleeding and require immediate medical attention. Injuries to the urinary system are usually found at the time of operation but sometimes are not found until later in the postoperative period. Symptoms of a urinary system injury include urinary incontinence, foul-smelling urine and bladder tenderness. Infectious complications, particularly infections of the surgical site, are characterized by abdominal tenderness, vaginal discharge, fever and chills.
Treatment
Most excessive-bleeding complications, as well as urinary system injury require surgical re-exploration and repair. Such repairs often have to be performed with an open technique with a large incision for adequate visualization of bleeder location or organ damage. Infections are usually treated initially with antibiotics, but abscesses or extensive wound infections may need surgical drainage and excision of infected tissue.
Prevention
One of the main causes of surgical complications in laparoscopic hysterectomies is inability to adequately visualize organs and other structures through the laparoscope. Although obesity is one main contributor to inability to view the intra-abdominal contents, scar tissue from prior operations that can cause organs to stick to other organs or the abdominal wall, called adhesions, are another major risk factor for failure to visualize. A study done by Dr. Vicken Sepilian and colleagues listed in PubMed reported over 21 percent of patients with prior laparoscopic procedures had adhesions to the undersurface of the umbilicus. Great precaution is required in performing repeat laparoscopic procedures in these patients.
