pp. 477-482 (doi:10.1006/gyno.1999.5511) Gamal H. Eltabbakh M.D.*, 1, M. Steven Piver M.D.>, Ronald E. Hempling M.D.> , Fernando O. Recio M.D.>, Tamera Paczos M.D.>
*University of Vermont, Burlington, Vermont
>Roswell Park Cancer Institute, Buffalo, New York <A HREF="http://http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10479514&form=6&db=m&Dopt=b">Medline Abstract</A>
<A HREF="http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&uid479514&Dopt=m">Medline Related Articles</A>
(Received March 15, 1999)
Abstract
Objective. To assess the incidence of and factors that predict failed or
complicated operative laparoscopy on a gynecologic oncology service.
Methods. Two hundred four consecutive operative laparoscopies were reviewed.
Procedures converted to laparotomy or associated with major operative or
postoperative complications were compared with uncomplicated laparoscopies
with respect to patient characteristics, details of operative procedure, and
length of hospitalization. The influence of patient characteristics,
operative findings, and specific procedures on the risk of failed or
complicated laparoscopies was estimated.
Results. Twenty-five (12.3%) procedures were either converted to laparotomy
or associated with major operative or postoperative complications. Women with
failed or complicated laparoscopies had significantly more previous
laparotomies and adhesions, greater blood loss, and longer hospital stay than
those with uncomplicated laparoscopies (60.0% vs 35.7%, P = 0.03, 68.0% vs
37.4%, P < 0.001, 275 ml vs 132 ml, P = 0.03; and 5.9 days vs 0.98 days, P <
0.001, respectively). Age, body mass index, parity, menopausal status,
preoperative CA-125, appearance of adnexal masses, and complexity of the
procedure had no significant influence on failed or complicated
laparoscopies. In univariate analysis, history of laparotomy and presence of
adhesions and in multivariate analysis only presence of adhesions were
predictive of failed or complicated laparoscopies (P = 0.03, < 0.001, and
0.006, respectively).
Conclusions. The incidence of failed and complicated laparoscopy is low on a
gynecologic oncology service. Presence of adhesions is the only significant
independent risk factor predictive of failed or complicated laparoscopy.
Copyright 1999 Academic Press.
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