Prevention of complications of laparoscopic operations in gynecologic patients with adhesions

G. M. Rutenburg; Рутенбург Г. М.; V. V. Strizheletsky; Стрижелецкий В. В.; T. Y. Zhemchuzhina; Жемчужина Т. Ю.; T. V. Gordeeva; Гордеева Т. В.

doi:10.17816/JOWD87592

Prevention of complications of laparoscopic operations in gynecologic patients with adhesions

Authors: Rutenburg G.M.¹^,2, Strizheletsky V.V.¹^,2, Zhemchuzhina T.Y.¹^,2, Gordeeva T.V.³
Affiliations:
1. Elizabethan Hospital
2. city center for laparoscopic surgery
3. Regional Clinical Hospital No. 1 named after S.V. Ochapovsky
Issue: Vol 54, No 5S (2005)
Pages: 97-97
Section: Reviews
Submitted: 15.11.2005
Accepted: 11.11.2021
Published: 15.11.2005
URL: https://journals.eco-vector.com/jowd/article/view/87592
DOI: https://doi.org/10.17816/JOWD87592
ID: 87592

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Abstract

Urgency of the problem. Last years the problem of laparoscopic operations in patients with abdominal adhesions attracted experts’ attention.

Keywords

laparoscopic operations, endoscopic interventions, the consequences of surgery, damage to the mesentery of the small intestine, damage to the iliac vein, organ adhesions, open laparoscopy

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Urgency of the problem. Last years the problem of laparoscopic operations in patients with abdominal adhesions attracted experts’ attention.

Material and methods. At the Municipal center of laparoscopic surgery since 1994 till 2005 we have treated 623 female patients with surgical and gynecologic pathology, who required endoscopic interventions, these patients previously had 727 abdominal operations (611 - one operation, 68 - two operations, 21 - three operations and 3 of them had four operations).

Results of the study. We have performed endoscopic interventions in 450 of these operated women (72,2%). At the first stage of operation - pneumoperitoneum and introduction of the first trocar - in 6 cases (0,96%) the injury of abdominal bodies took place (twice - small intestine, iliac vein and three times - the greater omentum). In four cases, the trocar punctures were made in several centimeters from operational cicatrices. Two complications (the injury of mesentery and iliac vein) took place with optical trocar (Visiport). It is necessary to say, that it was not possible to make preliminary pneumoperitoneum using the puncture needle in these patients because of adhesions. After that, we have started to introduce the first trocar using open laparoscopy method in patients with high probability of adhesions, and we haven’t had any injuries of abdominal organs. Recently we have been using ultrasonic examination of abdominal cavity for diagnostics of prevalence of adhesive process, which gave us the best results in comparison with others non-invasive methods (reliability about 64%). In the making, in 147 patients, the previous laparotomy was a relative contraindication for laparoscopic operations. The intraoperative analysis of prevalence of adhesions has allowed to establish, that in 81 patients (55,1%) of this group the safe laparoscopic intervention was possible with use of rational endosurgery approach.

Conclusions. Thus, the majority of patients with adhesions in abdominal cavity can have endoscopic operations. The most safe endosurgery approach in this case in our opinion will be the open laparoscopy.