Gynaecologist & Endoscopic Surgeon

Commentary on surgical data to end 2010

Please note that the current figures to the end of 2010 should be interpreted with caution. In particular it is possible that the reoperation rates reflects a lower number than reality as some patients may have had repeat surgery of which A/Prof Cooper is not aware. Some patients may have had more than one procedure.

A significant number of patients had severe endometriosis (393) and this will influence the complication rate.

 

Significant injuries included the following:

1.    Vascular:          3.          Two damage to the right common iliac vessels (one with a trocar, the other from dissection adjacent to the great vein in a patient with a partially blocked ureter). One trocar damage to a major blood vessel in the bowel (inspected at an open procedure but no repair required)

2.    Bowel:        7 stomas.     Of these 6 were patients with endometriosis. Four of the stomas were semi-planned at the time of the procedure. A primary reanastomosis was planned but intra-operative problems required a stoma. Three other patients had postoperative leaks requiring return to theatre for stoma. Unplanned stoma rate for endometriosis patients is 2/1016. Overall stoma rate for endometriosis patients is 6/1016 (these include all the bowel resection cases) or 0.6%. The overall stoma rate for the series is 7/6626 (0.1%).

3.    Bladder:         25 perforations: 23 of these were repaired via laparoscopy. One patient required an open incision early in the experience (1994). One patient developed a vesico-vaginal fistula following a hysterectomy which was ultimately repaired successfully.

4.    Ureter:        7        Two required placement of prophylactic stents for presumed damage, two were repaired at laparoscopy, two required conversion to laparotomy and one was noted 18 months after the initial procedure and required reimplantation.

5.    Return to OT:    13        5 returned for postoperative control of haemorrhage, 4 for drainage of a collection, 2 for pain where no surgical problem could be identified, 1 for a lost needle and 1 for oversew of an incisional hernia.

With these comments I attempt to explain all of my complications that I know of. I have been tracking this since commencing practice and find it a sobering yet highly educational experience. I am sure that I have become a better surgeon as a  result of tracking these numbers.

Further information can be provided by A/Prof Cooper.