Commentary on Procedures and Complications to end of May 2017.
The tables display all procedures and major complications to the end of May 2017. It should be noted that considerable care should be taken when interpreting these numbers. Associate Professor Cooper operates on a large number of patients with significant endometriosis and the risk profile of this group of patients for complications is higher than the general population. Secondly he may not be aware of some complications and as such these figures may under represent the true numbers.
Since commencing practice as a specialist gynaecologist in 1995 Associate Professor Cooper has undertaken over 10,000 operative procedures. He has performed over 5,500 laparoscopies most being of an operative rather than a diagnostic nature. Over the last 10-15 years his practice has predominantly moved towards endometriosis and he has performed over 1,500 interventions for the excision of endometriosis. Of these at the time of writing 388 have had bowel resections of various forms of being performed. These procedures represent the most difficult and complex of gynaecological surgery including cancer. The significant complications and issues are listed in the table.
There were 3 significant vascular complications all of which were treated by immediate laparotomy and oversewing of various vessels.
Fourteen patients required laparotomy to deal with some form of issue involving the bowel. There was an overall colostomy rate of 12 with a rate of 0.2% of all laparoscopies. Ten of the stomas related to patients with endometriosis and 6 of these were planned intra-operatively with a rate of 0.36% per endometriosis patient. Four unplanned stomas were performed in the post operative period at a rate of 0.24% Two patients who had procedures unrelated to endometriosis required stomas with an overall rate of 0.04%. An additional patient with endometriosis had a recto-vaginal fistula which healed spontaneously (0.02%).
Three patients required laparotomy for bladder injuries (0.05%) and of these 1 patient had endometriosis (0.06%).
Twelve patients required some form of intervention in relation to the ureter. All of these patients had endometriosis as an underlying condition. Delayed recognition of the injury occurred in 2 patients (0.12%) and 10 required some form of intra-operative repair or stent. Five stents were placed as prophylaxis to ensure against a possible leak in the post operative period.
Twenty nine patients had to return to theatre with an overall rate of 0.28%. These included the 3 bladder and 4 bowel patients mentioned above. Other issues included 7 post operative bleeds, 7 abscesses and infected areas, 2 patients who ultimately had no abnormality detected, 1 patient with a small bowel obstruction following a bowel resection, 1 omental herniation at a trocar site, 1 perforation at a hysteroscopic myomectomy, a vault dehiscence in a patient who initiated sexual activity in the early post operative period following a hysterectomy, a recurrent Bartholin’s abscess and 1 patient who had a microscopic needle identified in the recovery room following laparoscopic tubal reversal with a needle which had initially been counted as outside the patient.
There were no patient deaths. The overall major complication rate was 0.36% (38/10423). The rate per laparoscopy was 0.64% (35/5487). Specifically for endometriosis cases the rate was 0.78% (13/1674).
Associate Professor Cooper believes this complication profile is appropriate for the type of surgery he performs and is happy to discuss this analysis.