Extensive gynecologic surgery often entails meticulous dissection near the bladder, rectum, ureters, and great vessels of the pelvis. Complications of gynecologic surgery include hemorrhage, infection, thromboembolism, and visceral damage. The risk of complications depends upon the extent and approach to surgery and patient characteristics. Understandably, the more common complications from this surgery relate to injuries to these viscera and occur during extensive resections for the treatment of cancer or when anatomy is distorted due to infection or endometriosis. Other complications, such as pulmonary embolus, myocardial infarction, pneumonia, or fluid or electrolyte imbalance are common to all surgery. (See individual topic reviews on these subjects).
Hemorrhage in gynecologic surgery is discussed in detail separately. (See "Management of hemorrhage in gynecologic surgery".)
Uterine perforation is a potential complication of all intrauterine procedures and may be associated with injury to surrounding blood vessels or viscera (bladder, bowel). In addition, uterine perforations and associated complications that are not diagnosed at the time of the procedure can result in hemorrhage or sepsis. The risk of uterine perforation is increased by factors that make access to the endometrial cavity difficult (eg, cervical stenosis) or alter the strength of the myometrial wall (eg, pregnancy, menopause).
Uterine perforation is discussed separately. (See "Uterine perforation during gynecologic procedures".)
URINARY TRACT INJURIES
The rates of ureteric and bladder injury vary with the indication for surgery and the procedure. Risk factors for urinary tract injury include surgery for malignant disease and for urinary incontinence or pelvic organ prolapse.