Complications of gynecologic surgery
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
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.
- Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth 2004; 51:326.
- Charoenkwan K, Matovinovic E. Early versus delayed oral fluids and food for reducing complications after major abdominal gynaecologic surgery. Cochrane Database Syst Rev 2014; 12:CD004508.
- Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm 2005; 62:1247.
- Rowbotham DJ. Recent advances in the non-pharmacological management of postoperative nausea and vomiting. Br J Anaesth 2005; 95:77.
- Hindocha A, Beere L, Dias S, et al. Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews. Cochrane Database Syst Rev 2015; 1:CD011254.
- Liakakos T, Thomakos N, Fine PM, et al. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 2001; 18:260.
- Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol 1994; 170:1396.
- Al-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol 1999; 180:313.
- Montz FJ, Holschneider CH, Solh S, et al. Small bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings. Gynecol Oncol 1994; 53:114.
- Al-Sunaidi M, Tulandi T. Adhesion-related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol 2006; 108:1162.
- Mann WJ, Vogel F, Patsner B, Chalas E. Management of lymphocysts after radical gynecologic surgery. Gynecol Oncol 1989; 33:248.
- de la Torre SH, Mandel L, Goff BA. Evaluation of postoperative fever: usefulness and cost-effectiveness of routine workup. Am J Obstet Gynecol 2003; 188:1642.
- Badillo AT, Sarani B, Evans SR. Optimizing the use of blood cultures in the febrile postoperative patient. J Am Coll Surg 2002; 194:477.
- Schwandt A, Andrews SJ, Fanning J. Prospective analysis of a fever evaluation algorithm after major gynecologic surgery. Am J Obstet Gynecol 2001; 184:1066.
- Yahchouchy-Chouillard E, Aura T, Picone O, et al. Incisional hernias. I. Related risk factors. Dig Surg 2003; 20:3.
- Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 2000; 231:436.
- Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 1993; 80:1284.
- Burger JW, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004; 240:578.
- Gawande AA, Studdert DM, Orav EJ, et al. Risk factors for retained instruments and sponges after surgery. N Engl J Med 2003; 348:229.
- Leenhouts GH, Kylstra WA, Everaerd W, et al. Sexual outcomes following treatment for early-stage gynecological cancer: a prospective and cross-sectional multi-center study. J Psychosom Obstet Gynaecol 2002; 23:123.
- Thakar R, Ayers S, Clarkson P, et al. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 2002; 347:1318.
- Galyer KT, Conaglen HM, Hare A, Conaglen JV. The effect of gynecological surgery on sexual desire. J Sex Marital Ther 1999; 25:81.
- Mason A, Goldacre M, Meddings D, Woolfson J. Use of case fatality and readmission measures to compare hospital performance in gynaecology. BJOG 2006; 113:695.
- UTERINE PERFORATION
- URINARY TRACT INJURIES
- BOWEL INJURY
- Small bowel injury
- Colonic injury
- FISTULA FORMATION
- Urinary tract
- POSTOPERATIVE NAUSEA AND VOMITING
- LYMPHEDEMA AND LYMPHOCYST
- INFECTIOUS MORBIDITY
- POSTOPERATIVE THROMBOEMBOLISM
- RETAINED FOREIGN OBJECTS
- SEXUAL DYSFUNCTION
- SUMMARY AND RECOMMENDATIONS