Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Complications of gynecologic surgery

INTRODUCTION

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

Hemorrhage in gynecologic surgery is discussed in detail separately. (See "Management of hemorrhage in gynecologic surgery".)

UTERINE PERFORATION

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.

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: Oct 11, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth 2004; 51:326.
  2. Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm 2005; 62:1247.
  3. Rowbotham DJ. Recent advances in the non-pharmacological management of postoperative nausea and vomiting. Br J Anaesth 2005; 95:77.
  4. Wallenborn J, Gelbrich G, Bulst D, et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial. BMJ 2006; 333:324.
  5. Einarsson JI, Audbergsson BO, Thorsteinsson A. Scopolamine for prevention of postoperative nausea in gynecologic laparoscopy, a randomized trial. J Minim Invasive Gynecol 2008; 15:26.
  6. 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.
  7. Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol 1994; 170:1396.
  8. Al-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol 1999; 180:313.
  9. 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.
  10. Al-Sunaidi M, Tulandi T. Adhesion-related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol 2006; 108:1162.
  11. Mann WJ, Vogel F, Patsner B, Chalas E. Management of lymphocysts after radical gynecologic surgery. Gynecol Oncol 1989; 33:248.
  12. 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.
  13. Badillo AT, Sarani B, Evans SR. Optimizing the use of blood cultures in the febrile postoperative patient. J Am Coll Surg 2002; 194:477.
  14. Schwandt A, Andrews SJ, Fanning J. Prospective analysis of a fever evaluation algorithm after major gynecologic surgery. Am J Obstet Gynecol 2001; 184:1066.
  15. Yahchouchy-Chouillard E, Aura T, Picone O, et al. Incisional hernias. I. Related risk factors. Dig Surg 2003; 20:3.
  16. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 2000; 231:436.
  17. Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 1993; 80:1284.
  18. 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.
  19. Gawande AA, Studdert DM, Orav EJ, et al. Risk factors for retained instruments and sponges after surgery. N Engl J Med 2003; 348:229.
  20. 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.
  21. Thakar R, Ayers S, Clarkson P, et al. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 2002; 347:1318.
  22. Galyer KT, Conaglen HM, Hare A, Conaglen JV. The effect of gynecological surgery on sexual desire. J Sex Marital Ther 1999; 25:81.
  23. 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.