Bowel injury as a complication of laparoscopy

van der Voort, M; Heijnsdijk, E A M; Gouma, D J

doi:10.1002/bjs.4716

Cited by 248 publications

(211 citation statements)

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“…Furthermore, to avoid entry-related complications it is important to identify patients at risk, e.g., those with adhesions from previous laparotomy and obese and very thin patients. However, despite this identification, entry-related complications still occur at a constant rate [1,2,8]. In a recent survey of the U.S. Food and Drug Administration (FDA) Fuller et al, who reviewed all reports from January 1997 to June 2002, identified 31 fatal and 1353 nonfatal trocar injuries.…”

Section: Discussionmentioning

confidence: 99%

“…The overall mortality rate is reported to be about 4%, increasing to 21% for unrecognized bowel injury [5][6][7]. In several reports the fatalities result from about 75% vascular injuries and the remaining 25% from unrecognized bowel injuries [4,5,8]. Furthermore, it has been calculated that one half of all laparoscopic complications can be blamed on the entry technique [9][10][11].…”

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confidence: 99%

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Medical liability insurance claims on entry-related complications in laparoscopy

et al. 2007

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Background: Installation of the pneumoperitoneum is an essential part of laparoscopic surgery. Creation can be performed by either the open or a closed technique. The aim of this study was to assess the number of and contributing factors to entry-related complications in medical liability insurance claims in the Netherlands. Methods: A retrospective chart review was performed, including all malpractice claims filed at MediRisk, which is presently the largest medical liability mutual insurance company for institutions, mainly hospitals, in healthcare in the Netherlands. Results: From January 1993 to December 2005, 41 claims were identified as entry-related complications which comprised 18% of all laparoscopy-related complications leading to claims. Most were young (median age = 35 years) female patients who had routine, nonadvanced, laparoscopic procedures planned as shortstay or day-care procedures. The claims were equally divided between general surgery (n = 20) and gynecology (n = 21). A total of 51 structures were injured. There were 18 vascular structure injuries, 30 bowel injuries, and three other injuries. An open entry technique was used in only two (5%) patients. Vascular injury was exclusively associated with closed entry. In only 19 (46%) patients the entry-related complication was diagnosed peroperatively, consisting of 70% of the vascular and 25% of the bowel injuries. Twenty-six patients (64%) were admitted to the intensive care unit for a median of five days. There was no mortality. Besides conversion, the majority of the patients filed a claim to compensate for a longer hospital stay and related costs.A payment was made in 17 (57%) of the 30 settled claims. Conclusions: Medical liability claims concerning laparoscopic entry-related complications comprised a fifth of all laparoscopy-related claims. Claims concerning entry-related complications occurred in young patients who had routine, nonadvanced procedures. In the investigated cases most claims involved the closed-entry technique.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Medical liability insurance claims on entry-related complications in laparoscopy

et al. 2007

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“…6 Complications of operative laparoscopy in gynecologic surgery are infrequent but do occur; the most common such complications include vascular injuries, bowel injuries, genitourinary injuries, and incisional hernias. [10][11][12][13][14][15] With the increasing prevalence of operative laparoscopy in gynecology and the expansion toward use of operative laparoscopy for more complex surgical procedures, the natural course is that some centers and surgeons will be challenged with a higher volume of patients. The aim of the current study was to determine the impact of surgical volume on patient outcomes among patients undergoing gynecologic laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Impact of surgeon volume on patient safety in laparoscopic gynecologic surgery

Worley

Anwandter

Reis

et al. 2012

Gynecologic Oncology

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OBJECTIVE-To determine the impact of surgeon volume on patient outcomes in gynecologic laparoscopic surgery. METHODS-We reviewed all patients who underwent a laparoscopic procedure between January 2000 and December 2008. Surgeons were divided into 3 groups based on surgical volume. The mean number of surgeries per year was calculated for each surgeon. Means were categorized into 3 groups. The low-, medium-, and high-volume surgeon groups were compared with respect to level of surgical complexity and intraoperative and postoperative complications. RESULTS-The study included 829 surgeries. Low-volume surgeons (n=5) performed 5 (31.3%) low-complexity, 10 (62.5%) intermediate-complexity, and 1 (6.3%) high-complexity procedures. Medium-volume surgeons (n=6) performed 26 (11.1%) low-complexity, 203 (86.8%) intermediate-complexity, and 5 (2.1%) high-complexity procedures. High-volume surgeons (n=5) performed 47 (8.1%) low-complexity, 439 (75.8%) intermediate-complexity, and 93 (16.1%) high-complexity procedures. The distribution of surgical complexity was significantly different between the 3 groups of surgeons defined by volume (P<0.001). Conversion rates were higher for low-volume surgeons when compared to high-volume surgeons (18.8% vs. 5.2%; P=0.04). Similarly, overall complication rates (<30 days) were higher for low-volume surgeons compared to high-volume surgeons (31.3% vs. 17%, P=0.003). Mean length of hospital stay was longer for low-volume (2.4 days) than for medium-volume (1.3 days) and high-volume surgeons (1.6 days) (P=0.003). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. CONCLUSION-High- Conflict of Interest StatementThe authors report no conflict of interest. NIH Public Access

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“…van der Voort et al reported, based on 29 studies, the incidence of laparoscopyinduced gastrointestinal injury was 0.13 % (430/ 329,935) and of bowel perforation 0.22 % (66/ 29,532). The incidence may be under-reported due to retrospective and complication that occurred after leaving hospital being overlooked [16].The small intestine was most frequently injured 55.8 % (227/ 407), followed by the large intestine 38.6% (157/ 407), and the stomach 3.9 % (16/ 407) [17]. The reported bowel injury rates ranged from 0.16% (15/ 9,337) [11] to 0.62% (93/ 14,911); [12] 0.28% (2/ 722) in Lee et al LAVHs stud; [13] 0.33% (5/ 1,507) in Wu et al study.…”

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confidence: 99%