Repeated laparoscopy is at complication after gynaecological endoscopic operations

Abstract

The objective. To analyze the results of repeated laparoscopy for patients of gynecological type with suspicion of intra-abdominal postoperative complications. Materials and methods. 42 patients (middle age - 46±11,3 years) with postoperative abdominal complications after surgical treatment of different gynecological diseases needed repeated operations took part in the research. Depending on the method of the repeated interference patients are up-diffused into 2 groups: basic (n=20) are women for the correction of postoperative complications laparoscopy only; control (n=22) are women in which for the correction of postoperative complications during diagnostic laparoscopy there were the proposed testimonies to relaparotomy. In 8 patients of the control group relaparotomy is executed at once. A complex inspection was conducted on all patients with the application of clinical, instrumental, and laboratory methods of research. Groups were homogeneous in age and by the structure of operations, executed on the organs of the small pelvis, and statistically comparative. Results. During research, the analyzed results of repeated laparoscopy of 34 patients of gynecological type are suspicion of intra-abdominal postoperative complications. For all patients of the basic group (47,6%) laparoscopy appeared the unique and eventual method of treatment of postoperative complications, in 7 women repeated реlaparoscopy was used from 2 to 4 times, and in 13 laparoscopies it was conducted singly. In the group control (52,3%) 10 patients during diagnostic laparoscopy were exposure to testimony to relaparotomy, 4 patients of the possibility of an operating brigade and laparoscopic technique allowed to execute some elements of operation and complete mini-laparotomy access, and 8 patients relaparotomy is executed at once. Peritonitis and intra-abdominal bleeding predominate in the structure of early abdominal complications. Application of videolaparoscopic method allowed in 28,6% patients with the poured out peritonitis successfully to liquidate the developed complication, remove his source and conduct санацію of abdominal region. Laparoscopic hemostasis is successfully executed in 7 patients. By comparison to standard, the use of videoendoscopic method allowed to improve the indexes of diagnostic value: to increase the level of sensitiveness in 1,07 times, in 1,39 times of specificity and in 1,11 times of exactness of diagnostics. Conclusion. On the whole in an early postoperative period concerning the suspected complications it is executed 47 реlaparoscopy, that is explained by the leadthrough of programmable sanation of abdominal region by application of dynamic laparoscopy for control of motion of intra-abdominal complication. On the basis of analysis of the investigated material we are offer general testimonies and contra-indications to the leadthrough of реlaparoscopy in an early postoperative period with the purpose of diagnostics and treatment of postoperative complications. Substantiating each of points, we followed the real possibilities of method in general clinical practice, which in the row of cases act after the efficiency of relaparotomy.