Epidemiology of complications associated with gynecological laparoscopy procedures in Ukraine: results a multicenter study

Aidyn G Salmanov; Volodymyr V Artyomenko; Yuliia V Strakhovetska; Olha D Leshchova; Victor O Rud; Andriy I Chubatyy; Anastasia S Padchenko; Svitlana M Korniyenko; Oleksandr A Voloshyn; Tetiana A Stryk

doi:10.36740/wlek/195172

Epidemiology of complications associated with gynecological laparoscopy procedures in Ukraine: results a multicenter study

Salmanov AG, Artyomenko VV, Strakhovetska YV, Leshchova OD, Rud VO, Chubatyy AI, Padchenko AS, Korniyenko SM, Voloshyn OA, Stryk TA

Wiadomosci lekarskie (Warsaw, Poland : 1960), 2024

DOI 10.36740/wlek/195172 PMID 39661881

RRM Academy Synopsis

Complications arose in 16.2% of gynecologic laparoscopies at 10 sites

In a prospective cohort of women with benign disease at 10 Ukrainian hospitals, 16.2% of 14,440 gynecologic laparoscopies had complications. Of the cases with complications, 74.9% were found after the woman left the hospital. Complications were more common in harder operations and in women with earlier abdominal surgery.

Key Findings

The study recorded 2,340 complication cases among 14,440 laparoscopic operations, an incidence of 16.2% (95% CI, 15.9-16.5); 74.9% of those cases were detected after hospital discharge.
The overall frequency of major complications was 5.04% (95% CI, 4.8-5.6) and of minor complications 11.16% (95% CI, 10.9-11.5); Table 2 lists 728 major and 1,612 minor cases.
Serious complications occurred in 2.4% of simple, 5.2% of moderate and 15.7% of complex procedures (P < 0.001); minor complications rose from 3.9% to 7.5% to 24.0%.
Among patients with prior abdominal surgery, 21.1% had serious complications, against 10.9% without (P < 0.001); the adjusted odds ratio was 2.78 (95% CI, 1.54–4.95).
The cases included 130 intestinal perforations, 39 diagnosed during surgery and 91 afterward, and all 130 needed conversion to laparotomy; 13 great vessel injuries occurred during Veress needle insertion.

Interpretation

The study followed women with benign gynecologic disease at 10 regional hospitals for 30 days after laparoscopy, a window that captured complications appearing after discharge. Logistic regression found factors linked to complications, including obesity with failed laparoscopy (P < 0.001). A cohort design shows association and does not establish cause. Women with malignant tumors or severe heart, lung, liver or kidney dysfunction were excluded. The authors say results from these hospitals may not apply to other Ukrainian hospitals. Surgeon training and experience were not assessed.

RRM Context

The authors list surgery for severe endometriosis among advanced laparoscopic operations. They cite earlier reports that tie fellowship training and high case volume to better surgical results. Restorative reproductive medicine seeks the root cause of pelvic disease. For endometriosis, that puts weight on surgeon skill and on care for pelvic anatomy.

Our editorial summary of this paper, not the article's abstract.

Abstract

Aim

To estimate the frequency of complications during laparoscopic gynecologic surgery for benign diseases in women and identify associated risk factors in Ukraine.

Materials and Methods

A multicenter, prospective cohort study was performed in gynecological departments from 10 regional hospitals of Ukraine between January 1, 2020, to December 31, 2022. The study included gynecologic laparoscopies for benign diseases in women performed at these hospitals. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. Surveillance was performed during 30 days after gynecological laparoscopy procedures.

Results

A total of 14,440 laparoscopic surgeries were performed, 2,340 (16.2%) complications cases were observed. Of all complication's cases, 74.9% were detected after hospital discharge. The overall frequency of major complications was 5.04%, and that of minor complications was 11.2%. The most frequently reported complications types were serious bleeding complications (20.6%), intestinal perforation (17.9%), mild anemia (16.7%), severe anemia (transfusion) (16.1%), failed laparoscopy (9.3%), minor bleeding complications (8.3%), postoperative hematoma (6.7%), urinary tract infection (5.6%), and fever (5.0%). The level of technical difficulty and existence of prior abdominal surgery, and obesity were associated with a higher risk of complications associated with gynecological laparoscopy procedures.

Conclusions

Results this study suggest a high frequency of complications associated laparoscopic gynecologic surgery in Ukraine. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications.

Aidyn G Salmanov, Volodymyr V Artyomenko, Yuliia V Strakhovetska, Olha D Leshchova, Victor O Rud, Andriy I Chubatyy, Anastasia S Padchenko, Svitlana M Korniyenko, Oleksandr A Voloshyn, Tetiana A Stryk

A Salmanov, V Artyomenko, Y Strakhovetska, O Leshchova, V Rud, A Chubatyy, A Padchenko, S Korniyenko, O Voloshyn, T Stryk

PMID 39661881 39661881 DOI 10.36740/wlek/195172 10.36740/wlek/195172 Salmanov et al. 2024, Salmanov 2024

Epidemiology of complications associated with gynecological laparoscopy procedures in Ukraine: results a multicenter study

Complications arose in 16.2% of gynecologic laparoscopies at 10 sites

Key Findings

Interpretation

RRM Context

Abstract

By this author

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