PubMed · 11293625
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L M Joly, D Benhamou. 2001-03-31. Laparoscopic surgery.. https://doi.org/10.1016/s0140-6736(05)71620-2
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Complications after laparoscopic procedures in gynecological and surgical clinics were discussed at a symposium held in Stockholm in September of 2000. According to official and professional records the number of laparoscopic operations has increased, especially in surgical clinics. Although this technique entails many advantages for patients, it is accompanied by an increase in the number of complications, some of which are not seen in open surgery. About ten injuries to vessels in the abdominal wall or the abdominal cavity, leading to major bleeding, occur yearly in the course of insertion of laparoscopic instruments. In about the same number of cases the intestines are perforated. Many gynecological procedures are performed using laparoscopic technique, for instance 90% of sterilizations. In operations of the adnexa, the most common complications are related to introduction procedures. At hysterectomy, complication frequency is not higher in laparoscopic operations than when open or vaginal methods are used. About 70% of cholecystectomies in Sweden are performed laparoscopically. The total number of complications is not higher than in open surgery, but the number of injuries to the common and hepatic ducts is higher after laparoscopic cholecystectomy. The importance of perioperative cholangiogram to prevent such injuries is stressed.
Pregnancy is associated with an increased incidence of gallstones. However, most gallstones disappear spontaneously after pregnancy without having given any symptoms. New knowledge regarding the pathophysiology confirms changes in the motility of the gallbladder and the flow dynamics and lithogenicity of the bile. The studies have also shown, that these changes resolve completely after labour, which might explain the disappearance of most of the gallstones. These conditions support a conservative attitude towards treatment of gallstone disease during pregnancy. In case cholecystectomy is indicated, laparoscopic intervention seems safe during pregnancy and most optimal during the second trimester where the organogenesis of the fetus is completed and where the size of the uterus does not interfere with the operation technically. Laparoscopic cholecystectomy should under all circumstances be done in departments with routine in laparoscopic operations and with the possibility of gynaecological assistance, in case it is needed.
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