Complications in Gynecological Surgery PDF
Preview Complications in Gynecological Surgery
Complications in Gynecological Surgery Peter O’Donovan (Ed.) Complications in Gynecological Surgery Peter O’Donovan, MB, FRCOG, FRCS(ENG) The Merit Centre Bradford Royal Infifi rmary Bradford, West Yorkshire UK British Library Cataloguing in Publication Data Complications in gynecological surgery 1. Generative organs, Female—Surgery 2. Laparoscopic surgery I. O’Donovan, Peter J. 618.1′059 ISBN-13: 9781846288821 Library of Congress Control Number: 2007925708 ISBN: 978-1-84628-882-1 e-ISBN: 978-1-84628-883-8 © Springer-Verlag London Limited 2008 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publica- tion may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic repro- duction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specififi c statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 9 8 7 6 5 4 3 2 1 Springer Science+Business Media springer.com Contents Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii 1 Prevention of Infection Following Gynecological Surgery: The Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Ronnie F. Lamont and S.V.Z. Haynes 2 Complications in Gynecological Oncology . . . . . . . . . . . . . 11 Robin A.F. Crawford 3 Laparoscopic Entry Techniques: Consensus . . . . . . . . . . . 20 Savita Lalchandani and Kevin Phillips 4 Complications of Laparoscopic Surgery for Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Jeremy T. Wright 5 Abdominal Wound Closure: How to Avoid Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Patrick Hogston 6 Recent Advances in Adhesion Prevention . . . . . . . . . . . . . 52 Gere S. diZerega and Matthias Korell 7 What to Do When the Operation Is Over . . . . . . . . . . . . . . 61 Virginia A. Beckett and Derek J. Tuffnell 8 Laparoscopic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Joseph A. Ogah 9 Urinary Tract Complications . . . . . . . . . . . . . . . . . . . . . . . . 75 Joseph A. Ogah 10 The High-Risk Gynecology Patient: Assessment and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Guy W. Glover and Paul G.W. Cramp 11 Complications in Hysteroscopic Surgery: Prevention and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Paul McGurgan and Peter O’Donovan vi Contents 12 Minimizing the Risk of Sterilization Failure: An Evidence-Based Approach . . . . . . . . . . . . . . . . . . . . . . . . 106 Rajesh Varma and Janesh K. Gupta 13 Complications of Assisted Reproduction . . . . . . . . . . . . . . 127 Kee J. Ong, T.C. Li, Enlan Xia, and Yuhua Liu Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Contributors Virginia A. Beckett, MRCOG S.V.Z. Haynes, MB, ChB, MRCOG Bradford Teaching Hospitals NHS Clinical Research Fellow Foundation Trust Northwick Park Hospital and Bradford, West Yorkshire, UK St. Mark’s National Health Service Trust Paul G.W. Cramp, BSc, MB ChB, Harrow, Middlesex, UK MRCP, FRCA Department of Anaesthetics Patrick Hogston, BSc(Hons), FRCS, Bradford Teaching Hospitals NHS FRCOG Foundation Trust Department of Obstetrics and Bradford, West Yorkshire, UK Gynaecology St. Mary’s Hospital Robin A.F. Crawford, MD, FRCS, Portsmouth, Hampshire, UK FRCOG Department of Gynaecology Matthias Korell, MD Cambridge University Hospital Frauenklinik im Kilinikum (Addenbrookes Hospital) Duisberg Cambridge, UK Duisburg, Germany Gere S. diZerega, MD Savita Lalchandani, MRCOG, University of Southern California MRCPI (Obst/Gynae) Keck School of Medicine Clinical Research Fellow in Department of Obstetrics and Minimal Access Surgery Gynecology University of Hull and Castle Hill Livingston Reproductive Biology Hospital Laboratories Cottingham, UK Los Angeles, CA, USA Ronnie F. Lamont, BSc, MB, ChB, Guy W. Glover, MB ChB, FRCA MD, FRCOG Department of Anaesthesia Consultant and Reader in Bradford Royal Infifi rmary Obstetrics and Gynaecology Bradford, West Yorkshire, UK Department of Obstetrics and Gynaecology Janesh K. Gupta, MD, MSc, Northwick Park Hospital and St. FRCOG Mark’s National Health Service Department of Obstetrics and Trust Gynaecology Harrow, Middlesex, UK University of Birmingham and Birmingham Women’s T.C. Li, MD, PhD, MRCP, FRCOG Hospital Royal Hallamshire Hospital Birmingham, West Midlands, UK Sheffifi eld, UK viii Contributors Yuhua Liu, FRCOG, FRCP Kevin Phillips, MRCOG Hysteroscopic Center Consultant Obstetrician and Fuxing Hospital Gynaecologist Beijing, China Castle Hill Hospital Cottingham, UK Paul McGurgan, MB, BA, MRCOG, MRCPI Derek J. Tuffnell, FRCOG University of West Australia Department of Obstetrics and King Edward’s Memorial Gynaecology Hospital Bradford Teaching Hospitals NHS Perth, West Australia, Australia Foundation Trust Bradford, West Yorkshire, UK Peter O’Donovan, MB, FRCOG, Rajesh Varma, MA, MRCOG FRCS (ENG) Clinical Lecturer The Merit Centre Department of Obstetrics and Bradford Royal Infifi rmary Gynaecology Bradford, West Yorkshire, UK University of Birmingham and Birmingham Women’s Hospital Joseph A. Ogah, MBBS, MRCOG Birmingham, West Midlands, UK Department of Obstetrics and Gynaecology Jeremy T. Wright, FRCOG Bradford Royal Infifi rmary Centre for Endometriosis and Bradford, West Yorkshire, UK Pelvic Pain The Woking Nuffifield Hospital Kee J. Ong, BMedSc, MB, BS, Woking, Surrey, UK MMed(Syd), FRANZCOG ACH Enlan Xia Jessop Wing Hysteroscopic Centre Royal Hallamshire Hospital Fuxing Hospital Sheffifield, UK Beijing, China 1. P revention of Infection Following Gynecological Surgery: The Evidence Ronnie F. Lamont S.V.Z. Haynes Definition of Infection Terms such as inflflammation, contamination, infection, sepsis, and febrile morbidity may mean different things to different clinicians. It is important, therefore, that in audits of surgical outcomes, reports of research fifindings, and comparisons of studies, terminology is defifined; an example of this process is given in Table 1.1. The defifi nitions of various systemic inflfl ammatory responses and their associated clinical fifi ndings and laboratory test results are shown in Table 1.2. Pathogenesis The vagina contains more microorganisms than any other site in the body except the bowel. Uterine manipulation through the vagina, e.g., surgical ter- mination of pregnancy (TOP), or operations that open the vagina, e.g., hyster- ectomy, will result in contamination of normally sterile sites by bacteria that are normally resident in the vagina. Whether these organisms become estab- lished and cause infection and inflfl ammation depends on a mixture of surgical and host-related factors, including low socioeconomic status, poor nutrition, smoking, or preexisting medical conditions, such as impaired immunocom- petence. These risk factors may be interrelated, e.g., diabetes, obesity, increased blood loss, duration of surgery, and prolonged hospital stay, and many of the measures that can be taken to reduce the rate of postoperative infectious morbidity focus on reducing the impact of these risk factors. The risk of post- operative infection also depends on the virulence and size of the bacterial inoculum. Normal vaginal flfl ora is composed mainly of organisms of low viru- lence, dominated by lactobacilli species, which, by producing lactic acid from glycogen in vaginal secretions, render the pH of the vagina very acid (<4.5), in which milieu the growth of other potentially pathogenic organisms is suppressed. At this low-acid pH, lactobacilli are particularly effifi cient at producing HO, 2 2 which is toxic to bacteria. Under conditions where there is an increase in the 2 R.F. Lamont and S.V.Z. Haynes Table 1.1. Definition of Infection—Terminology Definition Inflammation Localized protective response elicited by injury or tissue damage Contamination Pathogenic microorganism(s) in normally sterile tissue without an inflammatory response Infection Pathogenic microorganism(s) in normally sterile tissue with a local inflammatory response Sepsis Infection with a local and systemic inflammatory response Febrile morbidity Temperature of >38.0°C on 2 occasions at least 6 hours apart, excluding the first 24 hours after the procedure Source: Adapted from and reproduced with kind permission from Tamussino [1]. alkalinity of the vagina (bleeding, semen, douching) or a change in the delicate vaginal ecosystem (few or poor-quality lactobacilli, antibiotics, changes in endocrine status, or phage virus parasitization of lactobacilli), much less HO 2 2 is produced. This results in a 1000-fold increase in other organisms, particu- larly anaerobes that produce keto acids such as succinate. Succinate blunts the chemotactic response of neutrophils and reduces their killing ability. This Table 1.2. Definitions of Systemic Inflammatory Responses Clinical Findings, Laboratory Definition Tests Systemic Signs and symptoms of Fever, tachypnea, tachycardia, inflammatory disseminated infection or leukocytosis, or leukopenia response toxins Sepsis Infection with a local and Tachypnea (>20 breaths/min) systemic inflammatory Tachycardia (>90 bpm) response Hyperthermia or hypothermia (>38.4°C or <35.6°C) Severe sepsis Sepsis plus evidence of organ Metabolic acidosis, acute dysfunction encephalopathy, oliguria, hypoxemia, disseminated intravascular coagulation, hypotension Septic shock Infection with an Hypotension (<90 mm Hg, or overwhelming systemic 40 mm Hg below baseline) inflammatory response leading to shock Sepsis syndrome or Sepsis plus evidence of altered Hypoxia, increased plasma multiple-organ organ perfusion lactate, altered mental state, syndrome oliguria Source: Reproduced with kind permission from Tamussino [1].
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