Common Intraoperative Complication Research Articles

Complications of Pure Transperitoneal Laparoscopic Surgery in Urology: The Taipei Veterans General Hospital Experience

We present our experience of complications of pure transperitoneal laparoscopic surgery in urology at Taipei Veterans General Hospital. Between September 2003 and March 2006, 185 laparoscopic urologic operations were performed, consisting of 70 nephrectomies (36 radical, 17 partial, 11 simple, 6 donor), 28 adrenalectomies, 28 nephroureterectomies, 22 radical prostatectomies, 17 ureterolithotomies, 6 radical cystectomies, 5 pyeloplasties, 2 renal cyst unroofings, 2 nephropexies and 5 other operations. We reviewed the database of the patients to evaluate the complications and analyze factors related to laparoscopic surgeries. A total of 25 patients had 26 complications (14.1%, major in 4, minor in 22). The complications were categorized into intraoperative and postoperative complications in 10 and 16 patients, respectively. The mortality rate was 0%. The conversion rate was 0.54% (1 patient). The re-operation rate was 1.08% (2 patients). The most common intraoperative complication was vascular injury (5 patients). The incidence of complication was related to the difficulty level of operation. No statistically significant differences were found between complication rate and patient age, patient body mass index or the American Society of Anesthesiologist score. The complications of laparoscopic urologic surgeries are strongly correlated with the operative difficulties. In spite of elevated complication rates in difficult surgeries, the major complication rate in this study was very low. As the laparoscopic surgeries in urology involve more and more technique-dependent difficult fields, documentation and analysis of experience of complications is important for the development of this surgical modality.

Complications of 2,775 Urological Laparoscopic Procedures: 1993 to 2005

We assessed the complications associated with urological laparoscopic surgery at a single high volume center during a 12-year period. A retrospective chart analysis was performed, focusing on complications associated with 2,775 laparoscopic surgeries occurring between 1993 and 2005. These included radical nephrectomy (549), partial nephrectomy (345), donor nephrectomy (553), simple nephrectomy (186), pyeloplasty (301), nephroureterectomy (105), retroperitoneal lymph node dissection (86), renal ablation (81), adrenalectomy (106) and radical prostatectomy (463). Complication data were tabulated according to case number, procedure type, patient age, the American Society of Anesthesiologists score, conversion status, length of hospitalization, Clavien classification system and annual complication rate during the study. Statistical analysis was performed with Fisher's exact and chi-square tests. A total of 614 complications (22.1%) occurred within each group, broken down into laparoscopic radical nephrectomy (20%), laparoscopic partial nephrectomy (28%), laparoscopic donor nephrectomy (28%), laparoscopic simple nephrectomy (15%), laparoscopic pyeloplasty (13.3%), laparoscopic nephroureterectomy (40.9%), laparoscopic retroperitoneal lymph node dissection (26.7%), laparoscopic renal tumor ablation (18.6%), laparoscopic adrenalectomy (25.4%) and laparoscopic radical prostatectomy (15%). Total intraoperative and postoperative complication rates were 4.7% and 17.5%, respectively. Vascular injuries were the most common intraoperative complications. Annual complication rates plateaued in the year 2000 and were not significantly different during the ensuing 4 years (p >0.05). Complications correlated with a greater American Society of Anesthesiologists score as well as a longer hospital stay (p <0.05). The data presented here help define the complication rates for laparoscopic urological procedures in experienced hands at a high volume institution.

Comparison of Biofragmentable Anastomosis Ring and Sutured Anastomoses for Subtotal Colectomy in Cats with Idiopathic Megacolon

To report use of a biofragmentable anastomosis ring (BAR) device in cats with idiopathic megacolon (FIM) and compare outcome after subtotal colectomy with sutured colocolic anastomosis. Retrospective study. Nineteen cats with megacolon. Medical records (January 1990-January 2004) of cats treated surgically for idiopathic megacolon with sutured (SUT) or BAR anastomosis were retrieved and reviewed. Operative, short- and long-term complications, and survival times were recorded and Kaplan-Meier survival analysis used to assess outcome. There were 11 SUT and 8 BAR cats. One BAR cat had anastomotic dehiscence 36 hours after surgery. Mild serosal tearing during BAR insertion in 6 cats was corrected by suture reinforcement. One SUT cat developed anastomotic stricture at 32 days. Short-term complication rates at 3 and 7 days were 18% and 45% in the SUT group and 25% and 87.5% in the BAR group, respectively (P=.058). Two SUT cats had persistent loose stool consistency and were euthanatized 254 and 1661 days after surgery. One BAR cat had recurrence of constipation which was managed medically. Long-term complication rates were not significantly different between SUT and BAR (P=.61). The 1 and 4-year survival rates were 90% for SUT and 100% for BAR (P=.29). No difference was detected for short and long-term complication rates and survival times between SUT and BAR groups. The BAR device can be used for colocolic anastomosis in cats with idiopathic megacolon. Serosal tearing during BAR insertion was a common intraoperative complication. Regardless of anastomotic technique, survival outcome after colonic resection is excellent for cats with FIM.

Luxación del cristalino: etiología y resultados

To evaluate the indications for surgery, visual results and postoperative complications of pars plana vitrectomy (PPV), in patients with retained lens fragments in the vitreous cavity. 86 Eyes from 83 patients who underwent PPV for retained lens fragments at the Hospital Central de Asturias between April 1997 and December 2004 were reviewed. The average age was 68 years (12-90 years). Patients with proliferative diabetic retinopathy, maculopathy and inadequate follow-up examination (less than 3 months) were excluded. The results have been analysed according to the etiology of the subluxation. The average follow-up time was 32.5 months (6-73 months). The most common cause for subluxation of the lenses was cataract surgery and trauma. In 48.15% an intraocular lens was implanted. The average preoperative visual acuity (VA) was 0.06 (logMAR 1.0) and postoperative VA 0.4 (logMAR 0.4). 61.7% of the eyes had increased preoperative intraocular pressure, whereas only 32 eyes (39.5%) had this postoperatively. The most common intra-operative complications were retinal tears (4) and retinal detachment (1). The most common postoperative complications were retinal detachment (3) and bullous keratopathy (2). PPV is a relatively simple and low risk technique, which allows good visual restoration and minimizes complications of the subluxated lenses.

Implementación de la cirugía del cáncer de recto por laparoscopia

The integration of laparoscopic surgery for rectal cancer in clinical practice is one of the challenges faced by surgical societies. The aim of the present study was to analyze the results obtained during the implementation phase of this technique. From January 2003 to June 2005, 40 patients with rectal carcinoma underwent laparoscopic surgery in our center. Clinical and pathological variables were prospectively collected for statistical analyses. A total of 27 men and 13 women underwent surgery: 11 high (HAR) and 20 low anterior resections (LAR) and 9 abdominoperineal resections (APR) were performed. Operative time was 240.4 +/- 200 min and was greater in the LAR group (259.7 vs 201.5 min; p=.02). The intraoperative complication rate was 22.5% (9% HAR vs 25% LAR; p=NS). The mean length of hospital stay was 8.7 +/- 4.8 days. The rate of postoperative complications was 32.5%. The conversion rate was 15% (6 patients), and was greater in the LAR group (25% vs 0% HAR vs 11.1% APR; p=0.02). The most common intraoperative complication and the most frequent cause of conversion consisted of stapling problems (4 patients). Surgery was considered curative in 34 patients (85%). One case of positive radial margins was encountered (3.3%). The mean distal and radial margins were 3.6 +/- 2.7 cm and 1.1 +/- 0.9 cm respectively. The overall results during the implementation stage of laparoscopic surgery for rectal surgery were satisfactory. Conversion rates were highest in LAR, which proved to be the most demanding procedure.

Anesthesia for Indian Ocean tsunami‐affected patients at a southern Thailand provincial hospital

On 26 December 2004, a giant earthquake shook South-East Asia, triggering deadly flood waves (tsunami) across the Indian Ocean. The Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand joined the Thai Red Cross Society to provide relief in southern Thailand. The objective of this article is to characterize the emergency surgical patients and anesthesia profiles of tsunami victims at Phang-Nga Provincial Hospital. Available records from the operating room and anesthesia unit of Phang-Nga Provincial Hospital, together with laboratory and administrative data, during the period 26-31 December 2004 were collected and analyzed using descriptive statistics. Thai Red Cross teams provided surgical emergency services for 107 cases during 28-30 December 2004. Ninety-three cases (86%) were Caucasian, one (0.9%) was Japanese and nine (8.4%) were Thai. ASA physical status classifications of 1, 2 and 3 were present in 87.8%, 8.4% and 0.4%, respectively. The majority of injuries comprised multiple soft tissue wounds with severe infection. Eighty-five per cent of cases received debridement and 14.0% tendon or nerve repair or fixation of bone. The anesthesia choices were general endotracheal with rapid sequence induction and intubation (69.2%), general under mask (19.6%), total intravenous anesthesia (4.7%), spinal anesthesia (3.7%) and local anesthesia (2.8%). Anesthesia-related problems included a lack of pre-operative laboratory investigation, hypovolemia, severe wound infection with early sepsis and aspiration pneumonia. Common intra-operative complications included hypotension and oxygen desaturation from pulmonary aspiration or lung contusion. There was one case of post-operative reintubation and no peri-operative mortality. Anesthesia-related problems in tsunami victims included pulmonary aspiration, hypovolemia, sepsis and lack of pre-operative laboratory investigation. General anesthesia was the most common anesthetic technique. Common intra-operative complications included hypotension and oxygen desaturation.

Vaginal hysterectomy: Results and complications of 886 patients

SummaryThe aim of this study was to determine the feasibility, results and complications of vaginal hysterectomy. A total of 886 consecutive patients who had undergone vaginal hysterectomy for benign gynecological diseases were retrospectively analysed. Vaginal hysterectomy was successfully performed in 96.1% of the nulliparous and 99.9% of the parous patients. The mean duration (min) of the operation was 89.1±29.1. The operation time (min) of the nulliparous women was significantly higher than that of the primiparous and multiparous women (109.3±40.2 vs 81.1±33.2 and 85.1±28.3, respectively). The overall complication rate was 14.6%. The intraoperative and postoperative complication rates were 4.1% and 10.5%, respectively. The most common intraoperative complication was bladder injury (2.5%). Vaginal hysterectomy for benign gynaecological diseases has high feasibility with acceptable complication rates.

Complications of laser-assisted uvulopalatopharyngoplasty (LA-UPPP) and radiofrequency treatments of snoring and chronic nasal congestion: A 10-year review of 5,600 patients

Recent laser and radiofrequency techniques for the treatment of snoring have provided improvements, but intraoperative and postoperative risks, complications, and long-term results have not been explored in a statistically large enough sample of patients. The goal of this article is to provide practitioners with important data and guidelines to help them in decision-making and prepare them to anticipate problems and recommend a systematic approach to avoid or treat complications. This investigation was a retrospective review of 5,600 cases, performed over a 10-year period by a single investigator, in a private practice setting. The data on complications were gathered from chart review as well as questionnaires filled out on each patient and by patient reports. The inclusion criteria for this review were: 1) patients with a history of chronic snoring or nasal congestion; 2) patients with an American Society of Anesthesiologists physical status classification (ASA) Classes I or II medical history; 3) patients provide a detailed preoperative snoring questionnaires; 4) patients provide informed consent; 5) patients were followed for a minimum of 2 years following surgery; 6) patients completed a comprehensive postoperative survey; 7) operative report stating the exact nature of any complications; 8) surgeons provided a clinical assessment; 9) sleep apnea reports if available; and 10) patient body mass index of less than 30 kg/m2. Laser-assisted uvulopalatopharyngoplasty (LA-UPPP) was used for the treatment of snoring and mild obstructive sleep apnea in all cases; 40% of patients also had simultaneous nasal radioablation. No fatalities were recorded and fewer than 3% of patients had long-term complications. The most common intraoperative complication was bleeding, which occurred in 9.5% of patients. Reducing the amount of tissue resected from the soft palate helped reduce or eliminate the common complications of traditional uvulopalatopharyngoplasty procedures. LA-UPPP and radioablation procedures are effective, safe, and can be carried out in an office setting equipped with anesthesia monitors and services. The complications associated with the procedure were rare and usually manageable.

Bedside tracheotomy: The northwestern experience

Objectives: To survey the indications, complications and contraindications for open bedside tracheotomies performed at Northwestern Memorial Hospital by the OtolaryngologyHead and Neck Surgery Service and compare it to that of data series published by other medical centers. Methods: This study was a retrospective chart-based review of all patients undergoing tracheotomy at Northwestern Memorial Hospital from August 1999 to August 2001 by the OtolaryngologyHead and Neck Surgery Department whose records were available for analysis. Data examined included indications for tracheotomy, duration of intubation prior to the tracheotomy, intraoperative and postoperative complications, and the presence of specific clinical contraindications for open bedside tracheotomy. Results: Our survey showed 200 tracheotomies performed from August 1999 to August 2001 performed by the OtolaryngologyHead and Neck Surgery Department. There were 172 patient records available for analysis. The majority of tracheotomies performed at Northwestern Memorial Hospital were secondary to neurosurgical diagnoses (64%). The most common indication for tracheotomy was prolonged ventilatory requirement (87%). The most common intraoperative complication was hemorrhage (2%). Postoperative complications were notable for an 8% hemorrhage rate, as well as an 8% mortality rate. However, none of the mortalities were due to the performance of the tracheotomy. Postoperative radiography, although routine, failed to assist in the diagnosis of any postoperative complication. Conclusion: The complication rate in our series was very low and in keeping with other published accounts despite a very sick patient population. Adherence to predetermined exclusion criteria probably further reduces the probability of serious complications.

Complications of abdominal urologic laparoscopy: longitudinal five-year analysis

Objectives To analyze complications of abdominal laparoscopic surgery of the urinary tract at a single institution during a 5-year period. Methods From 1996 to 2000, we identified 894 abdominal laparoscopic procedures performed at a single institution: 600 nephrectomies (live donor, simple, radical, nephroureterectomy, and partial), 112 pyeloplasties, 61 renal biopsies, 35 retroperitoneal lymph node dissections, 31 renal cyst ablations, 18 adrenalectomies, and 37 other abdominal procedures. The charts were retrospectively reviewed for complications, which were classified as operative, postoperative, or medical. Complications were correlated with patient age and American Society of Anesthesiologists score. Statistical analysis was performed with Fisher's exact test and chi-square tests. Results A total of 118 complications (13.2%) occurred. Two patients (0.2%) died. As a result of operative complications, the procedure of 13 patients (1.5%) was converted to an open one. As a result of postoperative complications, 13 (1.5%) underwent operative and 6 (0.7%) nonoperative intervention. The most common intraoperative complications were vascular (n = 23), adjacent organ (n = 10), and bowel (n = 9) injuries. The most common postoperative complications were neuromuscular pain (n = 12), hematoma (n = 11), urine leak (n = 7), and wound infection (n = 7). The differences in the annual complication rates for all procedures did not attain statistical significance ( P = 0.5). Among all procedures, excluding live donor nephrectomy, complications of any kind correlated with a greater patient American Society of Anesthesiologists score ( P = 0.01). Conclusions Rather than decreasing, the overall incidence of laparoscopic complications did not change significantly during a 5-year period at our institution. The factors contributing to this observation likely included the progression of inexperienced individual surgeons through the learning curve, the introduction of new, more sophisticated laparoscopic procedures, and stable rates of patient comorbidity. This experience may represent the average complication rate for urologic laparoscopy at a large-volume, academic training center.

Vertical Conjunctival Bridge Flaps in Pterygium Surgery

BACKGROUND AND OBJECTIVE: To evaluate the recurrence rates and clinical outcome following pterygium surgery using a vertical conjunctival bridge flap technique. PATIENTS AND METHODS: The study included 500 patients operated on for primary or recurrent pterygium during 6 years (between 1994 and 2000). Following receipt of informed consent, the patients were randomly distributed into two treatment groups: 250 patients were operated on using a vertical conjunctival bridge flap technique (Group 1) and the remaining 250 patients were operated on using a bare sclera technique (Group 2). Demographic characteristics of the patients were compared by analysis of variance. The mean follow-up period was 16 months, with a minimum of 6 months. The intraoperative and postoperative complications and recurrence rates were compared for each group. RESULTS: There was no statistically significant difference in age and gender distribution of the patients between the two groups ( P &gt; .05). The most common intraoperative complication was a broken or irregular flap, which was seen in 6 of 250 cases (2%) in the vertical conjunctival bridge flap group. The recurrence rate was 2% in the vertical conjunctival bridge flap group compared with 40% in the bare sclera group ( P &lt; .01). CONCLUSION: The vertical conjunctival bridge flap technique is a safe and effective method in pterygium surgery and offers low recurrence rates. [Ophthalmic Surg Lasers Imaging 2003;34:279–283.]

Retrospective analysis of canine miniature total hip prostheses.

To determine the practicality and clinical outcome of miniature total hip replacement (THR) in dogs. Retrospective study. Sample Population- Seventeen client-owned dogs that had miniature THR. Patient data surveyed included signalment, body weight, diagnosis, implant size, surgical technique, and intraoperative and postoperative complications. Radiographic evaluation included angle of lateral opening of the acetabular component, implant positioning, cement mantle quality, and femoral displacement measurement and ratio. Client questionnaire and orthopedic examination were used to obtain long-term follow-up information. Miniature THR was performed to address hip dysplasia and secondary osteoarthritis. In 1 dog, a staged bilateral procedure was performed. Mean body weight was 19 kg (range, 12 to 25 kg). Penetration or fissure of the femoral cortex was the most common intraoperative complication and occurred in 3 dogs. In 3 dogs, there was excessive coxofemoral laxity after reduction of the prosthesis. This instability was addressed specifically in 2 dogs by capsulorrhaphy or capsular prosthesis. Postoperative convalescent complications (craniodorsal luxation, 2 dogs; acetabular cup displacement, 1 dog) were related to surgical errors. Aseptic loosening of the femoral implant was diagnosed in 1 dog at 18 months. Mean follow-up time was 17 months (range, 4 to 42 months). Fifteen of 18 (83%) miniature THRs had good or excellent outcomes. Miniature THR should be considered a satisfactory alternative to femoral head and neck ostectomy in medium-size dogs affected by hip dysplasia and secondary osteoarthritis. The population of medium-size dogs that might derive more benefit from THR than FHO has yet to be defined. Miniature THR is a viable treatment option in medium-size dogs with hip dysplasia.

Results of cataract surgery in previously vitrectomized eyes

Purpose: To evaluate the difficulties and results of manual extracapsular cataract extraction (ECCE) and phacoemulsification cataract surgery performed in previously vitrectomized eyes. Setting: Pécs University of Sciences, Faculty of Medicine, Department of Ophthalmology, Pécs, Hungary. Methods: This retrospective case-control study comprised a series of 84 cataract extractions with or without intraocular lens implantation. Forty-three patients had manual ECCE and 41, phacoemulsification. The intraoperative and postoperative complications and visual outcomes in the 2 groups were analyzed and compared. Results: Cataract extractions were performed a mean of 15.8 months (range 1 to 86 months) after the pars plana vitrectomy. The indications for vitrectomy were diabetic retinopathy, retinal detachment, proliferative vitreoretinopathy, giant retinal tear, macular hole, eye trauma, vitreous hemorrhage after central retinal vein occlusion, and uveitis. Primary posterior capsule fibrosis was the most common intraoperative complication, occurring in 24% of eyes. Posterior capsule rupture occurred in 5 eyes in the ECCE group and 3 in the phacoemulsification group. Zonulysis occurred in 2 and 1 eyes, respectively. A dropped nucleus occurred in 3 cases in the phacoemulsification group. Posterior capsule opacification and secondary glaucoma were the most common postoperative complications, occurring in 5 and 3 cases in the ECCE group, respectively, and in 3 and 4 cases in the phacoemulsification group. Visual acuity 6 weeks postoperatively improved or remained within 2 Snellen lines in 95% of eyes, which is comparable to data in the recent literature. Conclusions: Phacoemulsification gave better results than manual ECCE in previously vitrectomized eyes. Underlying retinal disease limited the final visual acuity.

Functional outcome after shoulder arthroplasty for primary osteoarthritis: A multicenter study

Shoulder arthroplasty outcomes have been reported in many case series. Typically, these series have followed either a single prosthesis used to treat a variety of arthritic disorders of the shoulder or experience in a single institution. In contrast, this report of a prospective study summarizes the experience of several surgeons with a single prosthetic design for treatment of primary osteoarthritis of the shoulder. A prospective, multicenter clinical outcome study evaluated 176 shoulders in 160 patients with primary osteoarthritis. This study evaluated a single prosthetic design (Global Shoulder) used by 19 contributing surgeons. Enrollment included 133 total shoulder replacements and 43 humeral head replacements (hemiarthroplasty) in 98 men and 62 women. Neither age nor sex affected whether hemiarthroplasty or total shoulder arthroplasty was performed. Patients with full-thickness cuff tears preferentially had hemiarthroplasty. The decision to perform total shoulder arthroplasty or hemiarthroplasty was based on the surgeon's preference. There were significant improvements (P <.001) in all evaluated and self-assessed outcome parameters from the preoperative baseline for both total shoulder arthroplasty and hemiarthroplasty. The results confirm that prosthetic arthroplasty leads to dramatic improvement in pain, function, and patient satisfaction. Intraoperative complications occurred in 5.4% of cases, and postoperative complications occurred in 7.8%. The most common intraoperative complications were intraoperative fractures, occurring in 9 cases. The most common postoperative complications were glenoid component loosening and humeral head subluxation. Almost all cases of humeral head instability were associated with rotator cuff tears or glenoid component loosening (or both). Seven shoulders underwent 9 additional surgeries during the 5-year study period. Thirteen shoulders in 11 patients were lost as a result of death unrelated to the procedure; 2 shoulders in 1 patient were lost within 3 days/3 months after the bilateral replacements as a result of death from pulmonary embolism. Nine percent of the shoulders (16/176) had full-thickness rotator cuff tears. Eight of the 16 shoulderswith full-thickness supraspinatus cuff tears had hemiarthroplasty. All of these tears were isolated to the supraspinatus tendon, and all were repairable. There were no differences in postoperative pain, function, American Shoulder and Elbow Surgeons scores, or range of motion. There were no differences between total shoulder arthroplasty and hemiarthroplasty in those patients with a reparable rotator cuff tear. Total shoulder arthroplasty and hemiarthroplasty for treatment of primary osteoarthritis result in good or excellent pain relief, improvement in function, and patient satisfaction in 95% of cases. Avoiding intraoperative humeral shaft fractures through use of an uncemented, canal-filling prosthetic stem requires careful attention to reaming and component sizing. Postoperative humeral head subluxation is often associated with other factors including rotator cuff tears or glenoid component loosening. (J Shoulder Elbow Surg 2002;11:130-135)

Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course

BACKGROUNDA training course for cataract surgery with intraocular lens implantation was organised in April 1997 at the National Eye Centre, Kaduna, Nigeria. Operations were performed by six Nigerian consultant ophthalmologists...

Principles and Practice of Anesthesiology, 2nd Edition

Principles and Practice of Anesthesiology, 2nd Edition

Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery.

We set out to analyze the technical aspects, intraoperative complications, morbidity, and mortality of laparoscopic cholecystectomy in a multi-institutional study representative of Switzerland. Data were collected from 10,174 patients from 82 surgical services. A total of 353 different parameters per patient were included. We found intraoperative complications in 34.4% of patients and had a conversion rate of 8.2%. This rate was significantly increased in patients with complicated cholelithiasis and in those with previous upper-but not lower-abdominal surgery. In most cases, conversions to open procedures were required because of technical difficulties due to inflammatory changes and/or unclear anatomical findings at the time of operation. Bleeding was a common intraoperative complication, that significantly increased the risk of conversion. Patients with loss of gallstones in the peritoneal cavity had increased rates of abscesses. The rate of common bile duct injuries was 0.31%, but it decreased significantly as the laparoscopic experience of the surgeon increased. The rate of common bile duct injuries was not increased in patients with acute cholecystitis or in the 1.32% of patients undergoing laparoscopic common bile duct exploration. Intraoperative cholangiography did not reduce the risk of common bile duct injuries, but it allowed them to be diagnosed intraoperatively in 75% of patients. Local complications were recorded in 4.79% of patients, and systemic complications were seen in 5.59%. The mortality rate was 0.2%. Although laparoscopic cholecystectomy is a safe procedure, the rate of conversion to open cholecystectomy is still substantial. The conversion rate depends both on the indication and intraoperative complications. There is still a 10.38% morbidity associated with the procedure; however, the incidence of common bile duct injuries, which decreases with growing laparoscopic experience, was relatively low.

Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Selective dorsal rhizotomy (SDR) has been shown to be an effective treatment for the spasticity of cerebral palsy, but few studies have addressed specifically the side effects of the procedure. A retrospective study was performed to determine the frequency and nature of complications in 158 children who had undergone SDR at British Columbia’s Children’s Hospital from 1987 to 1996. Intraoperative, preoperative (immediate postoperative until discharge at approximately 7 days) and postdischarge complications occurred in 3.8, 43.6 and 30% of patients, respectively. The most common intraoperative complication was aspiration pneumonia, which was experienced by 2 patients (1.3%). Perioperatively, sensory changes were found in 8.9% of the children, and transient urinary retention in 4.4%. Complications after discharge included back pain starting more than 6 months after surgery in 10.8%, sensory changes in 13.9%, and neurogenic bladder or bowel problems in 12.7%. Persistent sensory changes occurred in 3.8%, were not important functionally, and tended to occur in patients with the largest amount of dorsal root tissue cut. In 8 patients (5.1%), bladder and/or bowel dysfunction attributed to the SDR was present at the latest follow-up, although in only 2 patients (1.3%) this dysfunction was a definite complication of the rhizotomy. The use of pudendal monitoring and/or cutting less than 50% of the S2 roots may have been associated with a lower incidence of long-term sphincter dysfunction. Data about the nature and frequency of complications may result in further modifications to the SDR procedure, and is critical for counseling about SDR and alternative options available for treatment of the child with spastic cerebral palsy.

Complications of surgical treatment of cervical carcinoma.

A total of 302 patients with stage Ib and IIa cervical carcinoma were submitted to radical hysterectomy and lymphadenectomy during the period from 1980 to 1994. The morbidity rate was 37.5% and the mortality rate 0.6%. The most common intraoperative complications were injuries to the great pelvic vessels and the most frequent postoperative complications involved the urinary tract. The leading causes of morbidity were urinary infection (20.8%), bladder dysfunction (9.2%) and ureteral fistulas (2.9%). Although the rate of complications was high, morbidity has been decreasing over the last five years. Thus, radical hysterectomy continues to be one of the methods for the treatment of early cervical carcinoma that presents an acceptable 5-year survival rate.

LAPAROSCOPIC CHOLECYCTECTOMY-REPORTS OF 327 CASES-

In this series a total of 327 patients who underwent laparoscopic cholecystectomy in the hospital between April 1991 and December 1993 are reviewed. There were 299 patients with cholelithiasis, 23 patients with polyps of the gallbladder, and five patients with adenomyomatosis. Postoperative histologic examinations of the specimens revealed a carcinoma of the gallbladder in four cases. The seconary operation including the resection of the liver bed and lymph nodes was performed for those cases. Twelve cases (3.7%) were converted to open cholecystecotmy. On the cases inappropriate visualization of the gallbladder with the preoperative drip infusion cholangiography, the incidence of conversion to the open cholecystectomy was high (10.2%). Common intraoperative complications included injury of the cystic wall and hemorrhage. Postoperatively remnant stone in the cystic duct, bile leakage, myocardial infarc-tion, and paralytic ileus were observed. Intraoperative cholangiography was tried in 247 cases and revealed some abnormality in 13 cases. Five cases out of the 13 cases were converted to open surgery because of misdissection of the common bile duct and remnant stone in the common bile duct.