Analysis of failed and complicated laparoscopy on a gynecologic oncology service

Objective. To assess the incidence of and factors that predict failed or complicated operative laparoscopy on a gynecologic oncology service. Methods. Two hundred four consecutive operative laparoscopies were reviewed. Procedures converted to laparotomy or associated with major operative or postoperative complications were compared with uncomplicated laparoscopies with respect to patient characteristics, details of operative procedure, and length of hospitalization. The influence of patient characteristics, operative findings, and specific procedures on the risk of failed or complicated laparoscopies was estimated. Results. Twenty-five (12.3%) procedures were either converted to laparotomy or associated with major operative or postoperative complications. Women with failed or complicated laparoscopies had significantly more previous laparotomies and adhesions, greater blood loss, and longer hospital stay than those with uncomplicated laparoscopies (60.0% vs 35.7%, P = 0.03, 68.0% vs 37.4%, P < 0.001, 275 ml vs 132 ml, P = 0.03; and 5.9 days vs 0.98 days, P < 0.001, respectively). Age, body mass index, parity, menopausal status, preoperative CA-125, appearance of adnexal masses, and complexity of the procedure had no significant influence on failed or complicated laparoscopies. In univariate analysis, history of laparotomy and presence of adhesions and in multivariate analysis only presence of adhesions were predictive of failed or complicated laparoscopies (P = 0.03, < 0.001, and 0.006, respectively). Conclusions. The incidence of failed and complicated laparoscopy is low on a gynecologic oncology service. Presence of adhesions is the only significant independent risk factor predictive of failed or complicated laparoscopy. (C) 1999 Academic Press.