The role of computerized tomography in the evaluation of complications after laparoscopic urological surgery

Purpose: Radiographic evaluation may be necessary to assess the possible complications of laparoscopic procedures. We undertook a retrospective review to determine the indications for and findings of computerized tomography (CT) in symptomatic patients after urologic laparoscopic surgery. Materials and Methods: Of 400 laparoscopic urological procedures performed between July 1993 and September 1996, 20 patients (5%) had postoperative symptomatology that could not be explained by physical exam or routine clinical studies. An abdominal CT scan was obtained (1 to 120 days after the procedure) to help determine a diagnosis. CT findings were correlated with the indication for the study and clinical followup. Results: The indications for CT were unexplained pain, fever, leukocytosis or falling hematocrit. Thirteen patients had significant findings related to their surgery that were identified by CT. In 2 cases, we identified pathology unrelated to the surgery. Therefore, CT identified a symptom-related diagnosis in 75% of patients (15 of 20). Each scan for decreasing hematocrit demonstrated a hematoma. In all patients with unexplained fever or leukocytosis, CT revealed the cause. CT evaluation of atypical postoperative pain demonstrated a pathological cause in 58% (7 of 12). Percutaneous or laparoscopic surgical intervention was required in 4 of 20 patients. In 8 patients scanned by postoperative day 6, intraperitoneal or retroperitoneal gas was identified in 3 who had an abdominal incision made for intact specimen removal and in 1 with a perforated ulcer. Conclusions: CT after urologic laparoscopy is indicated in patients with significant clinical findings in whom routine examination and tests are not diagnostic. CT can reliably identify postoperative bleeding, urinary leak or obstruction and can also detect nonurinary pathology.