Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study.

OBJECTIVES: To assess the morbidity from closed laparoscopic access and define the role of previous surgery on the occurrence of these complications.

DESIGN AND METHODS: We prospectively recorded data on all laparoscopic procedures between January 2000 and January 2001. We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and in the left upper quadrant for patients in group II.

SETTING: Gynaecology department of a University Hospital.

POPULATION: All laparoscopic procedures between January 2000 and January 2001.

MAIN OUTCOME MEASURES: We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and the left upper quadrant for patients in group II.

RESULTS: Four hundred and seventy-seven laparoscopies were carried out during the study period, 368 women without previous surgery were included in group I, and 109 women were included in group II. We recorded 1 complication (overall complication rate of 0.2% and 31 incidents (6.4%). One complication (small bowel injury) was related to the insertion of the Verres needle (0.2%). The incidents and complications occurred only in group II (P < 0.05). All the complications were treated by laparoscopy.

CONCLUSION: The complication rate of the entry step is low in gynaecological laparoscopy. A previous history of laparotomy increases the risk of these complications and incidents. Safety rules and other access method should be investigated for these patients.