Complications - Diagnostic laparoscopy endometriosis treatment

Bleeding

• Primary intraoperative bleeding: Can occur due to injury to vessels, particularly the pelvic veins, the uterine artery, or retroperitoneal vessels.
• Thermal damage to vessels: Improper use of electrosurgery can lead to delayed bleeding.
• Ovarian vein bleeding: Especially after excision of large endometriomas, secondary bleeding may occur.
• Treatment: Bipolar coagulation, clips, or hemostatics such as fibrin glue; in case of persistent bleeding, possibly suturing or switching to conventional surgery.

Ureteral Injuries

• Direct injuries through dissection or skeletonization of the ureter.
• Thermal damage from bipolar coagulation or laser.
• Secondary strictures due to excessive manipulation or scar formation.
• Treatment: If recognized intraoperatively, primary ureteral reconstruction or ureteral reimplantation; alternatively, intraoperative placement of a DJ stent.

Bowel Injuries

• Risk increased with deep infiltrating endometriosis of the rectosigmoid.
• Unnoticed serosal lesions can lead to peritonitis postoperatively.
• Treatment: Small lesions can be primarily sutured; larger defects may require bowel resection with anastomosis or protective stoma.

Bladder and Ureteral Injuries

• Direct bladder perforations in deep infiltrating endometriosis in the trigone area.
• Increased risk with adhesions between the bladder and uterus.
• Treatment: Primary bladder suturing with verification through intraoperative irrigation and placement of a bladder catheter for 7–10 days.

CO₂ Embolism

• Rare but potentially life-threatening due to accidental vascular insufflation with CO₂.
• Treatment: Immediate desufflation, repositioning in Trendelenburg position, circulatory stabilization.

Anesthesia-Related Risks

• Allergic reactions to medications
• Cardiovascular complications (e.g., arrhythmias)
• Aspiration pneumonia

Postoperative Bleeding and Hematomas

• Early bleeding from vascularized areas (pelvic wall, ovarian stumps, uterosacral ligaments).
• Late bleeding due to secondary vessel rupture or coagulation defects.
• Treatment: Often conservative observation is sufficient; in case of persistent bleeding, possibly re-laparoscopy.

Infections and Abscesses

• Increased risk with extensive bowel endometriosis with manipulations on the rectum.
• Postoperative Pelvic Inflammatory Disease (PID) due to bacterial superinfection.
• Wound infections
• Treatment: Broad-spectrum antibiotics, drainage in case of abscess formation.

Urinary Tract Problems

• Urinary retention after bladder manipulation or ureter compression.
• Strictures of the ureters due to scar formation.
• Treatment: DJ catheterization or endoscopic dilation; if persistent problems, ureter reconstruction is necessary.

Bowel Atony and Postoperative Ileus

• Possible after bowel manipulation or segmental resections.
• Treatment: Conservative measures such as fluid administration, mobilization, neostigmine; possibly reoperation in case of mechanical ileus.

Thrombosis and Embolism:

• Deep vein thrombosis
• Pulmonary embolism

Pain:

• Chronic pelvic pain
• Adhesions that can lead to pain and bowel problems

Diaphragmatic Irritation with Shoulder Pain

• Due to residual CO₂ gas after laparoscopy
• CO₂ gas irritates the diaphragm → radiating shoulder pain through the phrenic nerve