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Complications - Supracervical hysterectomy, cervicosacropexy with gyno-mesh, bilateral adnexectomy, and anterior colporrhaphy, laparoscopic

gynecology
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative Complications

    Bleeding:

    • Blood loss > 1000 ml in 1–3% of cases
    • Injury to the iliac artery or uterine arteries
    • Pelvic hematomas due to inadequate hemostasis

    Injuries to adjacent organs:

    • Bladder injury (0.59–1.0%), increased with prior surgeries (e.g., C-section)
      • After an intraoperative bladder injury, the mesh can be placed after adequate repair.
    • Ureteral injury (0.09–0.3%), often recognized postoperatively
    • Bowel injury (0.2–0.4%), more common with adhesions or endometriosis
      • In cases of rectal injury, the placement of a synthetic mesh should be avoided

    CO₂ insufflation complications:

    • Subcutaneous emphysema or gas embolism
    • Pneumothorax or mediastinal emphysema with excessive insufflation pressure

    Nerve injuries:

    • Lesion of the obturator nerve or sacral plexus
    • Postoperative neuropathic pain

    Technical complications:

    • Conversion to laparotomy (2–4%), e.g., in cases of massive adhesions
    • Inadequate coagulation or hemostasis

  2. Early postoperative complications

    Bleeding & Hematomas:

    • Postoperative bleeding (0.94–1.8%)
    • Pelvic hematoma or abdominal hematoma

    Urinary tract complications:

    • Urinary retention (0.5–1.6%) due to bladder neck edema
    • Urinary tract infections (0.7–2.2%) due to catheterization
    • Fistula formation with unrecognized bladder or ureter injury

    Bowel dysfunctions:

    • Postoperative ileus (0.09–1.0%), especially with adhesions
    • Constipation due to altered pelvic floor statics

    Infections:

    • Wound infection (0.9–2.4%) at trocar sites
    • Pelvic infection, hematoma, or abscess (1.0–5.4%)
    • Sepsis (0.03%)
    • Infection rate after synthetic meshes up to 3%.
    • Spondylodiscitis after sacrocolpopexy in <1% of cases.
    • Abscesses or chronic infections require partial or complete mesh removal.

    Thromboembolic events:

    • Deep vein thrombosis or pulmonary embolism (0.02–0.03%)

    Vaginal complications:

    • Dyspareunia due to scar formation

     

  3. Long-term effects

    Rates for mesh erosions vary depending on the method:

    • Anterior compartment: 1.2-3.2%
    • Vaginal mesh implantation: 0-30%, median 8%
    • Abdominal sacrocolpopexy: 0-10% after 7 years
    • Risk factors:
      • Concurrent hysterectomy
      • Smoking (OR 4.2)
      • Polytetrafluoroethylene meshes
      • BMI > 30 kg/m² (OR 10)
      • Treatment: Local estrogenization (success rate 24%), mesh excision in case of persistent complaints

    Urinary incontinence & bladder dysfunction:

    • Stress or urge incontinence
    • Altered bladder position with postoperative dysfunction

    Bowel dysfunction:

    • Chronic constipation due to altered anatomy

    Sexual dysfunction:

    • Dyspareunia due to scarring, overcorrections, mesh contraction, nerve damage
    • Reduced lubrication after oophorectomy

    Chronic pain:

    • Neuropathic complaints due to nerve irritation
    • Scar pain in the pelvis

  4. Reference

    1. Brummer TH, Jalkanen J, Fraser J, Heikkinen AM, Kauko M, Makinen J, et al. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod. 2011;26(7):1741-51. 
    2. Chapron C, Querleu D, Bruhat MA, Madelenat P, Fernandez H, Pierre F, et al. Surgical complications of diagnostic and operative gynecological laparoscopy: a series of 29,966 cases. Hum Reprod. 1998;13(4):867-72. 
    3. McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J, et al. Severe complications of hysterectomy: the VALUE study. BJOG: an international journal of obstetrics and gynecology. 2004;111(7):688-94
    4. AQUA Institute for Healthcare GmbH Mh-, 37073 Göttingen. AQUA. Federal evaluation for the procedure year 2012. 15/1 Gynecological Operations. https://wwwsqgde/downloads/Bundesauswertungen/2012/bu_Gesamt_15N1-GYNOP_2012pdf. 2013;Last accessed: 05.01.2015. 
    5. Foon R, Toozs-Hobson P, Latthe PM. Adjuvant materials in anterior vaginal wall prolapse surgery: a systematic review of effectiveness and complications. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1697-706. 341. 
    6. Jia X, Glazener C, Mowatt G, Jenkinson D, Fraser C, Bain C, et al. Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse. International Urogynecology Journal. 2010;21(11):1413-31. 342. 
    7. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016-24. 343. 
    8. Sung VW, Rogers RG, Schaffer JI, Balk EM, Uhlig K, Lau J, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol. 2008;112(5):1131-42. 344. 
    9. Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG, et al. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011;22(7):789-98.