[Laparoscopy complications in previously operated patients]

Laparoscopic complications among previously operated patients and patients without prior surgical treatment are compared in a retrospective study during the period 1994-1996. Complications occurred in 2.15% of the 789 (33.2%) previously operated patients and in 1.0% of the 1,588 (66.8%) patients not previously operated. Apart from early conversion to laparotomy if the intraabdominal situation is difficult, approaches recommended to reduce the incidence of severe complications in the case of previously operated patients include, from among the risk-minimized laparoscopic techniques for the Veress needle and optical troicart, the use of open laparoscopy, access from the left mammillary line at the margin of the costal arch and minilaparoscopy. With regard to avoiding severe complications during laparoscopic surgery, attention is drawn to the advantages of conventional surgery (sharp preparation and stitching techniques) as opposed to coagulation techniques, the necessity of exposing the ureter if the situation is unclear and, besides taking all necessary precautions, close visual inspection at the end of laparoscopy.