Management of major complications in laparoscopically assisted vaginal hysterectomy

We reviewed 722 laparascopically assisted vaginal hysterectomies performed between March 1991 and March 1996 at our institute, looking at the management or major complications. The indications for hysterectomy included adenomyosis, myoma uteri, intractable menorrhagia, endometriosis, and severe pelvic adhesion. During 1 to 6 years' follow-up, there were 12 (1.7%) major complications, comprising six bladder injuries, one iliac artery perforation, two bowel injuries, two cases of partial intestinal obstruction, and one pelvic abscess. Four complications were repaired successfully by laparotomy, six were repaired laparoscopically or vaginally, and two were treated conservatively. All the cases with visceral injuries were detected intraoperatively, therefore, adequate repair operations could be performed uneventfully. Early detection and treatment allow complications to be resolved more easily.