LAPAROSCOPY THE EYE THROUGH THE CLOSED DOOR IS IT SAFE IN GYNECOLOGIC EMERGENCY?

Introduction : Laparoscopy is one of the commonest operations in modern gynaecology and it has the potential to be
used either as a therapeutic or diagnostic modality. The inherent risks during laparoscopy may add to the risks of basic
procedures especially in emergencies.
Objectives: To evaluate the role of laparoscopy versus its complications in women presenting with acute pelvic pain
(APP) with uncertain diagnosis as gynecologic emergency.
Design: Retrospective observational clinical study.
Setting: Endoscopy unit in Obstetrics and Gynecology Department, El-Menoufiya University.
Methods : We have carefully reviewed and analyzed the medical records of 869 consecutive cases admitted for
laparoscopy during a three-year period. The incidence, indication, nature, cause, and operative sheet details were
recorded with special attention to complications in 40 women who presented with APP as an emergency.
Results : Gynecologic disorders were diagnosed and treated in 60% of cases and surgical disorders in 200/". Total
complication rate was 30%. There were 30% operative, 12.5W} anesthetic, 7.5% nursing and 25% equipment
complications. The complications were graded as mild in 70% moderate in 25% and severe in 5% and there were no
deaths.
Conclusions:
Laparoscopy is an ideal and useful as a diagnostic and therapeutic tool in gynecologic emergencies. However History
and careful physical examination together with ultrasound are mandatory to good patient care before laparoscopy.
Laparoscopic complications increase with increasing complexity of surgery and in emergency setting it is never too late
to change to laparotomy if the condition is demands or if the surgeon's skill is insufficient.
Rigid maintenance of equipment, proper patient selection, well trained operating room pcrsonnel and continuing
medical education can help to avoid complications, develop and maintian excellence.