intraoperative complications during gynecologic laparoscopy: does previous surgery matter?

background the benefits of laparoscopy over laparotomy include lower blood loss, decreased length of hospital stay, and decreased postoperative pain. it is unknown, however, whether patients with previous surgeries are good candidates for laparoscopic surgery. objectives to determine whether the location and type (laparoscopic surgery vs. laparotomy) of previous abdominal surgery is associated with increased complication rates during subsequent laparoscopic gynecologic surgery. patients and methods a total of 903 consecutive patients who underwent gynecologic laparoscopy from january 2000 to january 2009. intervention: patients were stratified according to whether they had previous abdominal surgery or not. patients who had undergone previous surgery were further stratified according to the location of surgery (lower abdominal surgery only, upper abdominal surgery only, or both lower and upper abdominal surgery), as well as type of surgery (laparoscopy or laparotomy). incidence of complications during subsequent gynecologic laparoscopy was then compared between patient subgroups. results intraoperative complications occurred in 15 (4%) of the 337 patients with no previous surgery, 1 (2%) of the 53 patients with previous upper abdominal surgery, 16 (4%) of the 422 patients with previous lower abdominal surgery, and 4 (4%) of the 91 patients with previous upper and lower abdominal surgery. rates of complications did not differ significantly among these groups. among patients with previous laparotomy, complication rates did not differ significantly by location of previous surgery. similarly, among patients with prior laparoscopy, complication rates did not differ by location of previous surgery. when patients were stratified according to location of previous surgery, rates of complications did not differ among the patients with a history of laparoscopy versus laparotomy. conclusions our findings suggest that previous abdominal surgery, regardless of location or surgical approach, should not be a contraindication to gynecologic laparoscopy.