Vascular injuries during gynecologic surgery.

Iatrogenic vascular injuries are common in the civilian western world. The frequency seen following gynecologic surgery is not known and a questionnaire was therefore sent to all gynecologic clinics in Sweden undertaking surgery, to establish the frequency during a 5-year period and to analyse the types of injury. Case reports in the literature were also analysed. The frequencies per 10,000 operations were: after laparoscopy, 0.93, after laparotomy, 0.76 and after major vaginal surgery, 0.33. All laparoscopic injuries were localized to the iliac arteries, caused bleeding, and were treated with arterial suture without complications or late sequelae. Injuries during laparotomy were most frequently venous and all patients had hemorrhage as the main symptom. In one case the external iliac vein was ligated, with immediate postoperative swelling, and in another case the external iliac artery was ligated, after which the patient developed postoperative ischemia. The internal iliac veins were ligated, and the other vessels reconstructed. There was no mortality, but a high rate of morbidity, also with late sequelae.