Early and Late-Onset Complications of Gynecologic Surgery

Gynecologic surgery is a surgical procedure performed on any part of a woman’s reproductive system, including urinary tract, bladder, cervix, fallopian tube, vagina, uterus, and ovaries. When there’s a condition affecting any of the above-mentioned reproductive organs in women, gynecologists recommend undergoing a surgical procedure, if medicines fail or turn unsatisfactory.

Based on the disease condition and its severity, your gynecologist may recommend the best suitable surgical or non-surgical treatment. However, multiple reports suggest that in many cases, a surgical procedure is a safest and most definite method to cure the gynecologic disease condition

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As with every other medical surgery, gynecologic surgeries too come with their own set of early and late-onset complications. Before discussing complications, let’s first look at the possible gynecologic conditions and their surgical treatment methods.

While each surgery involves certain risks and complications, the severity can be reduced through early diagnosis, timely treatment, and the choice of an expert gynecological surgeon.

As published under some authorized medical journals and articles, most women are reported to suffer from frequent postoperative complications. Those complications are divided into early-onset and late-onset.

Early-onset complications of gynecologic surgery:

• Hemorrhage and hematoma: This is one of the most common early-onset of complications that is noticed with gynecologic surgery.

• Urinary tract injuries: The incidence of urinary tract injuries in women who underwent pelvic surgery is 1%.  Also, bladder lesions and ureteral tract lesions are the most common urinary tract injuries noticed in women who underwent gynecologic surgery. 75% of urinary tract injuries are caused by gynaecologic surgery, and most of them occur in case of radical hysterectomy and lymph node dissection.

• Fluid collection and infection: As a result of visceral injury, infection and abscess may form. By using a CT scan, the doctor can find out the infection of a fluid collection or lymphocele, as well as an abscess. If your doctor finds gas bubbles in the test results, it can indicate the presence of gram-negative bacterial infection. Fistulization can be another possible complication of infection.

• Bowel injury: Bowel injury is another onset complication. It can happen during any gynecologic surgery. And so, it is necessary for any woman to choose the right and experienced surgeon from whom she can undergo the surgery and the best and safest hospital from where she can get the surgery done.

• Lymphocele: Lymphocele is one of the most common complications that occur during or after performing lymphadenectomy. According to reports, asymptomatic lymphoceles are seen in 1% to 58% of women who underwent Oncogynaecological procedures involving lymphadenectomy. A symptomatic lymphocele may compress adjacent structures like the urinary bladder, rectum, and ureters. As a result of this, women with lymphocele can suffer from pain, infections, urinary urgency, hydronephrosis (swollen kidney due to build-up of urine), and thrombosis.

• Thrombosis: Ovarian vein thrombosis is encountered as an early postpartum complication. However, it may also occur in case of abdominopelvic surgery for malignancies such as debulking surgery for ovarian cancer. It is usually depicted on MDCT images as an hypoattenuating filling defect within the ovarian vein eventually associated with surrounding soft tissue stranding in case of inflammation (thrombophlebitis) (Mantha et al., 2015). In doubtful cases, excretory phase may help to distinguish between a non-opacified vein and the ureters. Its recognition is important because it may be complicated by thrombosis of the inferior vena cava and in rare cases by pulmonary thromboembolism.

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Late-onset complications of gynecologic surgery:

Some of the late-onset complication of gynecologic surgery include-

• Urinary tract complications: Urinary tract complications can appear in both early and late [chronic] phases. One of the urinary tract complications that occur as a late-onset after gynecologic surgery is ureteral stenosis. Due to this, women can develop hydronephrosis [excess fluid in a kidney due to a back-up of urine]. This complication can be studied with the help of transabdominal ultrasound.

• Fistula: Fistula is another one of the most common delayed complications of gynecologic surgery. The reason is most often a bowel or urinary injury during the surgical procedure. It is most common in cases of malignant diseases or previous treatments that included radiotherapy. This complication is best studied with help of MRI and best treated either through oral contrast or endorectal catheter.

Final Word:

As a final word, we stress, while complications are inevitable in any surgery, the complications can be significantly reduced through an:

1. Early diagnosis,

2. Timely treatment,

3. Choice of an experienced surgeon and

4. Regular followup.

With advancements in sciences and precise medical equipments, the risk of complications today lie at less than 5% and even in the worst of cases, are mostly treatable. So, as a rule of thumb, always take regular pelvic and gynecological exams.

 An early diagnosis paves way for a timely treatment and a regular followup- minimises the complications.