A clinical audit of laparoscopic surgery for recto-vaginal endometriosis at a tertiary referral centre in KwaZulu-Natal.
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Aim: The aim of the study was to evaluate the operative and post-operative complications, and outcomes of laparoscopic surgery using the Harmonic scalpel in patients with recto-vaginal endometriosis (RVE). Furthermore, pre-operative work up and referral patterns were evaluated. Design: Retrospective chart review. Method: Following ethical (BREC No. BE O42/11) and hospital regulatory approvals, a retrospective chart review of the hospital case records of all patients who underwent laparoscopic surgery for RVE using the Harmonic scalpel from January 2004 to December 2010 was performed. All relevant clinical information was captured on structured data sheets which were kept confidential and used strictly for the purposes of the audit. Results: The case records of 105 women who had laparoscopic surgery for endometriosis between January 2004 to December 2010 were identified Thirty-three (31.4%) patients with RVE were treated using the Harmonic scalpel as the main energy source. From this cohort of patients, there was one case which required conversion to laparotomy for rectal injury which was successfully repaired; one case required re-laparoscopy for suspected intra-operative bleeding and another required cystoscopy and double J stenting due to anuria of 21 hours post- surgery. The mean hospital stay was 4 days. 76% of women had improvement of pain after surgical intervention and concomitant adjuvant medical therapy was used in 30.3%. Conclusion: The usage of Harmonic scalpel as the energy source in the management of RVE appears to be safe and the morbidity is comparable to other energy sources reported in literature.