How are complications of salpingo-oophorectomy prevented?

Updated: Feb 06, 2018
  • Author: Stacie M Ward, MD; Chief Editor: Christine Isaacs, MD  more...
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Complication Prevention

While the incidence of injury to internal organs (bowel, bladder, ureter, blood vessels, and nerves) is rare, it does occur. Patients with prior surgeries, history of pelvic infection, endometriosis, or other causes of adhesive disease are at greater risk. Ureteral injury may occur by clamping, transection, and ligation of the ureter, kinking of the ureter resulting in obstruction, or disruption of the ureteral blood supply. [5]

A common location of ureteral injury is at the pelvic brim, where it is in close proximity to the infundibulopelvic ligament. Prevention of ureteral injury occurs by direct visualization, palpation, or possible ureteral catheterization with lighted stents. If there is a question of possible injury, a cystoscopy may be performed.

Risk factors for nerve injury include the length of procedure (over 4 hours), thin patient, improper positioning, self-retaining retractors, and extensive tissue dissection. [6] Common nerves injured during pelvic surgery include the iliohypogastric and ilioinguinal, genitofemoral, femoral, lateral femoral cutaneous, obturator, sciatic, common peroneal, and the brachial plexus. [6]

To minimize the risk of nerve injuries, the surgeon should ensure appropriate padding between the patient and the table, stirrups, and arm boards. If the patient is to be positioned in dorsal lithotomy position, minimal thigh abduction and external hip rotation should be used. If a procedure continues for more than 4 hours, it may be helpful to reposition the patient if possible.

Antibiotic prophylaxis is not required for a salpingo-oophorectomy, whether performed laparoscopically or open. However, when performed in combination with a hysterectomy, antibiotics are recommended for prevention of postoperative infections. In patients in whom there is a suspicion of infection, the addition of appropriate antibiotic therapy should be considered. [7]

Therapy required for prevention of deep venous thromboses depends on the type of procedure, the patient's age, and other risk factors. Low-risk patients may only require early ambulation, whereas patients who are at higher risk may require heparin therapy and intermittent pneumatic compression devices. [8]

Absorbable adhesion barriers are available and are used by some practitioners for the prevention of adhesion formation. There are several types of adhesion barriers available for use; some barriers have more supportive data than others. [9, 10]

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