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Complications include intestinal perforation, urologic injury, air embolus, surgical site infection (superficial and deep), abdominal wall vascular injury, incisional hernia, and major vascular injury (MVI) (Wieslander & Wong, 2013). In a review of the literature, 84% of patients with retroperitoneal hemorrhage experienced abdominal or groin pain, whereas a minority displayed the classic periumbilical or flank ecchymosis (Cullen’s and Grey-Turner’s signs, respectively) (Moore, Vasquez, Lin, & Kaplan, 2005).

• Complications during the operative procedure may lead to open laparotomy in approximately 2.1% of laparoscopic cases (Wieslander & Wong, 2013). Most common reasons for complications are injuries to major vessels or the intestine. Vascular injuries are most likely to occur during blind placement of a Veress needle and trocars than during the procedure itself. Mortality associated with injuries to the aorta, inferior vena cava, and iliac arteries and veins is between 9% and 17%. Immediate conversion to an open procedure is usually required with transfusion. Bleeding may be concealed in large retroperitoneal hematomas.

Intestinal injuries are uncommon but associated with mortality rates of 2.5% to 5% (Wieslander & Wong, 2013). Injuries to the colon and small bowel may be from sharp instruments or thermal burns. Recognition is often delayed until postoperation when patients present with low-grade fever, leucopenia, or normal leukocyte count. In reviews of bowel injuries after laparoscopy, patients commonly presented with pain at the trocar site near the injury, abdominal distention, and diarrhea, whereas signs associated with peritonitis (severe pain, nausea, vomiting, and ileus) were uncommon. Other complications include bladder injuries, ventral hernias, subcutaneous emphysema, gas embolisms, and postoperative shoulder pain (see previous question).