‘Failed’ Laparoscopy, couldn’t access abdominal cavity?

[BloodyAngel]

Hi all,
I had surgery yesterday (diagnostic laparoscopy and Hysteroscopy) under GA for suspected endometriosis and ongoing heavy bleeding.
Truthfully, I’m feeling a little lost today.

It wasn’t my first of either of these procedures and though the hysteroscopy went well with biopsies taken, the laparoscopy failed as they couldn’t access my abdominal cavity.
The surgeon mentioned something about abrasions to the walls but he was very brief, I was high on morphine and I’m a little confused as to what this means. I’m by no means a supermodel, but I don’t believe my weight the issue as there were women larger than myself having the same procedure successfully.

I do have a follow up appointment in 3-4 weeks, along with a gynaecological MRI to investigate matters further. Naturally, I’m a little disheartened at not receiving a conclusive answer to my endometriosis but I’m more confused at the whole situation.

For reference, in 2018 I had emergency surgery due to an ovarian torsion/cyst and though they tried to do it through laparoscopy, I ended up having to have a full incision to remove the dead ovary and fallopian tube. The surgeon mentioned that it may have been the same issue back then but I had more wound sites last time due to the different ports whilst this time I only have the one singular incision. The gas port was definitely inserted this time as I’m full of gas pains and drowning in peppermint tea!

Of course I’ll be following up with my consultant, but has anyone else experienced this? I tried to Google but there wasn’t much information bout this specific failure and I’d love to hear other peoples experiences if so.

Thank you in advance.

I wonder if the surgeon said it wasn't possible due to adhesions?
Many years ago my fertility consultant wanted to do a laparoscopy but decided against it due to previous abdominal surgery. I had a laparotomy as a child, with a scar from hip to hip, he said he didn't want to go poking about in there blind. I assume he meant there was a risk of adhesions, he might have said this, I can't quite remember. I had a hysteroscopy, under GA, instead.

Edit to add adhesions are like scar tissue forming inside your belly, and can stick organs together, or to the abdominal wall. They can form as a result of previous surgery and might not cause you to have any symptoms so you wouldn't know they were there.

Sounds like they could not access this due to adhesions from the previous laparoscopy surgery. These are sticky strands that tether organs together. Drug treatments will not remove them, they can only be removed surgically. The surgeon was wise I think not to continue in this circumstance.

I would complain about being spoken to about adhesions whilst in the recovery room as this as it is poor practice on the part of the hospital and staff. If this was done in the NHS do complain to PALS. I am glad to read you have a follow up appointment in a few weeks time; again raise the issue of being spoken to about adhesions in the recovery room as you were in no state to understand.

I would put money on it that endometriosis is indeed the cause.

Thank you for your thoughtful replies. It’s very interesting considering that there was no mention of this possibility prior to surgery day and they certainly knew about my previous surgeries as it was performed at the same hospital. Reading your comments I feel as if I understand a lot more than I had so thank you very much. I‘ll certainly bring this up at my appointment.

anaesthetist pov... it's not that common but certainly not unheard of to have to bail out of a laparoscopy. Reading between the lines a bit and obvs with all the usual caveats that none of us were there so can't confirm anything....with the previous operation they didn't have the option of bailing out because it was an emergency procedure... the only option then would be to do the open procedure and fix the problem. Adhesions can be caused by a whole bunch of things.... sugery/infections/endo being just a few...they can be in the way and prevent one operation, but not be a problem for a different procedure depending on what it is. This time round, if it was an elective, diagnostic procedure, bailing out is always the back up plan and having had previous surgery (laparoscopic or open) meant that adhesions were a bit more likely (they wouldn't have started it though if they thought it was going to be so difficult). It sounds like they did actually manage to get into your abdomen and have a bit of a look but decided it wasn't safe or the risks outweighed the benefits of proceeding laparoscopically and they probably made a very sensible decision to bail out rather than cause a major injury on the inside that then needed a whole different procedure to fix. That doesn't necessarily mean they didn't get any information though. It does sound from what you've written like you've probably remembered most of what they'd have said. You should have had a discharge summary that may have info that supports what you remember. Sounds like organising the scan, waiting for the hysteroscopy reports and seeing you again to make more definitive plans is all pretty reasonable.

@Greybeardy Thank you so much for your very insightful reply, that has cleared up alot of my confusion. I agree with everything you said and understand a lot more now about the reason it was unsuccessful.
Would this mean that any future surgeries would be likely to be open, seeing that both laparoscopies have failed? Dependant on the findings of the MRI of course.

As a side note, the anaesthesiology team in my surgery were absolutely incredible, a real standout in the care I received, you guys are complete rockstars.

Would this mean that any future surgeries would be likely to be open, seeing that both laparoscopies have failed?
Surgeon that's actually seen the inside needs to answer that because it'll depend on exactly what the problem was. Different types of surgery are sometimes still possible after a failed procedure (eg. removing a gall bladder might be possible even if a gynae procedure wasn't if whatever problems there were were all down in the pelvis, but another gynae procedure might not be achievable). Or sometimes the same operation may be possible to achieve with a different team present (gynae surgeons sometimes have surgical colleagues from different specialties working with them to support doing a procedure as safely as possible)... really depends on the exact details though. Hope you get some helpful answers when you see them next.

@Greybeardy Thank you very much again for your reply!

I was admitted in July with a twisted ovarian cyst. Subsequent scans and it is the size of a grapefruit. I am overweight, but more important in terms of operation is the fact I’ve had two c-sections. The scar tissue is a big factor, as appears to be in your case. This plus the actual size of my cyst and when I do have the op I’m expecting it will be a full opening. But this was clearly discussed with me, and I also asked ChatGPT about the actual procedures step by step. This helped, and also helped with questions to ask during follow up appointments. Currently I’m trying to lose as much weight as I can to try and reduce that added risk. I had an MRI so they now have a pretty good idea of what things looks like - have you had one?