BMJ  2004;328:642 (13 March), doi:10.1136/bmj.328.7440.642-a

Letter

Results of eVALuate study of hysterectomy techniques

Conversion to open surgery should not be regarded as major complication

The first 150 words of the full text of this article appear below.

EDITOR—Although Garry et al look closely at outcomes for different surgical techniques in hysterectomy, I am concerned about the criteria they use to classify major complications.1

It is routine practice, at least in laparoscopic cholecystectomy, to seek patients' consent for conversion to an open procedure. This is recognised as prudent if persisting with the laparoscopic approach would add risk. To classify a strategy that encourages caution as a major complication therefore runs the risk of dissuading surgeons from converting appropriately and in a timely manner. In addition, it may open the way for complaints and litigation should a laparotomy be required.

It is widely accepted in laparoscopic gastrointestinal surgery that, although conversion rates should be kept as low as possible and audited appropriately, conversion to an open procedure in itself is not a major complication. The particular problem encountered may arise from the disease process or from an . . . [Full text of this article]

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Simon W Atkinson, consultant upper gastrointestinal surgeon

Guy's and St Thomas's NHS Trust, London SE1 7EH s.atkinson80@ntlworld.com


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Relevant Article

The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy
Ray Garry, Jayne Fountain, Su Mason, Jeremy Hawe, Vicky Napp, Jason Abbott, Richard Clayton, Graham Phillips, Mark Whittaker, Richard Lilford, Stephen Bridgman, and Julia Brown
BMJ 2004 328: 129. [Abstract] [Full Text] [PDF]

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