Perioperative complications of obstetric surgery at the reference health center in 5th municipality of the district of Bamako: place of urology.

Abstract

Objective: The aim of this study is to highlight the epidemiological, anatomy-clinical and surgical aspects of urological complications secondary to obstetric surgery at the CSRef of the commune V of Bamako. Methods: This was a prospective study going from January 1, 2020 to December 31, 2020. It covered the files of all patients operated on in the said department during the study period. Age, parity, antecedent of pelvic surgery, diagnosis, management Complication burden and follow-up were analyzed. Results: During 12 month of study, 411 complications were collected from 25 12 surgeries pelvic. The average age is 27t2 years with extremes of 18 to 38 years. 39.02% of patients had a BMI above normal. In our series 82.9% of our patients had an antecedent of obstetric surgery with uterus scar. There were 16 urological lesions, including 11 bladder lesions and a ligation of the lower right ureter discovered intraoperatively. 4 complications were diagnosed postoperatively: 2 vesico-vaginal fistulas (VVF) following a failure of the management of 2 bladder lesions, and 2 bilateral ligations of the lower ureters. Almost all of the first surgical procedures were carried out by of interns (FFI) and emergency cesarean section and hysterectomy were the main causative surgeries. The repair of complications was the work of specialists. The 2 VVF required vaginal fistulorrhaphy and the ligation of the lower ureter required ureteral reimplantation bladder according to the Lich Grégoire principle. Monitoring of repairs was unremarkable. 
Conclusion: Caesarean section and hysterectomy are the greatest providers of urological complications. These iatrogenic lesions are generally discovered post-operatively and their management involves experienced surgeons in specialized service in general.