Characteristics of total laparoscopic hysterectomy among women with or without previous cesarean section
retrospective analysis
Keywords:
Laparoscopy, Hysterectomy, Cesarean section, Postoperative complicationsAbstract
BACKGROUND: The number of hysterectomized patients with previous cesarean sections (CSs) has in- creased due to increasing CS rates. A previous history of CS has been demonstrated to be an important risk factor for major complications in total laparoscopic hysterectomy. The aim here was to evaluate the major complications and safety of TLH in patients with previous CS. DESIGN AND SETTING: Retrospective analysis in a tertiary-level center. METHODS: The medical records of 504 total laparoscopic hysterectomy patients operated between May 2013 and May 2017 were reviewed retrospectively. Data on age, parity, surgical indications, duration of op- eration, length of hospital stay, histopathological diagnosis and major intra and postoperative complica- tions were gathered. The patients were categorized into two groups according to their CS history, namely those with and those without previous CS. Major complications were defined as the presence of lower urinary tract injury (bladder or ureter injury), enterotomy/colostomy, bowel serosal injury or vascular injury. RESULTS: There was no difference between the groups in terms of parity, duration of operation, hos- pital stay or pre and postoperative hemoglobin levels. The conversion rates to laparotomy in the pre- vious CS and no CS groups were 2% and 1.7%, respectively. The rates of major complications in the previous CS and no CS groups were 5% and 1.3%, respectively, and these results did not differ signifi- cantly (P > 0.05). CONCLUSION: TLH could be performed safely in the previous CS group, since the complication rate was not different from that of the patients without previous CS.
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References
Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091-5. PMID: 17978124; doi:10.1097/01.AOG.0000285997.38553.4b.
Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009(3):CD003677. PMID: 19588344; doi:10.1002/14651858. CD003677.pub4.
Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM. Is previous cesarean section a risk for incidental cystotomy at the time of hysterectomy? A case-controlled study. Am J Obstet Gynecol. 2005;193(6):2041-4. PMID: 16325612; doi:10.1016/j.ajog.2005.07.090.
Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt 1):233-41. PMID: 23969789; doi:10.1097/AOG.0b013e318299a6cf.
Committee on Gynecologic Practice Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol. 2017;129(6):e155-e159. PMID: 28538495; doi:10.1097/ aog.0000000000002112.
Llarena NC, Shah AB, Milad MP. Bowel injury in gynecologic laparoscopy: a systematic review. Obstet Gynecol. 2015;125(6):1407-17. PMID: 26000512; doi:10.1097/aog.0000000000000855.
Sandadi S, Johannigman JA, Wong VL, et al. Recognition and management of major vessel injury during laparoscopy. J Minim Invasive Gynecol. 2010;17(6):692-702. PMID: 20656569; doi:10.1016/j. jmig.2010.06.005.
Leonard F, Chopin N, Borghese B, et al. Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol. 2005;12(4):312-7. PMID: 16036189; doi:10.1016/j. jmig.2005.05.015.
Munro MG, Parker WH. A classification system for laparoscopic hysterectomy. Obstet Gynecol. 1993;82(4 Pt 1):624-9. PMID: 8377992.
Poindexter YM, Sangi-Haghpeykar H, Poindexter AN, 3rd, et al. Previous cesarean section. A contraindication to vaginal hysterectomy? J Reprod Med. 2001;46(9):840-4. PMID: 11584488.
Lindquist SAI, Shah N, Overgaard C, et al. Association of Previous Cesarean Delivery with Surgical Complications after a Hysterectomy later in Life. JAMA Surg. 2017;152(12):1148-55. PMID: 28793157; doi:10.1001/ jamasurg.2017.2825.
Soong YK, Yu HT, Wang CJ, Lee CL, Huang HY. Urinary tract injury in laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol. 2007;14(5):600-5. PMID: 17848321; doi:10.1016/j.jmig.2007.05.004.
Lim S, Lee S, Choi J, et al. Safety of total laparoscopic hysterectomy in patients with prior cesarean section. J Obstet Gynaecol Res. 2017;43(1):196-201. PMID: 27928849; doi: 10.1111/jog.13191.
Sinha R, Sundaram M, Lakhotia S, Hedge A, Kadam P. Total laparoscopic hysterectomy in women with previous cesarean sections. J Minim Invasive Gynecol. 2010;17(4):513-7. PMID: 20621012; doi: 10.1016/j. jmig.2010.03.018.
Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP. Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review. Obstet Gynecol. 2018;131(1):100-8. PMID: 29215524; doi: 10.1097/aog.0000000000002414.
Adelman MR, Bardsley TR, Sharp HT. Urinary tract injuries in laparoscopic hysterectomy: a systematic review. J Minim Invasive Gynecol. 2014;21(4):558-66. PMID: 24462595; doi: 10.1016/j.jmig.2014.01.006.
