Characteristics of total laparoscopic hysterectomy among women with or without previous cesarean section: retrospective analysis

Abstract

BACKGROUND: The number of hysterectomized patients with previous cesarean sections (CSs) has increased 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 operation, length of hospital stay, histopathological diagnosis and major intra and postoperative complications 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, hospital stay or pre and postoperative hemoglobin levels. The conversion rates to laparotomy in the previous 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 significantly (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.

<p>Perioperative Complications of Hysterectomy After a Previous Cesarean Section: A Systematic Review and Meta-Analysis</p>

“…The procedure performed in five included studies was vaginal hysterectomy. 14,17,29,32,33 Ten of the remaining included studies assessed the odds of surgical complications following minimally invasive hysterectomy (laparoscopic-assisted vaginal hysterectomy, total laparoscopic hysterectomy, and roboticassisted hysterectomy) 16,[20][21][22][23]27,28,31,34,35 and 11 included studies assessed the odds of various types of hysterectomy including total abdominal hysterectomy and vaginal hysterectomy. 4,6,15,18,19,[24][25][26]30,36,37 Study designs of the included studies were cohort studies (24) 4,6,14-25,27-29,31-37 and case-control studies (two) 26,30 (Tables S3 and S4).…”

“…Figure 2 shows the summary of the risk of biases stratified by the type of study design. Quality assessment among 24 cohort studies using the Newcastle-Ottawa Scale indicated that high risks for comparability and outcome assessment were, respectively, noted in 15 [14][15][16][17][18][21][22][23][24][25]27,28,33,34,36 and 12 studies. 6,14,15,17,18,22,27,29,31,33,34,37 No cohort study was judged as having a high risk of selection bias.…”

Factors related to blood loss in laparoscopic hysterectomy

“…Seo et al [14] did not observe a difference in the retrospective review of 331 patients with those who had no history of abdominal surgery in terms of bleeding, transfusion, and complications. Koroğlu et al [15] reported that there was no significant difference in the hemoglobin levels between total laparoscopic hysterectomy patients with and without cesarean section (p = 0.785). Studies have reported that operation time, postoperative hospital stay, blood loss, operative complication rate, or conversion rate for open surgery were similar between patients with and without abdominal surgery history [16,17].…”

Descripción técnica reversa modificada para el abordaje laparoscópico de histerectomía total en patología benigna uterina

“…A pesar de estas ventajas, cifras recientes reportan que el abordaje de histerectomía es de 66, 22 y 12% para la vía abdominal, vaginal y laparoscópica, respectivamente. 16 En comparación con técnicas de mínima invasión (HVR) e histerectomía abdominal, la HTL aún se asocia a mayor incidencia de complicaciones intraoperatorias. Desde la primera descripción de la histerectomía lapa-roscópica las ventajas de la vía de abordaje han sido evidentes.…”