Laparoscopic hysterectomy in frozen pelvis—an alternative technique of retrograde adhesiolysis

Abstract

Hysterectomy in frozen pelvis is a challenging surgical condition whether done by laparotomy or laparoscopy. We describe an alternative technique of total laparoscopic hysterectomy with retrograde adhesiolysis in patients with frozen pelvis. Total laparoscopic hysterectomy with retrograde adhesiolysis was done in 25 patients with frozen pelvis between October 2003 and May 2012. The mean (standard deviation; 95 % confidence interval) age of patients was 42.6 (6.00; 40.1-45.07). Body mass index was 27.48 (5.06; 25.3-29.57). Twenty (80 %) patients had previous abdominal surgery, and three (15 %) patients had previous failed surgeries for attempted hysterectomy. Twenty-three patients had frozen pelvis due to severe endometriosis, and two patients had severe abdominopelvic adhesions due to multiple previous surgeries. One patient had intraoperative injury to the sigmoid colon and bladder during adhesiolysis, and laparotomy conversion was performed. The median (range) operating time was 210 (120-300) min, and estimated blood loss was 400 (300-600) ml. Length of post-operative stay was 1 (1-6) days, and the post-operative period was uneventful except in two patients who had paralytic ileus. The median (range) followup at 1 month and 6 months was 100 and 68 % (17 of 25), respectively. Our technique of laparoscopic hysterectomy with retrograde adhesiolysis and subsequent removal of adnexa is an alternative technique for hysterectomy in frozen pelvis and limits the potential hazards of injury to vital organs; it is associated with fewer complications. We emphasize that adequate surgical experience and expertise still remain the prerequisites for performing hysterectomy in frozen pelvis.