Vaginal Hysterectomy by Electrosurgery for Benign Indications Associated with Previous Cesarean Section

Abstract

Background: Vaginal hysterectomies have been associated with difficulties in patients who have had cesarean sections prior to such hysterectomies. However, the Purohit technique may obviate the problems and make it easier to perform these operations. Objectives: This research tested an approach designed to facilitate vaginal hysterectomy in patients with previous cesarean sections in the absence of fixed adhesions of uterine corpi to previous anterior abdominal scarring. Design/Method: An observational study was conducted in a private general hospital between February 2010 and June 2012. All candidates for hysterectomy for benign indications who had had previous cesarean sections were examined for the presence of clinical and sonographic signs of fixed adhesions of uterine corpi to anterior abdominal-wall incisions caused by prior cesarean sections. Candidates who had such adhesions were not given vaginal hysterectomies. Results: Sixty-four (64) consecutive candidates were selected for vaginal hysterectomies. Of these patients, 26 (40.62%) had 1 cesarean section, 33 (51.56 %) had 2 cesarean sections, and 5 (7.81%) had 3 cesarean sections. Four (4) patients had had prior pelvic operations. The uteri were smaller than 12 weeks' gestationsize in 62 (96.87%) cases. In 26 (40.62 %) cases, there were no obstruction to accessing the anterior cul-de-sacs and vaginal hysterectomies were performed using the Purohit technique. In 38 (59.37 %) cases, dense uterovesical adhesions obstructed access to the anterior cul-de-sacs and a posterioanterior approach was used to perform vaginal hysterectomy in these patients. Vaginal hysterectomy was completed in all 64 cases. Vaginal salpingo-oophorectomy was performed in 3 (4.68%) cases. The mean operative time was 78. 59 -33.15 (35-190) minutes. The mean weight of specimen uteri was 161.01 -108.87 (50-550) g. No patients needed conversions or blood transfusions. No patients had bladder, ureteric, or thermal injuries. Finally, there were no other major postoperative complications. Conclusions: In the absence of fixed adhesions of the uterine corpus to previous anterior abdominal scarring, vaginal hysterectomy for benign indications associated with previous cesarean section may be accomplished safely. The posterioanterior approach during vaginal hysterectomy may avoid unintended bladder injury in the presence of dense uterovesical adhesions caused by previous cesarean sections. ( J GYNECOL SURG 29:7)

Non-descent vaginal hysterectomy in women with previous caesarean section scar: our experience

“…6 In present days practice, cases of hysterectomy with previous caesarean section scar expanding due to higher caesarean section rates, which has been a relative contraindication for NDVH in fear of encountering adhesion and injury to adjacent organs specially to urinary bladder. 7,8,9 The size of the uterus, nulliparity, previous pelvic surgery or lower segment caesarean section (LSCS), pelvic adhesions and endometriosis are the commonly cited limitations for vaginal hysterectomy. 10 But now vaginal hysterectomy in larger sized uterus is facilitated by bisection, myomectomy, debulking, coring and clamp less approach etc.…”

Adnexectomy During Vaginal Hysterectomy for Benign Indications Using Bipolar Hemostasis of Lateral Pedicles and Transvaginal Adnexa Mobilization

“…The stretchibility of the infundibulopelvic ligament did not affect completion of adnexectomy in this study, when the ovaries were either visible or made visible using a fiberoptic light source transmitted by a pelvic illuminator. 5 Adhered adnexa have been identified as risk factors for unsuccessful adnexectomy by conventional methods 6,11 using sutures. In-pelvis adhered adnexa had been removed in all cases in this study after transvaginal manual mobilization maneuvers.…”

“…In all cases, vaginal hysterectomy was performed using the Purohit technique for vaginal hysterectomy. 4,5 After vaginal hysterectomy, salpingo-oophorectomy was attempted in all indicated cases using the procedures described for salpingo-oophorectomy for the Purohit technique for vaginal hysterectomy. 4 The round ligament stump was separated from the ovarian and tubal stumps by a split in broadligament.…”

“…Deaver retractors and a fiberoptic light source, precisely directed through a pelvic illuminator 5 instead of a rigid telescope, 4 were used when poor visibility obstructed the progress of an adnexectomy in a deeper operating field.…”

Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study of 30 cases

“…2 Because of increased cesarean sections, women undergoing hysterectomies with cesarean sections are increasing. 3 Earlier previous cesarean section was relative contraindication to vaginal hysterectomy due to uterovesical adhesions and risk for unintended cystostomy. A written informed consent was taken from all patients after explaining the procedure and special consent for conversion to abdominal hysterectomy if needed and chances of bladder injury was taken.…”