Total laparoscopic hysterectomy in patients with previous caesarean section: experience at a tertiary care center in India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20230816Keywords:
Adhesions, Caesarean section, Total laparoscopic hysterectomyAbstract
Background: With a surge in the rate of caesarean deliveries, the number of patients undergoing hysterectomy with a previous caesarean section for gynecological complaints has also increased. The presence of intra-abdominal and bladder adhesions to the uterus is the main concern in such cases, resulting in higher complication rates. This study aimed to determine the challenges and complications encountered during TLH in patients with previous caesarean sections.
Methods: We conducted a retrospective study analysing data from the medical records of 243 patients who had undergone TLH for various gynecological conditions in a single tertiary care center from January 2018 to January 2021. Patients were categorized into two groups namely no previous CS (n=193) and previous CS (n=50). The surgical outcomes of those patients including major complications were measured.
Results: The clinical characteristics of the two groups were comparable except for the patient’s age with younger patients in the previous CS group (p=0.001). There was no difference in terms of surgical indications, intraoperative and postoperative complications, and hospital stay between the groups. Operating time was significantly more in the previous CS group (p=0.001). One patient sustained a bladder injury in a previous CS group. The conversion rates to laparotomy in the previous CS and no CS groups were not statistically significant. Significant hemorrhage requiring blood transfusion was noted in two patients (4%) in the previous CS group and one (0.51%) patient in the no CS group (p=0.108).
Conclusions: TLH can be safely performed with lower complication rates by an experienced surgeon in patients with prior history of caesarean section.
References
International Institute for Population Sciences. (2017). NFHS-4 (National Family Health Survey-4)-2015-16 India fact sheet. Available from: http://rchiips.org/nfhs/factsheet_nfhs-4.shtml. Accessed on 1 January 2021.
Brill AI, Nezhat F, Nezhat CH, Nezhat C. The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstet Gynecol. 1995;85:269-72.
Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following caesarean and open intraabdominal gynaecological operations. Reprod Sci. 2011;18:1166-85.
Wang L, Merkur H, Hardas G, Soo S, Lujic S. Laparoscopic hysterectomy in the presence of previous caesarean section: a review of one hundred forty-one cases in the Sydney West Advanced Pelvic Surgery Unit. J Minim Invas Gynecol. 2010;17:186-91.
Soong YK, Yu HT, Wang CJ. Urinary tract injury in laparoscopic- assisted vaginal hysterectomy. J Minim Invas Gynecol. 2007;14:600-5.
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;193:2041-204.
Chapron C, Dubuisson JB, Ansquer Y, Fernandez B. Total hysterectomies for benign pathologies: laparoscopic surgery does not seem to increase the risk of complications. J Gynecol Obstet Biol Reprod. 1998;27:55-61.
Reich H. New techniques in advanced laparoscopic surgery. Baillieres Clin Obstet Gynaecol. 1989;3:655-81.
Nezhat F, Nezhat C, Gordon S, Wilkins E. Laparoscopic versus abdominal hysterectomy. J Reprod Med. 1992;37:247-50.
Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2009;144:3-7.
Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynecological disease. Cochrane Database Syst Rev. 2006:CD003677.
Koroglu N, Cetin BA, Turan G, Yıldırım GY, Akca A, Gedikbasi A. Characteristics of total laparoscopic hysterectomy among women with or without previous cesarean section: retrospective analysis. Sao Paulo Med J. 2018;136:385-9.
Jo EJ, Kim TJ, Lee YY, Choi CH, Lee JW, Bae DS, et al. Laparoendoscopic single-site surgery with hysterectomy in patients with prior cesarean section: comparison of surgical outcomes with bladder dissection techniques. J Minim Invas Gynecol. 2013;20(2):160-5.
Lim S, Lee S, Choi J, Chon S, Lee K, Shin J. Safety of total laparoscopic hysterectomy in patients with prior cesarean section. J Obstet Gynecol Res. 2017;43:196-201.
Sinha R, Sundaram M, Lakhotia S, Hedge A, Kadam P. Total laparoscopic hysterectomy in women with previous cesarean sections. J Minim Invas Gynecol. 2010;17:513-7.
Donnez O, Jadoul P, Squifflet J, Donnez J. A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures. BJOG. 2009;16:492-500.
Lafay Pillet MC, Leonard F, Chopin N, Malaret JM, Borghese B, Foulot H, et al. Incidence and risk factors of bladder injuries during laparoscopic hysterectomy indicated for benign uterine pathologies: a 14.5 years experience in a continuous series of 1501 procedures. Hum Reprod. 2009;24(4):842-9.
Cho FN. A technique to deal with severe adhesions between the uterus and bladder or rectum in laparoscopic-assisted vaginal hysterectomy. J Minim Invas Gynecol. 2007;14:750-1.
Chen SY, Namgung S, Choi J, Hwang S. 312: A method to prevent bladder injury in laparoscopically assisted vaginal hysterectomy (LAVH) for patients with vesicocervical adhesions. J Minim Invas Gynecol. 2007;14(6):S114.
