Surgical Outcomes and Complications of Total Laparoscopic Hysterectomy in Patients with a Surgical History of Cesarean Section.

OBJECTIVES

With the recent spread of laparoscopic hysterectomy (LH) and the rising rate of cesarean sections (CSs), increasing number of patients with a previous CS are undergoing total LH (TLH). Here, we retrospectively compared the surgical outcomes of TLH in patients with and without a history of CS.

MATERIALS AND

METHODS

We analyzed the surgical outcomes and complications of 609 TLHs performed from 2013 to 2023, according to the presence or absence of previous CSs.

RESULTS

Of the 609 patients who underwent TLH, 92 (15.1%) had a history of CS, and by the number of CSs, 58 patients had 1 CS, 27 had 2 CSs, 6 had 3 CSs, and 1 had 4 CSs. There was no significant difference in surgical outcomes between the non-CS and CS groups. The main complication was bladder injury in one patient with 3 previous CSs; the incidence of bladder injury in the ≥3 CS group was significantly higher than that in the non-CS group. There were four cases of vaginal cuff dehiscence (2 each in the CS and non-CS groups, indicating no significant difference).

CONCLUSION

It is important to be aware that the risk of bladder injury is increased in patients with previous CSs, especially in those with 3 or more. In addition, care should be taken intraoperatively to avoid such injuries, and sufficient information about their risk should be obtained preoperatively.