The impact of histopathologically proven adenomyosis on surgical outcomes and total laparoscopic hysterectomy complication rates, types, and severity.

BACKGROUND: To compare the surgical outcomes and complications of patients with and without a histopathologic diagnosis of adenomyosis after total laparoscopic hysterectomy (TLH). METHODS: A retrospective single-centre cohort study was conducted at the SanlıurfaTraining and Research Hospital to evaluate the histopathologic results of patients who underwent TLH for benign disease between January 2018 and August 2025. The patients were divided into two groups according to their postoperative histopathologic results (Group 1: adenomyosis, Group 2: without adenomyosis). We considered postoperative major surgical complications according to the Clavien–Dindo (CD) score. A logistic regression model was applied to estimate the association between the presence of adenomyosis and primary outcomes. RESULTS: A total of 332 patients underwent TLH, of whom 135 (40.7%) were in Group 1, and 197 (59.3%) were in Group 2. Patients with adenomyosis were less likely to report a total complication rate (OR 0.97, 95% CI 0.60–1.57, P = 0.913) and postoperative complications (OR 0.92, 95% CI 0.55–1.53, P = 0.766). However, they were more likely to report intraoperative complications (OR 1.26, 95% CI 0.41–3.84, P = 0.682). According to the CD score, the effect of adenomyosis was slightly lower in grade 1 complications (OR 0.50, 95% CI 0.17–1.43, P = 0.197) and similar in grade 2 and grade ≥ 3 complications (OR 1.03, CI 0.58–1.84, P = 0.903; OR 2.52, CI 0.64–9.83, P = 0.183). Patients with adenomyosis had a slightly higher risk of urinary tract/bladder injuries, bowel injuries, and vaginal cuff dehiscence (respectively, OR 1.78, 95% CI 0.53–5.97, P = 0.347; OR 4.45, 95% CI 0.45–43.28, P = 0.198; OR 1.47, 95% CI 0.29–7.39, P = 0.640). CONCLUSIONS: The present study showed that there was no significant difference in total complication rate, severity (CD score), and types of complications between patients with and without histopathologically proven adenomyosis who underwent TLH for benign disease.