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Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section.

Ko JH, Choi JS, Bae J, Lee WM, Koh AR, Boo H, Lee E, Hong JH - Obstet Gynecol Sci (2015)

Bottom Line: We compared the demographic, clinical characteristics, and surgical outcomes of two groups.There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups.LAVH is effective and safe for women with anterior wall adherence after cesarean section.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kangwon National University School of Medicine, Chuncheon, Korea.

ABSTRACT

Objective: To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section.

Methods: We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups.

Results: The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group.

Conclusion: LAVH is effective and safe for women with anterior wall adherence after cesarean section.

No MeSH data available.


Related in: MedlinePlus

Actual laparoscopic image of the urinary bladder after introducing carbon dioxide.
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Figure 2: Actual laparoscopic image of the urinary bladder after introducing carbon dioxide.

Mentions: The ovarian ligaments, round ligaments, and broad ligament were cut and dissected after ligating using laparoscopic extracorporeal knot-tying techniques [7]. The laparoscopic procedures included dissecting the broad ligament in front of the uterine artery, opening the bladder flap, and dissecting the bladder peritoneum. If the space between the urinary bladder and the uterine lower segment was unclear while moving towards the uterine cervix, a Foley catheter was used to introduce approximately 150 to 200 mL of normal saline or carbon dioxide (Fig. 2). The remaining vaginal procedures were performed as described for LAVH in our previous report [8]. After hysterectomy, the abdominal cavity was insufflated again with carbon dioxide and laparoscopically washed with normal saline solution. After confirming the ureteral peristalsis and bleeding, a Jackson-Pratt drain drainage tube was inserted through the 5-mm trocar, and the gas was removed.


Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section.

Ko JH, Choi JS, Bae J, Lee WM, Koh AR, Boo H, Lee E, Hong JH - Obstet Gynecol Sci (2015)

Actual laparoscopic image of the urinary bladder after introducing carbon dioxide.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663229&req=5

Figure 2: Actual laparoscopic image of the urinary bladder after introducing carbon dioxide.
Mentions: The ovarian ligaments, round ligaments, and broad ligament were cut and dissected after ligating using laparoscopic extracorporeal knot-tying techniques [7]. The laparoscopic procedures included dissecting the broad ligament in front of the uterine artery, opening the bladder flap, and dissecting the bladder peritoneum. If the space between the urinary bladder and the uterine lower segment was unclear while moving towards the uterine cervix, a Foley catheter was used to introduce approximately 150 to 200 mL of normal saline or carbon dioxide (Fig. 2). The remaining vaginal procedures were performed as described for LAVH in our previous report [8]. After hysterectomy, the abdominal cavity was insufflated again with carbon dioxide and laparoscopically washed with normal saline solution. After confirming the ureteral peristalsis and bleeding, a Jackson-Pratt drain drainage tube was inserted through the 5-mm trocar, and the gas was removed.

Bottom Line: We compared the demographic, clinical characteristics, and surgical outcomes of two groups.There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups.LAVH is effective and safe for women with anterior wall adherence after cesarean section.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kangwon National University School of Medicine, Chuncheon, Korea.

ABSTRACT

Objective: To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section.

Methods: We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups.

Results: The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group.

Conclusion: LAVH is effective and safe for women with anterior wall adherence after cesarean section.

No MeSH data available.


Related in: MedlinePlus