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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

Magnetic resonance image of the abdomen and pelvis showing the anterior wall adherence.
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Figure 3: Magnetic resonance image of the abdomen and pelvis showing the anterior wall adherence.

Mentions: Anterior wall adherence can be diagnosed through imaging studies, such as ultrasonography or magnetic resonance imaging performed before surgery. Women with a history of prior cesarean section might be suspected to have anterior wall adherence when there is a wide horn-shaped uterus peaking from the uterine fundus to the anterior abdominal wall (uterine peaking sign) or if the uterus appears to protrude into the abdominal wall through a gap between the uterus and rectus abdominis muscles when observed using pelvic sonography [131415]. It can also be diagnosed when the anterior wall of the uterus adheres to the anterior abdominal wall with evidence of obliteration of the fat plane, or when the uterine cervix is elongated facing the upper third of the posterior vaginal wall and located posterior to the bladder on magnetic resonance imaging (Fig. 3).


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)

Magnetic resonance image of the abdomen and pelvis showing the anterior wall adherence.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Magnetic resonance image of the abdomen and pelvis showing the anterior wall adherence.
Mentions: Anterior wall adherence can be diagnosed through imaging studies, such as ultrasonography or magnetic resonance imaging performed before surgery. Women with a history of prior cesarean section might be suspected to have anterior wall adherence when there is a wide horn-shaped uterus peaking from the uterine fundus to the anterior abdominal wall (uterine peaking sign) or if the uterus appears to protrude into the abdominal wall through a gap between the uterus and rectus abdominis muscles when observed using pelvic sonography [131415]. It can also be diagnosed when the anterior wall of the uterus adheres to the anterior abdominal wall with evidence of obliteration of the fat plane, or when the uterine cervix is elongated facing the upper third of the posterior vaginal wall and located posterior to the bladder on magnetic resonance imaging (Fig. 3).

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