Obstet Gynecol Sci.  2015 Nov;58(6):501-506. 10.5468/ogs.2015.58.6.501.

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

• KMID: 2314067
• DOI: http://doi.org/10.5468/ogs.2015.58.6.501

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.

Keyword

Anterior wall adherence; Cesarean section; Hysterectomy; Laparoscopy

MeSH Terms

Body Mass Index
Cesarean Section*
Female
Humans
Hysterectomy
Hysterectomy, Vaginal*
Lacerations
Laparoscopy
Length of Stay
Parity
Pregnancy
Retrospective Studies
Urinary Bladder

Figure

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  Fig. 1 Actual laparoscopic image of the anterior wall adherence.

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

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

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