Abstract
Objective To evaluate surgery-related outcomes of laparoscopic (LH) and vaginal hysterectomy (VH) in patients with a history of previous cesarean section (CS). Study design Data on 289 consecutive patients with a history of CS undergoing VH (n = 49, 17%) and LH (n = 219, 76%) were collected. Basic descriptive statistics, univariate and multivariate analyses were performed to evaluate surgery-related outcomes. A propensity-matched algorithm was applied in order to reduce allocation biases between groups. Results Patients undergoing LH were more likely to have a history of multiple cesarean sections (44% vs. 18%; p = 0.001). Additionally, uterine weight was greater among patients undergoing LH than VH (median weight: 235 (range, 45-2830) vs. 150 (range, 40-710) g; p <0.001). Three patients in each group experienced procedural bladder injuries (3/219 (1%) vs. 3/49 (6%); p = 0.07; RR: 1.65; 95%CI: 0.74, 3.68). The rate of grade 3 or worse postoperative complications was balanced between LH and VH (1% vs. 0%; p = 1.00). Patients undergoing LH experienced a shorter length of hospital stay in comparison to patients undergoing VH (1 vs. 2 days; p = 0.02). Considering the overall population, we observed via multivariate analysis that age (OR: 1.003 (95%CI: 1.001, 1.004) per 10-year increase in age; p = 0.002), VH (OR: 17.80 (95%CI: 1.762, 180,378); p = 0.01) and number of cesarean sections ≥ 2 (OR: 27.70 (95%CI: 1.976, 388,285); p = 0.01) increased the risk of developing bladder injuries during hysterectomy. Conclusions LH is a safe and feasible procedure in patients with previous CS, and it is associated with a low bladder injury rate.
| Original language | English |
|---|---|
| Pages (from-to) | 53-57 |
| Number of pages | 5 |
| Journal | European Journal of Obstetrics and Gynecology and Reproductive Biology |
| Volume | 184 |
| DOIs | |
| Publication status | Published - Jan 1 2015 |
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Keywords
- Bladder injury
- Cesarean section
- Laparoscopic hysterectomy
- Laparoscopy
- Vaginal hysterectomy
ASJC Scopus subject areas
- Obstetrics and Gynaecology
- Reproductive Medicine
- Medicine(all)
Cite this
Hysterectomy in patients with previous cesarean section : Comparison between laparoscopic and vaginal approaches. / Bogani, Giorgio; Cromi, Antonella; Serati, Maurizio; Di Naro, Edoardo; Casarin, Jvan; Marconi, Nicola; Pinelli, Ciro; Ghezzi, Fabio.
In: European Journal of Obstetrics and Gynecology and Reproductive Biology, Vol. 184, 01.01.2015, p. 53-57.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Hysterectomy in patients with previous cesarean section
T2 - Comparison between laparoscopic and vaginal approaches
AU - Bogani, Giorgio
AU - Cromi, Antonella
AU - Serati, Maurizio
AU - Di Naro, Edoardo
AU - Casarin, Jvan
AU - Marconi, Nicola
AU - Pinelli, Ciro
AU - Ghezzi, Fabio
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Objective To evaluate surgery-related outcomes of laparoscopic (LH) and vaginal hysterectomy (VH) in patients with a history of previous cesarean section (CS). Study design Data on 289 consecutive patients with a history of CS undergoing VH (n = 49, 17%) and LH (n = 219, 76%) were collected. Basic descriptive statistics, univariate and multivariate analyses were performed to evaluate surgery-related outcomes. A propensity-matched algorithm was applied in order to reduce allocation biases between groups. Results Patients undergoing LH were more likely to have a history of multiple cesarean sections (44% vs. 18%; p = 0.001). Additionally, uterine weight was greater among patients undergoing LH than VH (median weight: 235 (range, 45-2830) vs. 150 (range, 40-710) g; p <0.001). Three patients in each group experienced procedural bladder injuries (3/219 (1%) vs. 3/49 (6%); p = 0.07; RR: 1.65; 95%CI: 0.74, 3.68). The rate of grade 3 or worse postoperative complications was balanced between LH and VH (1% vs. 0%; p = 1.00). Patients undergoing LH experienced a shorter length of hospital stay in comparison to patients undergoing VH (1 vs. 2 days; p = 0.02). Considering the overall population, we observed via multivariate analysis that age (OR: 1.003 (95%CI: 1.001, 1.004) per 10-year increase in age; p = 0.002), VH (OR: 17.80 (95%CI: 1.762, 180,378); p = 0.01) and number of cesarean sections ≥ 2 (OR: 27.70 (95%CI: 1.976, 388,285); p = 0.01) increased the risk of developing bladder injuries during hysterectomy. Conclusions LH is a safe and feasible procedure in patients with previous CS, and it is associated with a low bladder injury rate.
AB - Objective To evaluate surgery-related outcomes of laparoscopic (LH) and vaginal hysterectomy (VH) in patients with a history of previous cesarean section (CS). Study design Data on 289 consecutive patients with a history of CS undergoing VH (n = 49, 17%) and LH (n = 219, 76%) were collected. Basic descriptive statistics, univariate and multivariate analyses were performed to evaluate surgery-related outcomes. A propensity-matched algorithm was applied in order to reduce allocation biases between groups. Results Patients undergoing LH were more likely to have a history of multiple cesarean sections (44% vs. 18%; p = 0.001). Additionally, uterine weight was greater among patients undergoing LH than VH (median weight: 235 (range, 45-2830) vs. 150 (range, 40-710) g; p <0.001). Three patients in each group experienced procedural bladder injuries (3/219 (1%) vs. 3/49 (6%); p = 0.07; RR: 1.65; 95%CI: 0.74, 3.68). The rate of grade 3 or worse postoperative complications was balanced between LH and VH (1% vs. 0%; p = 1.00). Patients undergoing LH experienced a shorter length of hospital stay in comparison to patients undergoing VH (1 vs. 2 days; p = 0.02). Considering the overall population, we observed via multivariate analysis that age (OR: 1.003 (95%CI: 1.001, 1.004) per 10-year increase in age; p = 0.002), VH (OR: 17.80 (95%CI: 1.762, 180,378); p = 0.01) and number of cesarean sections ≥ 2 (OR: 27.70 (95%CI: 1.976, 388,285); p = 0.01) increased the risk of developing bladder injuries during hysterectomy. Conclusions LH is a safe and feasible procedure in patients with previous CS, and it is associated with a low bladder injury rate.
KW - Bladder injury
KW - Cesarean section
KW - Laparoscopic hysterectomy
KW - Laparoscopy
KW - Vaginal hysterectomy
UR - http://www.scopus.com/inward/record.url?scp=84920585640&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84920585640&partnerID=8YFLogxK
U2 - 10.1016/j.ejogrb.2014.11.005
DO - 10.1016/j.ejogrb.2014.11.005
M3 - Article
VL - 184
SP - 53
EP - 57
JO - European Journal of Obstetrics, Gynecology and Reproductive Biology
JF - European Journal of Obstetrics, Gynecology and Reproductive Biology
SN - 0028-2243
ER -