Hysterectomy in patients with previous cesarean section

Comparison between laparoscopic and vaginal approaches

Giorgio Bogani, Antonella Cromi, Maurizio Serati, Edoardo Di Naro, Jvan Casarin, Nicola Marconi, Ciro Pinelli, Fabio Ghezzi

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 languageEnglish
Pages (from-to)53-57
Number of pages5
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume184
DOIs
Publication statusPublished - Jan 1 2015

Fingerprint

Hysterectomy
Vaginal Hysterectomy
Cesarean Section
Urinary Bladder
Length of Stay
Wounds and Injuries
Multivariate Analysis
Weights and Measures
Population

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 journalArticle

Bogani, Giorgio ; Cromi, Antonella ; Serati, Maurizio ; Di Naro, Edoardo ; Casarin, Jvan ; Marconi, Nicola ; Pinelli, Ciro ; Ghezzi, Fabio. / Hysterectomy in patients with previous cesarean section : Comparison between laparoscopic and vaginal approaches. In: European Journal of Obstetrics and Gynecology and Reproductive Biology. 2015 ; Vol. 184. pp. 53-57.
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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.",
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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

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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

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