[Hysterectomy for benign lesions: peroperative and early postoperative complications]

Although hysterectomy for benign disorders is a routine and usually well-tolerated procedure, complications do occur, and the resulting morbidity rates are not negligible. The aim of this prospective study was to report perioperative and early postoperative complications observed after hysterectomy, regardless of the route or the operator.

Between March 31, 1991 and December 14, 1998, 1,604 patients (mean age: 46.5 +/- 8.1 years) underwent an hysterectomy for benign disorders. Perioperative and early postoperative complications, in the 1,248 vaginal hysterectomies (77.9%), 190 laparoscopically-assisted vaginal hysterectomies (11.9%) and 166 abdominal hysterectomies (10.2%) were noticed in each group and compared.

None of the patients died in this series. Lesions on the urinary tract included 15 bladder injuries (0.9%) and 1 ureter injury (0.06%) without significant difference between routes. There were 9 (0.6%) intestinal injuries, with a significant increase when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 mL: and vaginal hysterectomy caused significantly fewer cases of heavy bleeding (2%, p < 0.001) than either laparotomy (6.7%) or laparoscopy (5.3%). The overall reoperating rate was 0.8% and this does not differ with the type of the procedure.

Peri- and early postoperative complications after hysterectomy for benign disorders are not a rare event. In order to control complications and decrease the morbidity, a high-risk population should be defined based on the patients' history of pelvic surgery and endometriosis, on their parity and the size of their uterus. For these patients, the most appropriate route should be preferred and complications should be assessed using different tests and subsequently treated during the same procedure.