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Vaginal, laparoscopic, or abdominal hysterectomies for benign disorders: immediate and early postoperative
M Cosson1, E Lambaudie, M Boukerrou
1Hopital Jeanne de Flandre, CHRU de Lille, Place de Verdun, 59000 Lille, France. argomc@aol.com
Objective:
hysterectomy for benign disorders is usually well tolerated, but complications do occur. The aim of this retrospective study is to document such complications.
Patients And Methods:
between March 1991 and December 1998, 1604 patients (mean age: 46 years) underwent hysterectomy for benign disorders. Peroperative and early postoperative complications were recorded for the 1248 vaginal hysterectomies (8%), 190 laparoscopically assisted vaginal hysterectomies (12%), and 166 abdominal hysterectomies (10%).
Results:
none of the patients died. There were 15 bladder (0.9%) and one ureter injury (0.06%) with no significant difference between routes. Intestinal injuries (0.6%) overall were more common when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 ml. The rates were vaginal hysterectomy (2%, P<0.001), laparotomy (6.7%), and laparoscopy (5.3%). The overall reoperation rate of 0.8% does not differ with the type of the procedure.
Conclusion:
Per and early postoperative complications after hysterectomy remain important and patients should be aware of them. 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.