Safety of total laparoscopic hysterectomy in patients with prior cesarean section

Patients who have undergone a cesarean section (CS) prior to hysterectomy are at a higher perioperative risk of complications. The purpose of this study was to evaluate the safety of total laparoscopic hysterectomy (TLH) in patients with prior CS.

We enrolled 482 patients treated with TLH. Surgical outcomes including major complications were compared between patients without prior CS (no CS group; n = 324) and patients with prior CS (prior CS group; n = 158). Major complications included vaginal cuff dehiscence, and bowel, bladder, ureter and great vessel injuries.

Major complications, uterus weight, hospital day, unscheduled transfusion and conversion to laparotomy did not differ significantly between groups. One bowel injury occurred in the no CS group. Two vaginal cuff dehiscences and one bladder injury occurred in the prior CS group. There were no ureter or great vessel injuries. Operation duration was longer (P = 0.030) in the prior CS group, but only seven minutes longer than the no CS group. The Foley catheter indwelling day was also significantly longer (P < 0.001) in the prior CS group, but did not last one day. The number of prior CS had no effect on the major complication rate. After treatment of major complications, no long-term sequelae were observed.

TLH in patients with a history of CS can be performed safely as such history had no effect on the major complication rate. Complications were rare and were treated successfully.