Does prior cesarean section increase the risk of periumbilical adhesions in total laparoscopic hysterectomy?

Periumbilical adhesions may complicate laparoscopic entry and increase the risk of intraoperative injury, yet the isolated effect of prior cesarean section (CS) remains unclear.

We aimed to evaluate the association between a history of CS and periumbilical adhesions in total laparoscopic hysterectomy, and assess the value of the visceral slide.

A total of 100 patients undergoing total laparoscopic hysterectomy were enrolled and divided into 2 groups: individuals with a history of CS and those with no prior abdominal surgeries. Preoperative visceral slide and intraoperative adhesion assessment were performed. Perioperative outcomes were recorded and a multivariable analysis was conducted.

Adhesions were more frequent in the CS group (22% vs 10%; P = 0.06) than the individuals without a history of abdominal surgery. A history of CS was not an independent predictor of adhesions (odds ratio, 0.468; P = 0.23). No major entry-related complications occurred. Perioperative outcomes were similar between the groups. The visceral slide showed low sensitivity (25%) but high specificity (100%).

A history of CS alone does not significantly increase periumbilical adhesions or compromise entry safety in total laparoscopic hysterectomy. Routine modification of the entry strategy may not be necessary. The visceral slide is useful for confirming adhesions, but does not exclude them.