Bleeding associated with vaginal hysterectomy

The increased use of blood transfusion, ultrasound evidence of postsurgical haematoma, the frequency of postoperative febrile morbidity of unknown cause and reports of these complications in large series which contain both abdominal and vaginal hysterectomy over the last 25 years, suggests that bleeding may be more common after vaginal hysterectomy. We performed laparoscopy routinely after vaginal hysterectomy in 50 patients. The frequency of bleeding was 48%, consistent with other studies ranging from 30 to 98%. Arterial bleeding from a branch of the uterine or vaginal artery occurred in 20%. The frequency of bleeding was not related to uterine size, ranging from normal to that equivalent in size to that of a pregnancy of 18 weeks' gestation. The most common site of bleeding was the vaginal vault. Liberal definitions of haemorrhage, possible emphasis in speed in performing hysterectomy, and difficulty in visualizing and ligating major and minor blood vessels, may have contributed to the increased frequency of bleeding reported after vaginal hysterectomy. Haemostasis is more easily obtained at laparoscopic surgery because of magnification, close inspection, routine use of suction irrigation and bipolar electrocoagulation. Routine laparoscopy at the completion of vaginal hysterectomy is recommended. New and improved methods of vessel closure are also required. Attitudes to haemorrhage during hysterectomy require change to further reduce the use of blood transfusion.