Total laparoscopic hysterectomy versus vaginal hysterectomy: a prospective randomized trial

AIM: The aim of the study was to compare the effects of total laparoscopic hysterectomy with those of vaginal hysterectomy. METHODS: We conducted a prospective randomised trial on 400 patients who agreed to be randomized to either laparoscopic total hysterectomy or vaginal hysterectomy. They were monitored for one year to evaluate the rate of major complications and the results on quality of life. RESULTS: Total laparoscopic hysterectomy was associated with a higher rate of major haemorrhages and ureteric injuries than vaginal hysterectomy (7% vs 2.5% and 2.5% vs 0%; P<0.05) only during the first year of study according to a normal learning-curve. It took longer to perform (85.9 min vs 46.6 min), but was less painful (visual analogue scale 5.3 vs 6.0; P<0.01) and there was a shorter stay in hospital after the operation (2.9 vs 3.3 days). Six weeks after the operation, total laparoscopic hysterectomy was associated with less pain and better quality of life than vaginal hysterectomy (SF-12). CONCLUSION: Total laparoscopic hysterectomy was associated with a significantly higher rate of major haemorrhages and ureteric injuries than vaginal hysterectomy only during the first year of study according to a normal learning-curve. It took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life.     

Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial

STUDY OBJECTIVE: Minimally invasive surgery aims to achieve at least a similar clinical effectiveness with a quicker recovery than traditional open techniques. Although there have been numerous randomized clinical trials comparing laparoscopic hysterectomy with hysterectomy by laparotomy, only a few studies have compared quality of life after different types of hysterectomy. None of these studies evaluated total laparoscopic hysterectomy. In this paper, we report on a randomized comparison of quality of life after total laparoscopic versus total abdominal hysterectomy. DESIGN: Randomized, controlled trial (Canadian Task Force classification I). SETTING: Single-center teaching hospital in The Netherlands. PATIENTS: Patients scheduled for hysterectomy for a benign condition, in whom a vaginal hysterectomy was not possible and laparoscopic hysterectomy was feasible (mobile uterus not exceeding the size of 18 weeks' gestation). INTERVENTIONS: Abdominal versus laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: Patients completed the Dutch version RAND-36 health survey preoperatively as well as at 5 time points in the first 12 weeks after surgery. The primary outcome of the study was quality of life as measured by the RAND-36. A linear mixed model was used for statistical analysis while accounting for baseline values. Secondary outcomes were hospital stay and complications. There were 88 patients eligible, of whom 59 gave consent for randomization. Twenty-seven women were allocated to the laparoscopic arm and 32 to the abdominal arm. We found a significant treatment effect favoring laparoscopic hysterectomy in the RAND-36 scale for vitality. Laparoscopic hysterectomy performed better on all other scales of the RAND-36, but these differences were not statistically significant. CONCLUSIONS: Laparoscopic hysterectomy results in more postoperative vitality when compared with abdominal hysterectomy. For this reason, all women with a benign condition requiring abdominal hysterectomy, in whom the laparoscopic approach is feasible, should have the chance to choose laparoscopic hysterectomy.     

Tubal prolapse after total laparoscopic hysterectomy

Prolapse of a uterine tube is a rare event after hysterectomy with adnexal conservation. It has been described in the literature after abdominal or vaginal hysterectomy. We report two cases occurring after total laparoscopic hysterectomy. Both patients presented with pelvic pain and vaginal discharge. The diagnosis was clinically suspected and was investigated using transvaginal ultrasonography. The diagnosis may be helped by histopathology. The diagnosis was confirmed by laparoscopy, and both patients were managed laparoscopically without complications.     

Prospective comparison of tissue trauma after laparoscopic hysterectomy types with retroperitoneal lateral transsection of uterine vessels using ligasure and abdominal hysterectomy

Objective The aim of this study was to evaluate the level of tissue trauma after laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels using ligasure as compared with abdominal hysterectomy. Study design A total of 45 women with various indications for hysterectomy were randomized into laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy. Laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels was performed by four-puncture laparoscopy and pre-, postoperative and postoperative 24th hour levels of interleukin-6 (IL-6) and C-reactive protein (CRP), the mean operative time, drop in hemoglobin concentration, weight of removed uterus, VAS scores, hospitalization period and major and minor operative complications were analyzed prospectively. Results CRP and IL-6 levels were significantly higher in the abdominal hysterectomy group compared to either laparoscopy groups at the postoperative 24th hour. There were no significant differences in the levels of CRP and IL-6 between the two laparoscopy groups. The longest operative times were observed in the total laparoscopic hysterectomy group. Conclusion Laparoscopic surgery causes less tissue trauma than the conventional open surgery; however, we observed no difference between the laparoscopic hysterectomy groups concerning the postoperative inflammatory response. We may prefer laparoscopic hysterectomy instead of total laparoscopic hysterectomy under suitable conditions, since laparoscopic hysterectomy causes the same level of tissue trauma as total laparoscopic hysterectomy, but has the advantage of a significantly shorter operative time. Meanwhile, hysterectomy done by laparoscopy with retroperitoneal lateral transsection of uterine vessels using ligasure is an effective and safe procedure.     

A randomized study of total abdominal, vaginal and laparoscopic hysterectomy.

OBJECTIVES: To evaluate operative time, blood loss and inflammatory response in patients submitted to hysterectomy. METHODS: Sixty patients referred for hysterectomy were prospectively randomized to total abdominal hysterectomy (n=20), vaginal hysterectomy (n=20), or laparoscopic hysterectomy (n=20). The operative time, blood loss (variation in erythrocyte and hemoglobin) and inflammatory answer (CRP and interleukin-6 dosages) were compared by using Kruskal-Wallis, Dunn non-parametric test and variance analysis with repeated measurements. RESULTS: Operative time was shorter for vaginal hysterectomy, and there was no significant difference between total abdominal hysterectomy and laparoscopic hysterectomy. Reduction in erythrocyte and hemoglobin was more noticeable after vaginal hysterectomy, followed by total abdominal hysterectomy and laparoscopic hysterectomy. CRP levels increased steadily from vaginal hysterectomy to laparoscopic hysterectomy and then to total abdominal hysterectomy. The increase in interleukin-6 was substantially higher in total abdominal hysterectomy, whereas no difference was noted between vaginal and laparoscopic hysterectomy. CONCLUSIONS: Vaginal hysterectomy presents superior results in terms of operative time and inflammatory response when compared with total abdominal and laparoscopic hysterectomy and it should be the first option for hysterectomy. Laparoscopic hysterectomy should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.     

Fallopian tube prolapse after laparoscopic resection of pelvic endometriosis

BACKGROUND: Fallopian tube prolapse is an unusual but often reported complication after hysterectomy. This problem has not yet been reported in a patient undergoing laparoscopy but not hysterectomy. CASE: Fallopian tube prolapse was diagnosed in a patient after laparoscopic excision of pelvic endometriosis, without hysterectomy. The prolapsed fallopian tube was preserved by laparoscopic retrieval from the vagina and closure of the vaginoperitoneal fistula. CONCLUSION: Laparoscopic surgery, when associated with the creation of a vaginoperitoneal fistula, is a risk factor for fallopian tube prolapse. This problem can be diagnosed and safely managed with a laparoscopic approach.     

A review of total laparoscopic hysterectomy: role, techniques and complications

PURPOSE OF REVIEW: The following review examines the current role of total laparoscopic hysterectomy, which is a hysterectomy completed entirely laparoscopically. Recent advances in equipment, surgical techniques and training have made total laparoscopic hysterectomy a well tolerated and efficient technique. It is increasingly being adopted around the world because of the benefits to patients and surgeons. This study discusses the role of total laparoscopic hysterectomy, provides some technical suggestions about how to perform a total laparoscopic hysterectomy and how to avoid possible complications. RECENT FINDINGS: Only a few surgeons performing total laparoscopic hysterectomy have published their techniques and results. The terminology and techniques for total laparoscopic hysterectomy used by different surgeons, such as energy sources, the use of uterine manipulators, vaginal tubes, the method for uterine artery ligation and method of vault closure, vary. This makes objective comparison of the literature, techniques and complication rates difficult. SUMMARY: As more surgeons become trained in advanced laparoscopic surgery, the role of total laparoscopic hysterectomy will increasingly take over indications for total abdominal hysterectomy. It remains important that surgeons share their experience and publish their techniques, results and complications. Advanced laparoscopic training and supervision are paramount before embarking on total laparoscopic hysterectomy, so that complications are minimized.     

Endometrial stromal sarcoma diagnosed after uterine morcellation in laparoscopic supracervical hysterectomy

Endometrial stromal sarcoma is a rare uterine cancer with no reliable method for preoperative diagnosis. A 30-year-old parous woman underwent laparoscopic supracervical hysterectomy because of a leiomyoma. The uterus was removed from the abdominal cavity with an electric morcellator with a spinning blade. The pathology report revealed low-grade endometrial stromal sarcoma. Two months after the initial surgery, a second laparoscopic procedure was performed. The final pathology report confirmed low-grade endometrial stromal sarcoma involving the ovary, fallopian tube, and ovarian artery. It was concluded that morcellation of leiomyomas at laparoscopic supracervical hysterectomy may potentially increase metastasis if the tumor is a sarcoma.     

Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review

The objective of this study was to investigate the randomized studies reporting on quality of life after laparoscopic hysterectomy as compared to abdominal hysterectomy. A systematic qualitative review was performed on published studies identified by the databases PubMed and EMBASE, as well as cross-references. Randomized clinical trials on laparoscopic versus abdominal hysterectomy were assessed for the methods in which studies reported on postoperative health or quality of life as an outcome measure. Study results were described qualitatively. Thirty papers, published between 1994 and 2004, were identified. Only seven studies, incorporating data on 1450 patients, reported on postoperative health or quality of life. Four of these studies used eight different validated quality of life questionnaires. Two of these four studies reported significant differences between the treatment groups, with better quality of life in the first 6 weeks after laparoscopic hysterectomy when compared to the abdominal approach. Although, the main reason for performing a laparoscopic hysterectomy instead of an abdominal hysterectomy is the improvement of quality of life, only a few studies have used this as an outcome measure. The data available show that laparoscopic hysterectomy performs equally or better in terms of postoperative health and quality of life in the first weeks after surgery. In the decision for an approach to hysterectomy, the advantage of better quality of life should be offset against the increased risk of complications in laparoscopic hysterectomy.     

Adnexal torsion after laparoscopic hysterectomy: description of seven cases

STUDY OBJECTIVE: To discover the prevalence of adnexal torsion after laparoscopic hysterectomy. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: A tertiary referral hospital. PATIENTS: One thousand thirty-three women underwent laparoscopic hysterectomies between the years 1995 and 2002. The mean age (+/- SD) of the women at the time of hysterectomy was 43.87 +/- 4.28 years. Intervention. Laparoscopic hysterectomy in which at least one adnexa was left intact. MEASUREMENTS AND MAIN RESULTS: The files of all women with adnexal torsion diagnosed by laparoscopy from 1995 to 2003 were retrospectively reviewed. In seven women, adnexal torsion occurred after laparoscopic hysterectomy. Torsion occurred 2.64 (+/- 1.79) years (mean +/- SD) after hysterectomy. Torsion was treated by laparoscopy in all of the women; either oophorectomy or detorsion and ovariopexy was performed. We calculated the prevalence of this complication to be 7.91/1000. CONCLUSION: Adnexal torsion can occur after laparoscopic hysterectomy.     

Vaginal evisceration after hysterectomy: a literature review

The purpose of this review is to highlight the risk factors, clinical presentation, and different surgical management options for vaginal evisceration after vaginal, abdominal, or laparoscopic hysterectomy. We identified all reports of vaginal evisceration after these procedures using sources in the literature from 1900 to the present. We found that a total of 59 patients were reported, 37 (63%) had a prior vaginal hysterectomy, 19 (32%) had a prior abdominal hysterectomy (2 of which were radical hysterectomy), and 3 (5%) had a prior laparoscopic hysterectomy. The majority of these patients were postmenopausal women. Also, the precipitating event was most often sexual intercourse in premenopausal patients and increased intra-abdominal pressure in postmenopausal patients. In addition, the small bowel was the most common organ to eviscerate. Most of the patients presented with vaginal bleeding, pelvic pain, or a protruding mass. We conclude that vaginal evisceration after hysterectomy remains a rare event. It is more often seen after vaginal hysterectomy than after other types of hysterectomy. It can also occur spontaneously or following trauma or vaginal instrumentation, or any event that increases intra-abdominal pressure. Vaginal evisceration represents a surgical emergency, and the approach to therapy for it may be abdominal, vaginal or a combination of the two.     

Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study

OBJECTIVE: To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. DESIGN: A prospective, open, randomised multicentre trial. SETTING: Five hospitals in the South East of Sweden. POPULATION: Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy. METHODS: Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively. MAIN OUTCOME MEASURES: Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time. RESULTS: No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group. CONCLUSIONS: General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.     

Respective consequences of abdominal, vaginal, and laparoscopic hysterectomies on women's sexuality

OBJECTIVE: To determine the relative effects of abdominal, vaginal or laparoscopic approaches for hysterectomy on female sexuality. STUDY DESIGN: One hundred and seventy women who underwent abdominal (n=68), vaginal (n=67), and laparoscopic (n=35) hysterectomy for benign disease were studied. Pre- and postoperative sexuality was assessed by questionnaire. RESULTS: Overall, sexuality after hysterectomy remained unchanged in 60.4% of cases, and improved or deteriorated in 21.3 and 18.3%, respectively. Postoperative delay in resuming sexual activity was shorter after vaginal (45.2+/-6.7 days) hysterectomy than after abdominal hysterectomy (62.4+/-9.3 days). Deterioration of sexual function occurred more frequently after abdominal hysterectomy (24%) than after vaginal (13.5%) or laparoscopic (8.5%) hysterectomy. CONCLUSION: These results indicate that the impact of vaginal and laparoscopic hysterectomy on women's sexuality may be milder than that of abdominal hysterectomy.     

Vaginal Vault Dehiscence after Hysterectomy

Study ObjectiveThe purpose of our study was to evaluate factors predisposing vault dehiscence after hysterectomy and its manifestation.DesignCase series and review of the literature (Canadian Task Force classification II-3).SettingMulticenter study.PatientsRetrospective analysis of 16 unpublished cases of vaginal vault dehiscence after total laparoscopic hysterectomy from physicians who participated in the exchange on the topic of vaginal vault dehiscence at the American Association of Gynecologic Laparoscopists Endo Exchange List (group A) and review of 38 reported cases in the literature (group B).InterventionsThe participating physicians were asked to complete a detailed questionnaire related to vault dehiscence. In addition, we performed literature search using the keywords “vault dehiscence,” “vaginal vault dehiscence,” “vault prolapse,” and “hysterectomy,” and conducted the search in MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews.Measurements and Main ResultsWe estimated risk factors and characteristic features for vaginal vault dehiscence. The incidence of vault dehiscence was higher after laparoscopic hysterectomy (1.14%) than after abdominal hysterectomy (0.10%, p <.0001, OR 11.5) and after vaginal hysterectomy (0.14%, p <.001, OR 8.3). The time interval between hysterectomy and occurrence of vault dehiscence in the laparoscopic group (8.4 ± 1.2 weeks) was significantly shorter than in the abdominal hysterectomy (112.7 ± 75.1 weeks, p = .01) and in vaginal hysterectomy (136.5 ± 32.2 weeks, p <.0001) groups, respectively. It appears that sexual intercourse was the main triggering event for vault dehiscence (58.8%). Vaginal bleeding (50%) and vaginal evisceration (48.1%) were the main symptoms.ConclusionOur data suggest that vaginal vault dehiscence is rare but may occur more often after laparoscopic hysterectomy than after other hysterectomy approaches. Whether it is related to the technique of laparoscopic suturing is unclear. Other risk factors such as early resumption of regular activities and sexual intercourse may play a role.     

Total laparoscopic hysterectomy versus total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial carcinoma: a randomised controlled trial with 5-year follow-up

This report is on recovery and long-term outcomes in a small-scale randomised controlled trial (RCT) after total laparoscopic hysterectomy versus total abdominal hysterectomy in (potential) endometrial carcinoma patients. An RCT was performed among women with atypical endometrial hyperplasia and endometrial carcinoma scheduled for hysterectomy in a teaching hospital in The Netherlands. Women were randomised to total laparoscopic hysterectomy versus total abdominal hysterectomy both with bilateral salpingo-oophorectomy and were followed until 5 years after the intervention. Patients completed the RAND 36-Item Short Form Health Survey (RAND-36), Quality of Recovery-40 (QoR-40) and Recovery Index-10 (RI-10) until 12 weeks after surgery. Main outcome measure was quality of life and recovery in the first 12 weeks after surgery. A linear mixed model was used for statistical analysis while accounting for baseline values where applicable. Seventeen women were included, of whom 11 allocated to the laparoscopic arm and 6 to the abdominal arm. Laparoscopic hysterectomy performed better on all scales and subscales used in the study. A statistically significant treatment effect, favouring laparoscopic hysterectomy, was found in the total RAND-36 (difference between groups 142 units, 95% confidence interval 46; 236). Clinical follow-up was completed after median 60 months, but this study was too small for conclusions regarding the safety and survival. Laparoscopic hysterectomy results in better postoperative quality of life in the first 12 weeks after surgery when compared with abdominal hysterectomy.     

More With LESS: A Novel Report of Nerve Sparing Radical Hysterectomy Performed Using LESS

Laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery are now being used in gynecologic oncologic procedures. We used our expertise with LESS to perform nerve-sparing laparoscopic radical hysterectomy. A 45-year-old woman with stage IA2 cervical cancer was referred to us. The biopsy specimen showed grade II invasive keratinizing squamous cell carcinoma. We duplicated the steps of our laparoscopic nerve-sparing radical hysterectomy procedure to perform a nerve-sparing radical hysterectomy via LESS using conventional ports and instruments. Oncologic clearance was comparable to that in conventional laparoscopic radical hysterectomy. Bladder function recovered completely after removal of the Foley catheter. Nerve-sparing laparoscopic radical hysterectomy using fewer ports is technically feasible. The oncologic clearance and functional results are comparable to those in the multiport variant.     

A randomised prospective trial comparing laparoscopic and abdominal hysterectomy

Objective To compare short term clinical results in a prospective randomised trial of laparoscopic hysterectomy compared with abdominal hysterectomy.
Methods One hundred and forty-three women scheduled for total abdominal hysterectomy, with or without salpingo-oophorectomy and with a maximum uterine width of less than 11 cm, were prospectively randomised to undergo the procedure by laparoscopic hysterectomy (   n = 71  ) or abdominal hysterectomy (   n = 72  ). During laparoscopic hysterectomy, the uterine arteries as well as the upper portion of the cardinal ligaments were transected laparoscopically. The perioperative and post-operative courses of the groups were compared.
Results The number of women with a complication did not differ significantly between laparoscopic hysterectomy (27%) and abdominal hysterectomy (33 %) groups. The post-operative fall in erythrocyte volume fraction was significantly greater following abdominal hysterectomy (5.6% compared with 4.1 % median value, P 0.001). Post-operative pain, assessed by the patients two days after surgery on a visual analogue scale, was significantly higher following abdominal hysterectomy (4.2 compared with 3.6 units median value,   P < 0.05  ). Although laparoscopic hysterectomy took longer (148 min compared with 85 min median value,   P < 0.001  ), the women undergoing this procedure had a shorter post-operative time in hospital (two compared with four days median value,   P < 0.001  ) and a shorter convalescence (16 compared with 35 days median value,   P < 0.001  ).
Conclusions Laparoscopic hysterectomy is a safe procedure for selected patients scheduled for abdominal hysterectomy, and offers benefits to the patients in the form of less operative bleeding, less post-operative pain, shorter time in hospital and shorter convalescence time.     

Laparoscopic Supracervical Hysterectomy Performed With and Without Excision of the Endocervix: A Randomized Controlled Trial

Study ObjectiveTo compare the occurrence of vaginal bleeding and patient satisfaction 12 months after laparoscopic supracervical hysterectomy performed with and without excision of the endocervix.DesignA prospective, randomized, controlled trial.Design ClassificationCanadian Task Force Classification I.SettingNorwegian university teaching hospital.PatientsOne hundred forty consecutive premenopausal women referred for hysterectomy on the basis of a benign condition.InterventionsThe study participants were randomized to standard laparoscopic supracervical hysterectomy (n = 70) or laparoscopic supracervical hysterectomy with excision of the endocervix in a reverse cone pattern (n = 70).Measurements and Main ResultsThe main outcome measures were the occurrence of vaginal bleeding and patient satisfaction 12 months after the procedure. One hundred thirty women (92.3%) were followed up according to the study protocol. In total, 43 women (33.1%) reported bleeding episodes during the first 12 months after the laparoscopic supracervical hysterectomy; 22 (16.9 %) of these women had cyclic bleeding. All reported bleeding episodes were minimal. Patient satisfaction after the hysterectomy was very high with a mean visual analog score (on a scale of 0–10) of 9.3 (standard deviation = 1.4). There were no significant differences between the 2 treatment groups regarding the main outcomes 12 months after the procedure.ConclusionThe patient satisfaction after laparoscopic supracervical hysterectomy is very high. Episodes of minimal vaginal bleeding after the procedure are relatively common, but such bleeding does not affect patient satisfaction. Removal of the endocervix by reverse conization during laparoscopic supracervical hysterectomy appears to have no effect in terms of reduced bleeding or improved patient satisfaction.     

Pelvic organ function in randomized patients undergoing laparoscopic or abdominal hysterectomy

STUDY OBJECTIVE: To assess the incidence of urinary incontinence, bowel dysfunction, and sexual problems after laparoscopic hysterectomy as compared with abdominal hysterectomy. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: Single-center teaching hospital in the Netherlands, experienced in gynecologic minimal access surgery. PATIENTS: Women with a benign or malignant condition scheduled for hysterectomy where vaginal hysterectomy was not feasible and laparoscopic hysterectomy was possible. INTERVENTIONS: Laparoscopic (n = 38) and abdominal hysterectomy (n = 38). MEASUREMENTS AND MAIN RESULTS: Patients were asked before and 3 months after surgery whether they experienced urinary incontinence and completed the validated questionnaires Urogenital Distress Inventory, Incontinence Impact Questionnaire, Defecatory Distress Inventory, and the Questionnaire for screening Sexual Dysfunctions 1 year after surgery. The incidence of urinary incontinence at 3 months after surgery decreased equally in both groups as compared with baseline. De novo urinary incontinence and sexual problems were rare. One year after surgery, a significant treatment effect favoring laparoscopic hysterectomy was found in the Urogenital Distress Inventory and Incontinence Impact Questionnaire, whereas no differences were found in the Defecatory Distress Inventory and Questionnaire for screening Sexual Dysfunctions. CONCLUSION: Laparoscopic hysterectomy is superior to abdominal hysterectomy with respect to postoperative symptoms of urinary dysfunction.     

Adhesion-related bowel obstruction after hysterectomy for benign conditions

OBJECTIVE: To evaluate the occurrence of small bowel obstruction after hysterectomy. METHODS: Analysis of 326 cases of women who were admitted with a diagnosis of small bowel obstruction during the period 1998-2005. Among cases with small bowel obstruction after hysterectomy for benign conditions, we evaluated the type and technique of hysterectomy and whether the parietal peritoneum was sutured at the completion of the procedure. RESULTS: The main causes of bowel obstruction were intra-abdominal adhesions (41.9%) and abdominal malignancy (40.1%). After excluding oncologic cases, we found that, of 135 cases of adhesion-related small bowel obstruction, gynecologic operations played the largest role in the occurrence of bowel obstruction (n=68, 50.4%). Among all gynecologic operations for benign conditions, total abdominal hysterectomy (TAH) was the most common cause of small bowel obstruction (13.6 per 1,000 TAHs). We did not encounter small bowel obstruction after laparoscopic supracervical hysterectomy. The reduction in absolute risk of small bowel obstruction from TAH to laparoscopic supracervical hysterectomy is 13.6 per 1,000 cases; 73 patients would undergo laparoscopic supracervical hysterectomy to prevent one small bowel obstruction. The median interval between TAH and small bowel obstruction was 4 years. The adhesions were adherent to the previous laparotomy incision in 27 cases (75%) and to the vaginal vault in nine cases (25%). Peritoneal closure was not associated with small bowel obstruction. CONCLUSION: Hysterectomy plays a major role in the occurrence of adhesion-related small bowel obstruction. Closure of the parietal peritoneum does not contribute to the occurrence of adhesion-related small bowel obstruction, and small bowel obstruction rarely occurs after laparoscopic supracervical hysterectomy. LEVEL OF EVIDENCE: II-3.