Effect of adhesions on laparoscopically-assisted vaginal hysterectomy outcome: a 10-year retrospective, comparative study of 1683 consecutive cases.

introductionHysterectomy is a frequently employed treatment modality in gynaecological diseases. In the context of various approaches to vaginal hysterectomy, laparoscopically-assisted vaginal hysterectomy (LAVH) could eventually improve the safety in cases where patients without genital prolapse present with preoperative peritoneal adhesions. The present analysis examined intraoperative and immediate postoperative adhesions-related outcomes.

methodsMonocentric, comparative, retrospective study of a single cohort of women without genital prolapse who underwent LAVH for benign gynaecological conditions between January 2010 and December 2019. Patients without peritoneal adhesions were compared with patients with adhesions, as diagnosed at the beginning of the procedure. Mann-Whitney-U test was used for the comparative analysis.

resultsAmong 1,638 patients, 562 patients (34.3%) had preoperative adhesions. Main indications were for myoma (71%) and adenomyosis (14.9%). The mean operation time in the adhesion group was significantly longer than in the no-adhesion group (106 ± 44 min vs. 90 ± 35 min; p < 0.001). Adhesiolysis was required in 88% within the adhesion group (n = 495). No significant differences were observed regarding mean estimated intraoperative blood loss (87 ± 100 ml vs. 90 ± 95 ml; p = 0, 418), uterine weight (220 ± 227 g vs. 230 ± 203 g; p = 0, 38), or morcellation (52% vs. 55.8%; p = 0, 142). Most patients in both groups did not experience complications (95% vs. 97.2%). Laparoconversion due to technical difficulties in performing the endocopic surgery or due to the presence of adhesions was rarely needed (1.6% vs. 0.6%). The intraoperative complication rate was low but significantly different in both groups (2% vs. 0.7%; p = 0.02), including bowel injuries (n = 6 vs. n = 3) and urinary bladder injuries (n = 4 vs. n = 5). %), which were diagnosed immediately and treated successfully. The postoperative complication rate was similar in both groups (3.4% vs. 2.1%; p = 0.138), mainly urinary tract infection. All adverse events were treated successfully; second laparoscopic surgery was conducted in five patients with adhesions and in nine patients without adhesions for haematoma removal.

conclusionLAVH could be considered a safe and feasible surgical approach for women without genital prolapse who have preoperative peritoneal adhesions and require vaginal hysterectomy for benign gynaecological conditions. This approach facilitates the localisation and treatment of adhesions at the commencement of surgery, as well as the control of possible injuries that may arise during the procedure, and is associated with a low complication rate.