Donnish Journal of Medicine and Medical Sciences

October 2015 Vol. 2(7), pp. 103-107

Copyright © 2015 Donnish Journals

Original Research Paper

Hysterectomy in Patients with Previous Cesarean Section: Comparison between Laparoscopic and Vaginal Approaches. A Prospective Randomized Controlled Study

Moez Kdous*, Jad Diari, Marwen Braham, Monia Ferchiou and Fethi Zhioua

Center of Reproductive Biology, Department of Gynecology and Obstetrics, Aziza Othmana Hospital, Tunis, University of Tunis El Manar, Tunisia.

Corresponding Author E-mail: kdousmoez@gmail.com

Accepted 7th July, 2015.

Abstract

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Objective: To compare intra- and post-operative data of laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in patients with a history of previous cesarean section (CS). Study Design: A prospective, randomized study was performed at our gynecologic surgery center between January 2010 and January 2014. A total of 120 women with a history of cesarean section, indicated to undergo hysterectomy for benign uterine disease were randomly assigned to 2 groups LH (n=60), and VH (n=60). Results: VH had the shortest operating time (80.75 min ± 28.2 versus 101.2 min ± 24.5; p=0.031). However, mean blood loss was significantly higher when compared with LH (176.2 mL ± 88.5 versus 81.8 mL ± 52.4; p=0.004). Intra- and post-operative complications were balanced between the two groups. Two patients in the VH group and 3 in the LH group experienced procedural bladder injuries (3.3% versus 5%, NS). Post-operative pain on day 0 (VAS: 5.21 ± 3.5 versus 2.63 ± 2.7; p=0.023) and the mean use of analgesics (8.2 U ± 0.62 vs 4.2± 0.41; p=0.012) were higher in the vaginal group (p=0.023 and p=0.017, respectively). LH was associated with a reduced hospital stay (LH: 2.7 ± 0.5 days; VH: 3.2 ± 0.6 days; p<0.001). Conclusion: Both LH and HV are safe and feasible procedures in patients with previous CS. LH is associated with a reduction of blood loss, post-operative pain, and hospital stay. However, HV is associated with a reduced mean surgery time as compared with laparoscopy.

Keywords: Bladder injury, Cesarean section, Laparoscopic hysterectomy, Vaginal hysterectomy, Randomized.

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Cite This Article:

Moez Kdous, Jad Diari, Marwen Braham, Monia Ferchiou and Fethi Zhioua. Hysterectomy in Patients with Previous Cesarean Section: Comparison between Laparoscopic and Vaginal Approaches. A Prospective Randomized Controlled Study. Donnish Journal of Medicine and Medical Sciences 2(7) 2015 pp. 103-107.