Laparoscopic treatment of hemorrhage after vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH)

Background: This study examines the use of laparoscopy for the treatment of secondary hemorrhage following vaginal or laparoscopically assisted vaginal hysterectomies (LAVH). Methods: Over a 5-year period, the incidence and management of postoperative bleeding following vaginal hysterectomies or LAVH were registered prospectively. Results: The overall incidence of hemorrhage after vaginal hysterectomies or LAVH was 1.2% (17 of 1319). Over the 5-year period, it decreased from 2.4% (five of 209) to 0.6% (two of 315). Surgical revision was initiated transvaginally in nine patients and by laparoscopy in eight patients. Five of the eight patients profited from the prompt use of laparoscopy; inconclusive vaginal exploration was followed by laparoscopy in another five patients. Conclusion: Hemorrhage following vaginal hysterectomy or LAVH can be treated by laparoscopy in the majority of patients. Laparoscopy is recommended if the source of bleeding cannot be identified clearly by vaginal examination and/or if an intraabdominal bleeding source is suspected.