Clinical outcomes of Laparoscopically Assisted Vaginal Hysterectomy at patients who had previous abdominopelvic surgery

Objective: To determine clinical outcomes of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) at patients who had previous abdominopelvic surgery. Design: A clinical observational, prospective, non randomised trial comparing outcomes of 13 patients who had previous abdominopelvic surgery with outcomes of 19 patients who had not surgery. Setting: Adnan Menderes University Faculty of Medicine, Department of Obstetrics and Gynecology. Patients: Thirty-two subjects [average age 51,1 +/- 6,9 (37-66)] who had indication of total abdominal hysterectomy and bilateral salpingooferectomy due to benign pathologies. Interventions: According to ACOG, LAVH was performed by using the Garry technique at the trocar insertions, the Reich technique at the laparoscopic phase and the Heaney technique at the vaginal phase by the same operator. After adhesiolysis and diagnostic procedures, ureters were dissected medially. By coagulating, bilateral round and infundibulopelvic ligaments were cut after the mobilisation of bladder. The operation was completed by the same operation team by vaginal approach consequently. At all operations, 80 W unipolar or 150 W bipolar diathermic dissection and 25-35 W unipolar diathermic cutting were performed. Main outcome measures: Age, parity, menopausal status, preoperative indications, type of previous abdominopelvic surgey and incision, intraoperative indications, adhesion scores, rate of unintended laparotomy, operative time, uterus weight, loss of blood, complications, postoperative pain scores and analgesic requirements, time necessary for returning to normal intestinal function, length of hospitalisation and rate of readmission to hospital. Results: When compared with the patients who had not previous abdominopelvic surgery, all adhesion scores, uterus weight, operative time and the number of total postoperative complications were found significantly high at patients who had previous surgery. Loss of blood, the rate of unintended laparotomy, the number of total intraoperative complications, the length of hospitalisation, postoperative pain scores and analgesic requirements, and the time necessary for returning to normal intestinal functions were not found significantly difference between the two groups. Conclusions: LAVH is an operation adding the superiority of vaginal hysterectomy to the advantages of abdominal hysterectomy. By carrying the superiority of laparoscopy over laparotomy, it could be performed by an acceptable complication rate depending of increasing experience and technical opportunities.