Total Laparoscopic Hysterectomy in Women with Previous Cesarean Section: An Observational Study

Abstract

Background: Cesarean sections (CS) and hysterectomies are common gynecological surgeries, with CS rates increasing recently. Patients undergoing hysterectomy with a history of CS face higher risks, such as blood loss and urologic injuries, due to pelvic adhesions, which occur in 30%-90% of those with prior laparotomies. The choice of hysterectomy method is crucial, with options including abdominal, vaginal, laparoscopic, and robotic approaches. Laparoscopic hysterectomy, particularly total laparoscopic hysterectomy (TLH), offers benefits like reduced blood loss and faster recovery, though it remains challenging in patients with prior CS. Aim of the study: The study aims to evaluate how previous cesarean deliveries affect the outcomes of total laparoscopic hysterectomy (TLH). Methods: This cross-sectional observational study involved 110 patients undergoing total laparoscopic hysterectomy (TLH) at in the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and in two private Hospitals Dhaka, Bangladesh, from February 2019 to January 2023. Following ethical approval. Patients were divided into two groups: Group A (55 patients) had a previous cesarean section, and Group B (55 patients) did not. Inclusion criteria included women over 30 with a history of cesarean section, while exclusions were for those with laparotomy or genital malignancy. Data on surgery duration, complications, and recovery were analyzed using SPSS, with significance set at p<0.05. Result: The study compared two groups of patients undergoing total laparoscopic hysterectomy, focusing on demographic, clinical, and intraoperative variables. The majority were aged 40-49 years, with similar BMI and parity. Common indications included abnormal uterine bleeding (27.27% in Group A vs. 30.91% in Group B; p=0.325). Chronic pelvic pain was more frequent in Group A (25.45% vs 9.09%; p=0.266). Mean operative time was longer in Group A (73.72±16.47 vs. 59.26±10.57 ...