Laparoscopic Removal of the Cervical Stump after Supracervical Hysterectomy for Persistent Pelvic Pain and Endometriosis
We evaluated the safety of laparoscopic removal of the cervical stump after supracervical hysterectomy. In six women the cervical stump was left due to the presence of severe endometriosis or adhesions in the posterior cul-de-sac between the rectum or uterosacral ligaments and cervix. One woman also expressed a desire to preserve her cervix. Cervical stump removal was secondary to the treatment of endometriosis or adhesions, both of which contraindicated a vaginal approach. A vaginal approach would not have allowed treatment of endometriosis involving the rectosigmoid colon, and it is unlikely that pain relief would be adequate. Five women had extensive pelvic endometriosis despite having had supracervical hysterectomy. Four of the five also had undergone bilateral salpingo-oophorectomy. Severe adhesions were present in all women, especially intestinal and omental attachments to the vaginal apex and adjacent structures. Mean blood loss was 100 ml (range 50-200 ml). There were no major intraoperative or postoperative complications. The only minor complication occurred in a woman who experienced minimal postoperative vaginal spotting from granulation tissue formation in the cuff. This was treated locally. Pathologic examination revealed endometriosis and fibrosis in all patients. Four women had complete pain relief and the other two had partial relief after follow-up of 2 to 24 months. If it is necessary to remove the cervical stump, it can be done safely by laparoscopy.
Nezhat
CH
Center for Special Pelvic Surgery, 5555 Peachtree-Dunwoody Road, Suite 276, Atlanta, GA 30342.
Nezhat
A
Borhan
S