Operative injuries during vaginal hysterectomy.
OBJECTIVE
To evaluate incidence, characteristics and consequences of urinary and intestinal tract injuries during vaginal hysterectomy for benign conditions.


METHODS
From January 1970 to December 1996, 3076 vaginal hysterectomies with or without additional procedures, were performed for benign conditions in our department. We retrospectively analyzed operative injury cases.


RESULTS
Incidence of urinary and intestinal tract injuries were 1.7 and 0.5%, respectively. Concerning urinary tract injuries, we observed only one ureteral lesion, all others being bladder lacerations (54 cases). The bladder lacerations occured during the hysterectomy step of the surgery in 61% of cases and during the additional procedures in 39%. All bladder injuries were recognized and treated during the primary operation. We observed four cases of vesico-vaginal fistula as a consequence of these injuries; all fistulas occured after bladder laceration during the hysterectomy step of the surgical procedure. Intestinal tract injuries (16 cases) were rectal lacerations occuring during the hysterectomy step of the surgery (31% of cases) and during the additional procedures (69%). All rectal injuries were recognized and repaired during the primary operation and all healed without sequellae.


CONCLUSIONS
Operative injuries during vaginal hysterectomy are relatively rare. They are easily recognized and treated during the primary operation without important sequellae.
Mathevet
P
P
Department of Gynecology, Hopital E. Herriot, Pavillon L., 69437 Lyon Cedex 03, France.
Valencia
P
P
Cousin
C
C
Mellier
G
G
Dargent
D
D
D000368:Aged; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000401:mortality; D007422:Intestines / Q000293:injuries*; D007431:Intraoperative Complications; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D012007:Rectum / Q000293:injuries; D012189:Retrospective Studies; D014513:Ureter / Q000293:injuries; D001743:Urinary Bladder / Q000293:injuries / Q000601:surgery; D014551:Urinary Tract / Q000293:injuries*; D014594:Uterine Neoplasms / Q000601:surgery; D014596:Uterine Prolapse / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000209:etiology; D002578:Uterine Cervical Dysplasia / Q000601:surgery