Bladder injury after LAVH: a prospective, randomized comparison of vaginal and laparoscopic approaches to colpotomy during LAVH.
OBJECTIVE
To compare results of a vaginal approach to colpotomy (type IA) and laparoscopic-assisted abdominal colpotomy (type ID) in performing a laparoscopic-assisted vaginal hysterectomy (LAVH).


METHODS
Prospective, randomized study (Canadian Task Force classification I).


METHODS
Tertiary teaching hospital.


METHODS
Five hundred forty-one women, 274 in group 1 (type 1D) and 267 in group 2 (type 1A).


METHODS
LAVH with follow-up for 3 months to 5 years.


RESULTS
There were no statistically significant differences in age, preoperative and postoperative hemoglobin values, or postoperative hospital stay between groups. Operating time and estimated blood loss were significantly reduced in group 2 (p <0.001 and <0.001, respectively). Women in group 1 had nine urinary tract injuries (3.28%), including eight cases of intraoperative bladder injury (2.91%) and one vesicovaginal fistula (0.36%), but no ureteral injury. The bladder injury rate in group 2 was 0.37%, which was significantly lower (p = 0.038). There were no significant differences in ureteral or bowel injuries, pelvic hematomas, or pelvic abscesses.


CONCLUSIONS
LAVH type IA achieved better results than type ID in preventing bladder injury.
Horng
Shang-Gwo
SG
Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital, Taipei, Taiwan, ROC.
Huang
Kuan-Gen
KG
Lo
Tsia-Shu
TS
Soong
Yoong-Kuei
YK
D016063:Blood Loss, Surgical; D020884:Colpotomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D001743:Urinary Bladder / Q000293:injuries*; D014719:Vesicovaginal Fistula / Q000209:etiology