title: Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy.
abstract: OBJECTIVE
  The aim of the study was to estimate the incidence of cyclical bleeding after laparoscopic supracervical hysterectomy (LSH) when the uterus is amputated at or below the level of internal cervical os.
  
  
  METHODS
  Prospective series of consecutive patients (Canadian Task Force classification II-3).
  
  
  METHODS
  Single surgery team, independent surgery center.
  
  
  METHODS
  Women with symptomatic uterine leiomyomata, abnormal uterine bleeding, dysmenorrhea, or chronic pelvic pain.
  
  
  METHODS
  Laparoscopic supracervical hysterectomy (with concurrent bilateral salpingo-oophorectomy if required), along with laparoscopic biopsy sampling of the cervical stump.
  
  
  RESULTS
  From October 2002 through February 2004, we performed 67 consecutive LSH procedures. At the completion of uterine amputation, two biopsies were obtained from the cervix at 12 o'clock and 6 o'clock positions and submitted for histologic evaluation to identify the tissue type. We assumed the presence of endocervical tissue on cervical biopsy would indicate the uterine amputation took place at or below the level of internal os. All 67 patients were contacted 3- to 15-months postoperatively to inquire about bleeding status, and 64 (96%) responded. The overall bleeding incidence was 12/64 (19%). Among the subgroup with endocervical tissue on biopsy, 7/41 (17%) experienced cyclical bleeding. The continuous variables (i.e., age, body mass index [BMI], parity, uterine weight) and categorical variables (i.e., indications for surgery, status of endometriosis, adenomyosis, endocervical fulguration, cervical biopsy, history of cesarean section) were not statistically significant in association with the bleeding time.
  
  
  CONCLUSIONS
  Our data suggest the overall incidence of post-LSH cyclical bleeding is 19%. When the uterus is amputated at or below the level of internal os, the incidence is 17%. To our knowledge, this is the first study in the medical literature to report on cyclical bleeding after LSH when the uterine amputation is demonstrated to have occurred at or below the level of internal cervical os.
authors.affiliation: Department of Obstetrics and Gynecology, University at Buffalo, State University of New York, Buffalo, New York 14222, USA. alighomi@buffalo.edu
authors.forename: Ali
authors.initials: A
authors.lastname: Ghomi
authors.forename: Jeff
authors.initials: J
authors.lastname: Hantes
authors.forename: E C
authors.initials: EC
authors.lastname: Lotze
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008599:Menstruation Disturbances / Q000209:etiology*; D008875:Middle Aged; D011446:Prospective Studies