title: When is laparotomy needed in hysterectomy for benign uterine disease?
abstract: OBJECTIVE
  We sought to study laparotomy (conversion and initial) and complication rates among patients who underwent hysterectomy initially performed laparoscopically whenever feasible.
  
  
  METHODS
  A retrospective cohort study (Canadian Task Force classification II-3).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A continuous series of 680 patients, operated on between January 1, 2000, and December 31, 2003, was analyzed. Patients with malignancy and prolapse were excluded.
  
  
  METHODS
  Hysterectomy.
  
  
  RESULTS
  Overall, 7.2% of patients underwent laparotomy. In all, 27 (3.9%) patients were treated by initial laparotomy and 22 procedures were converted to laparotomy, 13 to laparoscopic-assisted vaginal hysterectomy (1.9%). Intraoperative and postoperative bladder complication rates were 0.8% and 0.4%, respectively. Ureteric complications were 0.3% and 0.4%, respectively, and bowel complications (bowel occlusion, peritonitis) were 0.4% and 0.4%, respectively. Three patients received blood transfusion. Of 19 patients who had repeated surgery for early or late postoperative complications, 13 were treated by laparoscopy and/or vaginally.
  
  
  CONCLUSIONS
  Including management of complications, laparotomy was necessary in 8.1% of cases. Laparoscopic hysterectomy may be safely used in most patients.
authors.affiliation: CHU Clermont-Ferrand, Department of Obstetrics Gynecology and Reproductive Medicine Polyclinique de l'Hôtel Dieu, Clermont-Ferrand, France. mcanis@chu-clermontferrand.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
authors.forename: Revaz
authors.initials: R
authors.lastname: Botchorishvili
authors.forename: Catarina
authors.initials: C
authors.lastname: Ang
authors.forename: Benoît
authors.initials: B
authors.lastname: Rabischong
authors.forename: Kris
authors.initials: K
authors.lastname: Jardon
authors.forename: Arnaud
authors.initials: A
authors.lastname: Wattiez
authors.forename: Gérard
authors.initials: G
authors.lastname: Mage
mesh_terms: D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007431:Intraoperative Complications / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007813:Laparotomy; D008875:Middle Aged; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000601:surgery*