When is laparotomy needed in hysterectomy for benign uterine disease?
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.
Canis
Michel
M
CHU Clermont-Ferrand, Department of Obstetrics Gynecology and Reproductive Medicine Polyclinique de l'Hôtel Dieu, Clermont-Ferrand, France. mcanis@chu-clermontferrand.fr
Botchorishvili
Revaz
R
Ang
Catarina
C
Rabischong
Benoît
B
Jardon
Kris
K
Wattiez
Arnaud
A
Mage
Gérard
G
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*