title: Persistent bleeding after laparoscopic supracervical hysterectomy.
abstract: OBJECTIVE
  In our clinical experience, there seemed to be a correlation between cervical stump bleeding and adenomyosis. Therefore, we wanted to conduct a study to determine whether there was an actual correlation and to identify other risk factors for persistent bleeding after a laparoscopic supracervical hysterectomy.
  
  
  METHODS
  The study included women who underwent laparoscopic supracervical hysterectomy from January 1, 2003, through December 31, 2012. Data were collected on age, postmenopausal status, body mass index (BMI), uterine weight, indication for hysterectomy, concomitant bilateral salpingo-oophorectomy (BSO), presence of endometriosis, surgical ablation of the endocervix, adenomyosis, presence of endocervix in the specimen, and postoperative bleeding.
  
  
  RESULTS
  The study included 256 patients, of whom 187 had no postoperative bleeding after the operation, 40 had bleeding within 12 weeks, and 29 had bleeding after 12 weeks. The 3 groups were comparable in BMI, postmenopausal status, uterine weight, indication for hysterectomy, BSO, surgical ablation of the endocervix, adenomyosis, and the presence of endocervix. However, patients who had postoperative bleeding at more than 12 weeks were significantly younger (P = .002) and had a higher rate of endometriosis (P < .001).
  
  
  CONCLUSIONS
  Risks factors for postoperative bleeding from the cervical stump include a younger age at the time of hysterectomy and the presence of endometriosis. Therefore, younger patients and those with endometriosis who desire to have no further vaginal bleeding may benefit from total hysterectomy over supracervical hysterectomy. All patients who are undergoing supracervical hysterectomy should be counseled about the possible alternatives, benefits, and risks, including continued vaginal bleeding from the cervical stump and the possibility of requiring future treatment and procedures.
authors.affiliation: Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
authors.forename: Kirsten J
authors.initials: KJ
authors.lastname: Sasaki
authors.affiliation: Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
authors.forename: Aarathi
authors.initials: A
authors.lastname: Cholkeri-Singh
authors.affiliation: James R. and Helen D. Russell Institute for Research and Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
authors.forename: Suela
authors.initials: S
authors.lastname: Sulo
authors.affiliation: Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Miller
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000601:surgery*
keywords: Cervical stump bleeding; laparoscopic supracervical hysterectomy