title: Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section.
abstract: OBJECTIVE
  To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section.
  
  
  METHODS
  We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups.
  
  
  RESULTS
  The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group.
  
  
  CONCLUSIONS
  LAVH is effective and safe for women with anterior wall adherence after cesarean section.
authors.affiliation: Department of Obstetrics and Gynecology, Kangwon National University School of Medicine, Chuncheon, Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Ko
authors.affiliation: Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Joong Sub
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Jaeman
authors.initials: J
authors.lastname: Bae
authors.affiliation: Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Won Moo
authors.initials: WM
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: A Ra
authors.initials: AR
authors.lastname: Koh
authors.affiliation: Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Hyeyeon
authors.initials: H
authors.lastname: Boo
authors.affiliation: Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Eunhyun
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Hong
keywords: Anterior wall adherence; Cesarean section; Hysterectomy; Laparoscopy