title: Safety of total laparoscopic hysterectomy in patients with prior cesarean section.
abstract: OBJECTIVE
  Patients who have undergone a cesarean section (CS) prior to hysterectomy are at a higher perioperative risk of complications. The purpose of this study was to evaluate the safety of total laparoscopic hysterectomy (TLH) in patients with prior CS.
  
  
  METHODS
  We enrolled 482 patients treated with TLH. Surgical outcomes including major complications were compared between patients without prior CS (no CS group; n = 324) and patients with prior CS (prior CS group; n = 158). Major complications included vaginal cuff dehiscence, and bowel, bladder, ureter and great vessel injuries.
  
  
  RESULTS
  Major complications, uterus weight, hospital day, unscheduled transfusion and conversion to laparotomy did not differ significantly between groups. One bowel injury occurred in the no CS group. Two vaginal cuff dehiscences and one bladder injury occurred in the prior CS group. There were no ureter or great vessel injuries. Operation duration was longer (P = 0.030) in the prior CS group, but only seven minutes longer than the no CS group. The Foley catheter indwelling day was also significantly longer (P < 0.001) in the prior CS group, but did not last one day. The number of prior CS had no effect on the major complication rate. After treatment of major complications, no long-term sequelae were observed.
  
  
  CONCLUSIONS
  TLH in patients with a history of CS can be performed safely as such history had no effect on the major complication rate. Complications were rare and were treated successfully.
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Soyi
authors.initials: S
authors.lastname: Lim
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Seungho
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Joohyun
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Seungjoo
authors.initials: S
authors.lastname: Chon
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Kwangbeom
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jinwoo
authors.initials: J
authors.lastname: Shin
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D017604:Cesarean Section, Repeat / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications; D012449:Safety; D000267:Tissue Adhesions / Q000150:complications / Q000209:etiology; D016896:Treatment Outcome
keywords: cesarean section; hysterectomy; laparoscopy; safety