Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy.

STUDY OBJECTIVE: The aim of the study was to estimate the incidence of cyclical bleeding after laparoscopic supracervical hysterectomy (LSH) when the uterus is amputated at or below the level of internal cervical os. DESIGN: Prospective series of consecutive patients (Canadian Task Force classification II-3). SETTING: Single surgery team, independent surgery center. PATIENTS: Women with symptomatic uterine leiomyomata, abnormal uterine bleeding, dysmenorrhea, or chronic pelvic pain. INTERVENTION: Laparoscopic supracervical hysterectomy (with concurrent bilateral salpingo-oophorectomy if required), along with laparoscopic biopsy sampling of the cervical stump. MEASUREMENTS AND MAIN RESULTS: From October 2002 through February 2004, we performed 67 consecutive LSH procedures. At the completion of uterine amputation, two biopsies were obtained from the cervix at 12 o'clock and 6 o'clock positions and submitted for histologic evaluation to identify the tissue type. We assumed the presence of endocervical tissue on cervical biopsy would indicate the uterine amputation took place at or below the level of internal os. All 67 patients were contacted 3- to 15-months postoperatively to inquire about bleeding status, and 64 (96%) responded. The overall bleeding incidence was 12/64 (19%). Among the subgroup with endocervical tissue on biopsy, 7/41 (17%) experienced cyclical bleeding. The continuous variables (i.e., age, body mass index [BMI], parity, uterine weight) and categorical variables (i.e., indications for surgery, status of endometriosis, adenomyosis, endocervical fulguration, cervical biopsy, history of cesarean section) were not statistically significant in association with the bleeding time. CONCLUSION: Our data suggest the overall incidence of post-LSH cyclical bleeding is 19%. When the uterus is amputated at or below the level of internal os, the incidence is 17%. To our knowledge, this is the first study in the medical literature to report on cyclical bleeding after LSH when the uterine amputation is demonstrated to have occurred at or below the level of internal cervical os.

Double cervix and vagina with a normal uterus and blind cervical pouch: a rare müllerian anomaly.

OBJECTIVE: To report a rare müllerian anomaly with a blind cervical pouch. DESIGN: Case report. SETTING: Private practice and community hospital. PATIENT(S): A 27-year-old nulliparous patient referred for evaluation of suspected müllerian anomaly. INTERVENTION(S): Clinical and outpatient surgical evaluation of the anomaly. MAIN OUTCOME MEASURE(S): Assessment of the anomaly according to standard müllerian classification system and subsequent literature search. RESULT(S): A rare müllerian anomaly was found that did not fit within the standard classification system, which included a double cervix and vagina with a normal uterus and blind cervical pouch. This was found to have been described only once before after extensive review of the literature. CONCLUSION(S): The described anomaly is extremely rare, with no prior cases reported in the United States. The described anomalies in this case report are inconsistent with the generally accepted understanding of müllerian development and do not fit into the current classification system.