RESUMO
OBJECTIVE: To examine whether laparoscopic hysterectomy is safe in the presence of previous caesarean section (CS). DESIGN: Canadian Task Force Classification II-2. SETTING: Laparoscopic hysterectomies performed for nonmalignant conditions by 7 gynecologic surgeons in public and private hospitals in Western Sydney. PATIENTS: Data were collected from January 2001 through December 2007, involving 574 patients, of which 141 patients had 1 or more previous CS. INTERVENTION: Laparoscopic hysterectomy. MEASUREMENTS: Conversions to laparotomy and major intraoperative and postoperative complications (within 6 weeks of surgery) were recorded and compared between cohorts of patients with and without previous caesarean sections. MAIN RESULTS: Of the 574 laparoscopic hysterectomies identified, 141 (24.6%) patients had at least 1 previous CS. Most women with previous CS had only 1 CS (51.8%), whereas 13.5% had 3 or more CS. The overall major complication rate among patients undergoing laparoscopic hysterectomy was 10.1%. The most common complication was hemorrhage (7.3% of patients) and inadvertent cystotomy (2.1%). The rate of major complications varied between the CS and non-CS groups. Among the non-CS group, the complication rate was 8.8%, whereas the complication rate among the CS group was 14.2%. The rate of inadvertent cystotomy in the group with no previous CS was 5 in 433 patients (1.2%). The rate of bladder complications showed an increase with the number of previous CS: 2.5% of patients with 1 or 2 previous CS and 21.1% of patients with 3 or more previous CS. The rate of inadvertent cystotomy in patients with 3 or more CS was 18 times that of patients with no CS (95% CI 5.1, 66.0). Twenty-four (5.5%) patients without previous CS and 15 (10.6%) patients with previous CS required conversion to laparotomy because of dense bladder or bowel adhesions. CONCLUSION: Laparoscopic hysterectomy in the setting of previous CS is recommended because long-term sequelae are rare. There are higher rates of major complications in patients undergoing laparoscopic hysterectomy with previous CS; the higher the number of previous CS, the higher the rate of complications. The most significant increase is seen in patients with more than 2 previous CS.
