Source: DGNews  |  Posted 2 years ago

By Bruce Sylvester

CHICAGO -- May 9, 2009 -- Previous laparotomy does not affect surgical outcomes or increase complications during laparoscopic-assisted hysterectomy with retroperitoneal uterine ligation, researchers reported here on May 4 at the 57th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG).

“We found that prior laparotomy should not preclude a patient from receiving a laparoscopic hysterectomy; there is no higher risk of complications from such a procedure,” said Ruchi Puri, MD, George Washington University Hospital, Washington, DC.

Dr. Puri and colleagues conducted a retrospective review of 349 consecutive cases (between January 2004 and November 2007) of laparoscopic-assisted hysterectomy, originating with retroperitoneal ligation of the uterine artery, for benign indications.

The researchers stratified subjects according to number of prior laparotomies (0, 1, 2, or >2) for caesarean delivery, myomectomy, appendectomy, or other intra-abdominal indication. An exact Kruskal-Wallis test was used to analyse frequency variables, and a general linear model regression was used for continuous variables.

No statistically significant differences were found among the groups in estimated blood loss (P = .99), operating time (P = .46), or length of stay in the hospital (P = .84).

A significant difference in uterine weight was found between patients who had no prior surgery and those who had had 2 and >=2 surgeries (P = .0002). No differences among groups were found in readmissions (P = .39), blood transfusions (P = .27), bowel complications (P = 47), urinary tract complications (P = .10), or number of adhesions (P = .22).

Because surgical outcomes were not affected by prior laparotomy and complications were not increased during laparoscopic-assisted hysterectomy, the researchers concluded that “abdominal surgery alone should not be considered a contraindication to this approach.”

[Presentation title: Review of Prior Laparotomy in 349 Laparoscopic Hysterectomies With Retroperitoneal Uterine Artery Ligation. Abstract 47]