Surgical Outcomes between Routes of Hysterectomy in Patients with a Previous Cesarean Section

• Published in: Journal of minimally invasive gynecology Vol. 30; no. 4; p. 319
• Main Authors: Kroft, Jamie, McCaffrey, Carmen, Kim, Eliane, Jolliffe, Courtney, Liu, Grace Y, Saskin, Refik, Gatley, Jodi M, Ordon, Michael
• Format: Journal Article
• Language: English
• Published: United States 01.04.2023
• Subjects: Cesarean Section - adverse effects; Cohort Studies; Female; Humans; Hysterectomy - adverse effects; Hysterectomy, Vaginal - adverse effects; Laparoscopy - adverse effects; Ontario; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Pregnancy; Retrospective Studies; Treatment Outcome; Ontario; Pregnancy; Laparoscopy; Hysterectomy; Laparotomy; Vaginal
• ISSN: 1553-4669
• DOI: 10.1016/j.jmig.2023.01.003

To determine the difference in surgical complications for patients with a previous cesarean section (CS) undergoing abdominal, vaginal, or laparoscopic hysterectomy. A population-based retrospective cohort study. Province of Ontario, Canada. 10 300 patients with at least 1 CS between July 1, 1991, and February 17, 2018. Benign, nongravid hysterectomy between Apr 1, 2002, and March 31, 2018. The primary outcome was a composite of all surgical complications within 30 days of surgery. Secondary outcomes were rate of genitourinary complications, readmission to hospital, and emergency department visit occurring within 30 days of surgery. Of 10 300 patients who had at least one previous CS, who underwent subsequent hysterectomy for a benign indication, 7370 underwent an abdominal hysterectomy (71.55%), 813 (7.9%) had a vaginal hysterectomy, and 2117 (20.55%) underwent a laparoscopic hysterectomy. The adjusted odds of any surgical complication from hysterectomy was significantly lower when performed by the vaginal approach than the laparoscopic approach (odds ratio, 0.32; 95% confidence interval, 0.20-0.51; p <.0001). There was no difference in the odds of surgical complication between abdominal and laparoscopic approaches (odds ratio, 1.09; 95% confidence interval, 0.87-1.37; p = .45). Our retrospective population-based study demonstrates that, after previous CS, patients selected to undergo vaginal hysterectomy experienced lower risk than either abdominal or laparoscopic approaches. This suggests that CS alone should not be a contraindication to vaginal hysterectomy.