Shirish S Sheth1. 1. Breach Candy Hospital, Mumbai, India. silsal@bom2.vsnl.net.in
Abstract
OBJECTIVE: To perform vaginal hysterectomy (VH) safely in women with a history of 2 or more cesarean deliveries (CDs). METHODS: A 4-step method was followed to safeguard the bladder, access the vesicouterine peritoneum (VUP), and perform VH in 312 patients with a history of 2 or more CDs. If access to the VUP did not occur at the end of step 2, step 3 and, if necessary, step 4 were implemented. RESULTS: Hysterectomy was performed vaginally in 311 patients, and the abdominal route was resorted to in 1 patient because of hemorrhage. Only 1 patient incurred bladder trauma, which was promptly repaired. CONCLUSION: In the absence of contraindications, the 4-step VH method described and the surgical techniques involved are safe to implement in women with a history of 2 or more CDs who need a hysterectomy.
OBJECTIVE: To perform vaginal hysterectomy (VH) safely in women with a history of 2 or more cesarean deliveries (CDs). METHODS: A 4-step method was followed to safeguard the bladder, access the vesicouterine peritoneum (VUP), and perform VH in 312 patients with a history of 2 or more CDs. If access to the VUP did not occur at the end of step 2, step 3 and, if necessary, step 4 were implemented. RESULTS: Hysterectomy was performed vaginally in 311 patients, and the abdominal route was resorted to in 1 patient because of hemorrhage. Only 1 patient incurred bladder trauma, which was promptly repaired. CONCLUSION: In the absence of contraindications, the 4-step VH method described and the surgical techniques involved are safe to implement in women with a history of 2 or more CDs who need a hysterectomy.
Authors: Sofie A I Lindquist; Neel Shah; Charlotte Overgaard; Christian Torp-Pedersen; Karin Glavind; Thomas Larsen; Avery Plough; Grace Galvin; Aage Knudsen Journal: JAMA Surg Date: 2017-12-01 Impact factor: 14.766