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The incidence of complications by hysterectomy for benign disease in correlation to an assumed preoperative score

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Hysterectomies are preformed abdominally, vaginally, laparoscopic or with robotic assistance. When choosing the route of hysterectomy, the physician should take into consideration the safest and most cost-effective route to fulfill all needs of the patient.

Methods

Data were collected retrospectively from 953 patients who underwent hysterectomy between 2002 and 2010 for benign indications at UKSH, Germany. Preoperative risk scores were assigned to patients. The data were statistically evaluated to investigate relationship between the occurrence of the complication and the preoperative score at the time of the hysterectomy. For the preoperative score, patients who had undergone a previous laparoscopy were assigned 1 point; those who had undergone a previous Pfannenstiel laparotomy were assigned 2 points; those who had undergone 1 cesarean delivery were assigned 3 points; those who had undergone 2 cesarean deliveries were assigned 4 points; those who had undergone 3 cesarean deliveries were assigned 5 points; and those with no previous operations were assigned 0 points. The preoperative score was recorded for 785 patients.

Results

Of the 785 women with complete data, the mean preoperative score was 1.09 ± 1.51 for AH, 0.75 ± 0.96 for VH, 1.04 ± 1.30 for LSH, 1.0 ± 1.40 for LAVH, and 1.38 ± 1.52 for TLH. The prevalent scores in the VH were 0 and 1, the LASH and TLH showed a prevalence over VH in the preoperative scores 3 and 4 and AH showed a prevalence over the other methods in the preoperative score 3–8. Intraoperative complications were recorded in 28 of 953 (2.9 %) cases: 10 (35.7 %) cases of VH; 13 (46.4 %) cases of AH; 3 (10.7 %) cases of LSH; 1 (3.6 %) case of LAVH; and 1 (3.6 %) case of TLH. The intraoperative complications appeared to be more frequently with heavier uterine weight showing a significant statically correlation (P < 0,001). Major postoperative complications occurred in 17 of 953 (1.8 %) cases. Minor postoperative complications were recorded in 56 of 953 (5.9 %) hysterectomies. Operation duration, hospital stay and hemoglobin decline correlated significantly with preoperative score (P < 0.001).

Conclusion

The suggested preoperative score is apparently successful in screening out the high-risk patients, despite the low incidence of intra and postoperative complications. The usefulness of the preoperative scoring system is worthy of further development and evaluation. The AH was favored as the ‘fallback option’ with high preoperative score.

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References

  1. Altgassen C, Michels W, Schneider A (2004) Learning laparoscopic-assisted hysterectomy. Obstet Gynecol 104(2):308–313

    Article  CAS  PubMed  Google Scholar 

  2. Briese V, Ulfig N, Mylonas I (2002) Die vaginale Hysterektomie. Gynäkologe 116:24

    Google Scholar 

  3. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM et al (2008) Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol 198(1):34 e1–34 e7

    Article  Google Scholar 

  4. Mettler L, Clevin L, Ternamian A, Puntambekar S, Schollmeyer T, Alkatout I (2013) The past, present and future of minimally invasive endoscopy in gynecology: a review and speculative outlook. Minim Invasive Ther Allied Technol 22(4):210–226

    Article  PubMed  Google Scholar 

  5. Reich H (1992) Laparoscopic hysterectomy. Surg Laparosc Endosc 2(1):85–88

    CAS  PubMed  Google Scholar 

  6. Semm K (1991) Hysterektomie per laparotomiam oder per pelviskopiam. Ein neuer Weg ohne Kolpotomie durch CASH. Geburtshilfe und Frauenheilkunde 996–1003. Geburtshilfe Frauenheilkd 51(12):996–1003. doi:10.1055/s-2008-1026252

  7. Donnez J, Nisolle M (1993) Laparoscopic supracervical (subtotal) hysterectomy (LASH). J Gynecol Surg 9(2):91–94

    Article  CAS  PubMed  Google Scholar 

  8. Brandner P, Neis KJ (1995) The significance of laparoscopically-assisted vaginal hysterectomy—LAVH. Zentralbl Gynakol 117(12):620–624

    CAS  PubMed  Google Scholar 

  9. Neis KJ, Ulrich K, Zeilmann W, Brandner P (1993) Die laparoskopisch-assistierte vaginale Hysterektomie. Der Frauenarzt 1091–6. Arch Gynecol Obstet (1996) 258:55–64

  10. Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R (2006) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2:CD003677

    PubMed  Google Scholar 

  11. Mettler L, Schollmeyer T, Alkatout I (2012) Adhesions during and after surgical procedures, their prevention and impact on women’s health. Womens Health Lond Engl 8(5):495–498

    Article  CAS  PubMed  Google Scholar 

  12. Muller A, Thiel FC, Renner SP, Winkler M, Haberle L, Beckmann MW (2010) Hysterectomy-a comparison of approaches. Deutsches Arzteblatt Int 107(20):353–359

    Google Scholar 

  13. Radosa MP, Meyberg-Solomayer G, Radosa J, Vorwergk J, Oettler K, Mothes A et al (2014) Standardised registration of surgical complications in laparoscopic-gynaecological therapeutic procedures using the clavien-dindo classification. Geburtshilfe Frauenheilkd 74(8):752–758

    Article  PubMed Central  PubMed  Google Scholar 

  14. Canis MJ, Wattiez A, Mage G, Bruhat MA (2004) Results of eVALuate study of hysterectomy techniques: laparoscopic hysterectomy may yet have a bright future. BMJ 328(7440):642–643 author reply 3

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J et al (2004) Severe complications of hysterectomy: the VALUE study. BJOG Int J Obstet Gynaecol 111(7):688–694

    Article  CAS  Google Scholar 

  16. Brummer TH, Jalkanen J, Fraser J, Heikkinen AM, Kauko M, Makinen J et al (2011) FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod 26(7):1741–1751

    Article  PubMed  Google Scholar 

  17. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R et al (2009) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 3:CD003677

    PubMed  Google Scholar 

  18. Schindlbeck C, Klauser K, Dian D, Janni W, Friese K (2008) Comparison of total laparoscopic, vaginal and abdominal hysterectomy. Arch Gynecol Obstet 277(4):331–337

    Article  PubMed  Google Scholar 

  19. Wallwiener M, Taran FA, Rothmund R, Kasperkowiak A, Auwarter G, Ganz A et al (2013) Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations. Arch Gynecol Obstet 288(6):1329–1339

    Article  PubMed  Google Scholar 

  20. Hillis SD, Marchbanks PA, Peterson HB (1996) Uterine size and risk of complications among women undergoing abdominal hysterectomy for leiomyomas. Obstet Gynecol 87(4):539–543

    Article  CAS  PubMed  Google Scholar 

  21. Bachmann C, Abele H, Wallwiener D, Kagan KO (2014) Neonatal and maternal risk in Hermansky-Pudlak syndrome: peripartum management-brief report and review of literature. Arch Gynecol Obstet 289(6):1193–1195

    Article  PubMed  Google Scholar 

  22. Mueller A, Boosz A, Koch M, Jud S, Faschingbauer F, Schrauder M et al (2012) The Hohl instrument for optimizing total laparoscopic hysterectomy: results of more than 500 procedures in a university training center. Arch Gynecol Obstet 285(1):123–127

    Article  PubMed  Google Scholar 

  23. Ou CS, Joki J, Wells K, Zabriske V, Hamilton K, Tsuang M et al (2004) Total laparoscopic hysterectomy using multifunction grasping, coagulating, and cutting forceps. J Laparoendosc Adv Surg Tech A 14(2):67–71

    Article  PubMed  Google Scholar 

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We confirm that there are no instances of conflict of interest in our manuscript.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Hospitals Schleswig–Holstein, Campus Kiel, Arnold-Heller Strasse 3, Haus 24, 24105, Kiel, Germany

    Mohamed Elessawy, Thoralf Schollmeyer, Liselotte Mettler, Walter Jonat, Christian Schem & Ibrahim Alkatout

  2. Institute of Medistat GmbH for Statistically Operation, Schauenburgerstraße 116, 24118, Kiel, Germany

    Ulrike von Hehn

Authors
  1. Mohamed Elessawy
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  2. Thoralf Schollmeyer
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  3. Liselotte Mettler
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  4. Walter Jonat
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  5. Christian Schem
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  6. Ulrike von Hehn
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  7. Ibrahim Alkatout
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Corresponding author

Correspondence to Mohamed Elessawy.

Additional information

This work is dedicated to Dr. M. Ibrahim and PD. Dr. T. Schollmeyer who taught me that the best kind of knowledge to have is that which is learned for its own sake.

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Elessawy, M., Schollmeyer, T., Mettler, L. et al. The incidence of complications by hysterectomy for benign disease in correlation to an assumed preoperative score. Arch Gynecol Obstet 292, 127–133 (2015). https://doi.org/10.1007/s00404-014-3594-9

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  • DOI: https://doi.org/10.1007/s00404-014-3594-9

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