CHARACTERISTICS OF TOTAL LAPAROSCOPIC HYSTERECTOMY AMONG WOMEN WITH OR WITHOUT PREVIOUS ABDOMINAL SURGERY: RETROSPECTIVE ANALYSIS

Problem statement: Total laparoscopic hysterectomy (TLH) is associated with reduced postoperative morbidity and length of hospital stay, compared to abdominal hysterectomy, and it can be complicated by previous abdominal surgeries.

Methods: Retrospective observational study of complications after TLH in the last 3 years (2020-2022) and its correlation with previous abdominal surgeries. Statistical analysis was performed using SPSS software.

Results: A total of 145 women underwent TLH between 2020 and 2022, of which 59,3% (n=86) had at least one abdominal surgery. Cesarean section (C-section) was the most frequent previous surgery (n=36), following bilateral tubal ligation (n=30), appendectomy (n=16), ressetoscopy (n=14), gastric bypass (n=10), cholecystectomy (n=10), hernioplasty umbilical cord (n=5), curettage (n=4), ovarian cystectomy (n=3) and Nissen fundoplication (n=1).

About 4.1% of women had complications intraoperatively, with bleeding > 1000ml (n=2), conversion to laparotomy (n=1), iatrogenic bladder injury (n=1) and intestinal (n=1) and vaginal (n=1) lacerations. From the 10th day after surgery, there were about 11.7% of postoperative complications, including vaginal cuff granuloma (n=6), vaginal cuff hematoma (n=4), vaginal cuff dehiscence (n=2), vaginal cuff abscess (n=2), grade 1 vaginal cuff prolapse (n=1), aggravated stress urinary incontinence (n=1) and pain in the umbilical scar (n=1).

Women with previous abdominal surgery submitted to LTH had a higher proportion of postoperative complications (21%) compared to those without previous abdominal surgery (7%), although without statistically significant difference (X2=3.494,p=0.062 ).

Regarding the type of previous abdominal surgery, the proportion of postoperative complications in the group with a history of bariatric surgery was significantly higher than in the group without bariatric surgery (0.4% vs 0.11 %, X2=6.824, p=0.009), such as in the group of women with previous appendectomy (25% vs 11.6%, X2=6.227, P=0.044). No differences were observed about the length of hospital stay or type of operative complication.

Conclusion: This study demonstrated that bariatric surgery and appendectomy may be associated with a higher proportion of postoperative complications; however, the study is retrospective and the population sample is small, requiring further studies to validate the results presented. Overall, HTL appears to be a safe approach in women with previous abdominal surgeries, with no increase in postoperative morbidity.