Total laparoscopic hysterectomy in patients with previous caesarean section: experience at a tertiary care center in India

Background: With a surge in the rate of caesarean deliveries, the number of patients undergoing hysterectomy with a previous caesarean section for gynecological complaints has also increased. The presence of intra-abdominal and bladder adhesions to the uterus is the main concern in such cases, resulting in higher complication rates. This study aimed to determine the challenges and complications encountered during TLH in patients with previous caesarean sections. Methods: We conducted a retrospective study analysing data from the medical records of 243 patients who had undergone TLH for various gynecological conditions in a single tertiary care center from January 2018 to January 2021. Patients were categorized into two groups namely no previous CS (n=193) and previous CS (n=50). The surgical outcomes of those patients including major complications were measured. Results: The clinical characteristics of the two groups were comparable except for the patient’s age with younger patients in the previous CS group (p=0.001). There was no difference in terms of surgical indications, intraoperative and postoperative complications, and hospital stay between the groups. Operating time was significantly more in the previous CS group (p=0.001). One patient sustained a bladder injury in a previous CS group. The conversion rates to laparotomy in the previous CS and no CS groups were not statistically significant. Significant hemorrhage requiring blood transfusion was noted in two patients (4%) in the previous CS group and one (0.51%) patient in the no CS group (p=0.108). Conclusions: TLH can be safely performed with lower complication rates by an experienced surgeon in patients with prior history of caesarean section.