Linear cutting stapler for hysterotomy during cesarean hysterectomy for patients with placenta accreta spectrum disorder

To evaluate the impact of performing hysterotomy utilizing a linear cutting stapler on minimizing blood loss during cesarean hysterectomy compared to the classical hysterotomy technique in patients with suspected placenta accreta spectrum disorders. This is a single-center retrospective cohort study including a total of 95 patients undergoing cesarean hysterectomies between January 2014 and January 2022. The intervention of interest is utilizing a linear cutting stapler to perform the hysterotomy, a method that was introduced at our institution in 2019. The control group underwent the traditional classical hysterotomy method. Exclusion criteria included undiagnosed accreta at the time of surgery and emergent surgeries. The primary outcomes are quantitative total blood loss, units of packed red blood cell transfusion, length of postoperative stay, and intensive care unit admission. Logistic regression analyses were performed and adjusted for the effects of resuscitative endovascular balloon occlusion of the aorta, severity of disease, and number of prior cesarean deliveries. There were 64 patients undergoing the classical hysterotomy method and 31 patients undergoing the linear stapler hysterotomy technique. Compared to the classical hysterotomy group, the median blood loss in the stapler hysterotomy group was 1000 vs 2553mL (p<0.001), the median units of pRBC transfused was 1 vs 3 units (p<0.001), and postoperative length of stay was 3 vs 4 days (p<0.001). The rates of surgical blood loss of >2000ml in the stapler hysterotomy group was 22.6% vs 48.4% (p< 0.02, (aOR) 0.23[0.06-0.79]). The rate of transfusion of >4unit of pRBC in the stapler hysterotomy group was 16.1% vs 48.4% (p< 0.002, aOR 0.26[0.07-0.97]). The rate of cases not requiring blood transfusion in the stapler hysterotomy group was 45.2% vs 20.3% (p< 0.02, aOR 3.02[1.05-8.73]). The rate of ICU admission was not different between both groups. Performing hysterotomy utilizing a linear cutting stapler was associated with a significant reduction in blood loss in patients undergoing cesarean hysterectomy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)