Surgical Outcomes and Complications of Total Laparoscopic Hysterectomy in Patients with a Surgical History of Cesarean Section

Objectives: With the recent spread of laparoscopic hysterectomy (LH) and the rising rate of cesarean sections (CSs), increasing number of patients with a previous CS are undergoing total LH (TLH). Here, we retrospectively compared the surgical outcomes of TLH in patients with and without a history of CS. Materials and Methods: We analyzed the surgical outcomes and complications of 609 TLHs performed from 2013 to 2023, according to the presence or absence of previous CSs. Results: Of the 609 patients who underwent TLH, 92 (15.1%) had a history of CS, and by the number of CSs, 58 patients had 1 CS, 27 had 2 CSs, 6 had 3 CSs, and 1 had 4 CSs. There was no significant difference in surgical outcomes between the non-CS and CS groups. The main complication was bladder injury in one patient with 3 previous CSs; the incidence of bladder injury in the ≥3 CS group was significantly higher than that in the non-CS group. There were four cases of vaginal cuff dehiscence (2 each in the CS and non-CS groups, indicating no significant difference). Conclusion: It is important to be aware that the risk of bladder injury is increased in patients with previous CSs, especially in those with 3 or more. In addition, care should be taken intraoperatively to avoid such injuries, and sufficient information about their risk should be obtained preoperatively.