Factors associated with complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomy

OBJECTIVE: To identify risk factors for complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomy (LAVH). DESIGN: Retrospective study. SETTING: Tertiary referral hospital. POPULATION: All 2012 consecutive women who underwent LAVH for non-malignant diseases in a single institution. METHODS: Retrospective study. MAIN OUTCOME MEASURES: Operative complications and conversion to laparotomy. RESULTS: Most of the LAVHs were successful, but conversion to laparotomy was required in 97 women (4.8%) because of pelvic adhesion (n= 71), large uterine size (n= 18) or bowel injury (n= 8). There were 45 women (2.2%) with complications (bladder injury, 26; bowel injury, 9; vascular injury, 9; and ureteral injury, 1). A history of previous cesarean section (twice or more) was a significant risk factor for complications [odds ratio (OR) 3.38]. A body mass index ≥30 kg/m(2) (OR 2.98), history of previous myomectomy (OR 6.19) and uterine weight ≥500 g (OR 3.24) independently influenced the risk of conversion to laparotomy. CONCLUSIONS: Risk factors identified in this study include a history of previous cesarean section (twice or more) and myomectomy, body mass index ≥30 kg/m(2) and uterine weight ≥500 g. The findings may be useful in counseling women preoperatively about the potential complications of LAVH.