<p>Perioperative Complications of Hysterectomy After a Previous Cesarean Section: A Systematic Review and Meta-Analysis</p>

Abstract

Background: With increasing rates of cesarean sections (CS), the number of hysterectomies performed among women with a previous CS is on the rise. Objective: To provide the association between the odds of complications following a hysterectomy performed later in life and a previous CS. Search strategy: A comprehensive search was performed using major electronic databases, ie, MEDLINE, Scopus, ISI Web of Science, from their inception to April 2019. Selection criteria: Analytical studies, irrespective of language or publication status, were included. Data collection and analysis: Outcomes were extracted in duplicate. The methodological quality of the included studies was independently evaluated by two review authors. A threelevel meta-analysis was applied for outcomes with dependent effect sizes. Main results: Twenty-six studies were included involving 54,815 women. The odds of the following complications were increased in women with a previous CS: urinary tract injury (pooled unadjusted odds ratio (OR)=3.15, 95% CI=2.01-4.94, 15 studies, 33,902 women, and pooled adjusted OR=2.21, 95% CI=1.46-3.34, 3 studies, 31,038 women), gastrointestinal tract injury (pooled unadjusted OR=1.73, 95% CI=1.19-2.53; 7 studies, 30,050, and pooled adjusted OR=1.83, 95% CI=1.11-3.03, 1 study, 25,354 women), postoperative infections (pooled unadjusted OR=1.44, 95% CI=1.22-1.71, 6 studies, 37,832 women), wound complications (pooled unadjusted OR=2.24, 95% CI=1. 9 studies,37,559 women), reoperation (pooled unadjusted OR=1.46, 2 studies,9,899 women), and blood transfusion (pooled unadjusted OR=1.35, 95% CI=1.03-1.76, 7 studies, 13,430 women). Conclusion: Previous CS increases risks of various complications following hysterectomy. This information reminds the gynecologists to be aware of the associations between previous CS and potential complications among women undergoing hysterectomy. Prospero registration number: CRD42018085061.

Consensus on safe implementation of vaginal natural orifice transluminal endoscopic surgery (vNOTES)

“…With respect to multiple previous caesarean sections as a possible contraindication the concern was the potential higher risk of lower urinary tract injury in the setting of such a novel surgical technique. It must be noted however that risk of urinary tract injury is significantly higher in cases of previous caesarean sections and is reported in all types of hysterectomy [15,[20][21].…”

Cesarean scar perforation in laparoscopic hysterectomy for endometrial cancer: a case report

“…The frequency of performing caesarean section has increased rapidly in recent years [14], and the prevalence of hysterectomies in patients with a history of caesarean section has similarly increased [14]. Hysterectomy leads to higher rates of adjacent organ damage, postoperative infection, fistula formation, and blood transfusion in patients who have undergone caesarean section than in those who have not [6,14,15]. In addition, approximately 45% of patients with a caesarean section have adhesions [16].…”

Intraoperative Bowel Injury During Hysterectomy

“…3 Of note, a 2019 systematic review and meta-analysis of 26 studies found that any history of cesarean section conferred an increased risk of intraoperative bowel injury during hysterectomy with an odds ratio (OR) of 1.83. 8 Adhesions within the posterior culde-sac increase the risk of rectosigmoid damage during vaginal hysterectomy. 9 Interestingly, most studies fail to show conclusive evidence of increased risk of bowel injury during hysterectomy with increasing body mass index.…”