Secondary hemorrhage after different modes of hysterectomy

Abstract

Secondary hemorrhage after hysterectomy is rare but a life-threatening complication. The aim of this study is to estimate the cumulative incidence, patient characteristics, and potential risk factors of secondary hemorrhage after abdominal, vaginal, and laparoscopic hysterectomies. We did a retrospective observational study in which 1,623 cases of total laparoscopic hysterectomy (TLH), 963 cases of total abdominal hysterectomy (TAH), and 1,171 cases of vaginal hysterectomy (VH) were analyzed. Of the total 37 hemorrhages following hysterectomies, 23 were after TLH, 8 following VH, and 6 were after TAH. The cumulative incidence of secondary hemorrhage after any type of total hysterectomies was 0.98 %. TLH was associated with the highest risk of secondary hemorrhage (1.51 %) followed by VH (0.68 %) and TAH group (0.62 %). The relative risk of secondary hemorrhage following TLH compared to TAH and VH were 2.3 and 2.1, respectively. Both were statistically significant. The average size of the uterus in the TLH group was 516.7 g, and in the TAH and VH group, it was 140 and 142.5 g, respectively, which was statistically significant. The median time interval between hysterectomy and secondary hemorrhage was 11 days in TAH and VH group and 13 days in TLH group. Our data suggest that secondary hemorrhage is rare but may occur more often after TLH than after other hysterectomy approaches. Whether it is related to the application of thermal energy to tissues which cause more tissue necrosis and devascularization than sharp colpotomies in the TAH and VH groups is unclear. Large size of uteri, excessive use of energy source for uterine artery, and colpotomy may play a role.

Efficacy and Safety of Electrothermal Bipolar Vessel Sealer vs ENSEAL in Total Laparoscopic Hysterectomy for Large Uterus: A Comparative Study in Mysuru, South India

“…Another study at the same center reported that cumulative incidence of secondary hemorrhage following TLH was 1.3%. 12,13 Large uterus size, excessive use of energy source, vaginal vault hematoma, or infection could be the possible factors. A total of three cases of secondary hemorrhage were detected in our study and were managed conservatively by vaginal packing and tranexamic acid.…”

Barbed vs Polyglactin 910: A Comparative Study of the Efficacy in Laparoscopic Vaginal Cuff Closure

“…3 However, longer operative duration and higher rates of complications, such as secondary hemorrhage, lower urinary tract injuries, and vaginal cuff dehiscence, have been reported more in laparoscopic than abdominal hysterectomy probably due to increased use of thermal energy by electrocoagulation. [8][9][10][11] These limitations are mostly due to longer learning curve required for laparoscopic procedures as well as for laparoscopic closure of vaginal vault. 9 In laparoscopic surgeries, the surgeon enters the body cavity through a small incision and operates with a limited range of motion.…”

Conservative endovascular management for intractable delayed hemorrhage after laparoscopic-assisted vaginal hysterectomy: Two case reports

“…Hysterectomy is a common gynecological surgical procedure performed for benign and malignant conditions [ 1 ]. Hemorrhage after hysterectomy is an infrequent but potentially life-threatening complication that may require immediate intervention [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] ].…”

“…Hysterectomy is a common gynecological surgical procedure performed for benign and malignant conditions [ 1 ]. Hemorrhage after hysterectomy is an infrequent but potentially life-threatening complication that may require immediate intervention [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] ]. In addition to reactionary hemorrhage, which is defined as occurring 24–48 h after hysterectomy [ [2] , [3] , [4] , 8 ], delayed hemorrhage from the vaginal stump, which occurs thereafter, is of significant concern and may be life-threatening [ 1 , [5] , [6] , [7] , [8] ].…”

“…Most cases involving delayed hemorrhage can be managed by vaginal packing with or without transvaginal suturing of the vaginal vault [ 1 ]. However, the failure of such primary management results in a diagnostic and therapeutic challenge requiring urgent further intervention [ 1 , [6] , [7] , [8] ].…”