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. © 2013 Springer-Verlag Berlin Heidelberg.