FEATURES OF LAPAROSCOPIC HYSTERECTOMY IN WOMEN WITH A HISTORY OF CESAREAN SECTION

Azim A. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Goal. Assessment of the severity of adhesions after cesarean section, as well as identification of the risk of complications during hysterectomy in this contingent of women. Methods. Videos of 550 laparoscopic operations performed between 2013 and 2015 were viewed. 44 (8.0%) of these patients had a history of one or more caesarean sections. Among them, the number of women operated on for hysterectomy with a history of CS was 10 (22.7%±6.3). Women with a history of at least one caesarean section, as well as those who underwent a hysterectomy, were included in the study. The exclusion criteria were patients with a history of any other operations in the base and abdominal cavity, patients with inflammatory diseases in the pelvic region or endometriosis, cancer patients. Results. All patients were in the age group of 40 years or more. The average age of the patients was 50.4 ± 1.1 (46-57). Moderate adhesions were observed in 4 women and intensive adhesions in 6 women. The average age of patients with moderate to severe adhesions was approximately the same. All the splices found were multiple (100%). The spikes are predominantly localized in the lower center pelvic 33,3%±8,61. 23.3%±7.72 adhesions were located in the lower left. 13.3%±6.21 adhesions had a Central location, 13.3±6.21 in the upper right area and 13.3±6.21 in the lower right area. The smallest spikes were located in the right lateral region of 3.3±3.28. In 76.7%±7.72 cases, the adhesions were sufficiently dense and required acute dissection. In 13.3±6.21 cases, very strong vascularized adhesions were found, which required acute dissection and also entailed a risk of damage. Cesarean section does not pass without a trace for patients. Adhesive process of varying severity is observed in almost all women with abdominal delivery in history. Intense adhesions between the omentum, intestinal loops and the anterior abdominal wall create obstacles to penetration into the abdominal cavity. Dense adhesions of the uterus with the anterior abdominal wall and bladder in these patients lead to visual changes in the anatomy of the pelvic cavity. Also, patients with a history of cesarean section should expect an extension of the time of hysterectomy due to technical difficulties and the need for more accurate and careful dissection of fibrotic tissues. Pronounced adhesive process as a consequence of cesarean section formed between the anatomical structures in the pelvis and the abdominal cavity create technical difficulties during hysterectomy. In almost all patients who underwent cesarean section, during hysterectomy, there was a pronounced fibrosis in the retroperitoneal spaces, making it difficult to distinguish topographic landmarks and important structures located here. Dense adhesions of the uterus with the anterior abdominal wall and bladder in these patients lead to visual changes in the anatomy of the pelvic cavity. Conclusion. Having a history of cesarean section increases the risk of damage to the urinary system during hysterectomy and also leads to an increase in the duration of surgery.

caesarean section, adhesions, hysterectomy

1.  Tulandi T, Lyell D. Classification of intra-abdominal adhesions after cesarean delivery. J. Gynecol Surg. 2013;10:25-9.
2. Savel’eva GM. Kesarevo sechenie i ego rol’ v sovremennom akusherstve. Akusherstvo i ginekologija. 2008;3:10-4. [in Russiаn].
3. Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol. 2013;209(4):294-306.
4. Atlasov VO. Sovremennye tehnologii abdominal’nogo rodorazreshenija v profilaktike perinatal’noj smertnosti i zabolevaemosti rodil’nic. Zhurnal akusherstva i zhenskih boleznej. 2008;LVII(1):80-5. [in Russiаn].
5. Shi Z, Ma L, Yang Y, Wang H, Schreiber A, Li X, et al. Adhesion formation after previous caesarean section – a meta-analysis and systematic review. BJOG. 2011;118(4):410-22.
6. Bayramova TE, Bağırova HF. Qarın və çanaq boşluğunun cərrahi əməliyyatlarına məruz qalmış xəstələrdə laporoskopik histerektomiyanın nəticələri. Azərbaycan tibb jurnalı. 2011;4:15-20. [in Azeri].
7. Celle C, Pomés C, Durruty G, Zamboni M, Cuello M. Total laparoscopic hysterectomy with previous cesarean section using a standardized technique: experience of Pontificia Universidad Catolica de Chile. Gynecol Surg. 2015;12:149-55.

«Bulletin of problems biology and medicine» Issue 4 Part 1 (153), 2019 year, 62-65 pages, index UDK 616.381-072.1-089.82

10.29254/2077-4214-2019-4-1-153-62-65