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Hum. Reprod. Advance Access originally published online on September 1, 2006
Human Reproduction 2007 22(1):260-265; doi:10.1093/humrep/del336
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals

E. David-Montefiore1, R. Rouzier1, C. Chapron2, E. Daraï1,3 and the Collegiale d’Obstétrique et Gynécologie de Paris-Ile de France

1 Service de Gynécologie-Obstétrique, Hôpital Tenon, Université Pierre et Marie Curie-Paris VI and 2 Service de Chirurgie Gynécologique, Hôpital Baudelocque-Port-Royal, AP-HP, Université Paris V, Paris, France

3 To whom correspondence should be addressed at: Service de Gynécologie-Obstétrique, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France. E-mail: emile.darai{at}tnn.ap-hop-paris.fr

BACKGROUND: Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders. METHODS: Of the 15 university hospitals belonging to Collégiale de Gynécologie-Obstétrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach. RESULTS: In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients’ mean age (±SD), BMI, parity and previous Caesarean sections were 51.4 ± 10.3 years, 25 ± 5.7 kg/m2, 2 ± 1.6 children and 0.2 ± 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P < 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P < 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53–5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39–4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01–4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P < 0.0001). CONCLUSIONS: This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.

Key words: benign disorders/France/hysterectomy/laparoscopy/laparotomy

Services de Gynécologie Obstétrique: Prof. Fernandez and Prof. Friedman, Hôpital Antoine Béclère; Prof. Deval and Prof. Levardon, Hôpital Beaujon; Dr Dhainaut and Prof. Madelénat, Hôpital Bichat; Prof. Paniel, Hôpital Intercommunal de Créteil; Prof. Sibony and Prof. Oury, Hôpital Robert Debré; Prof. Lecuru, Hôpital Européen Georges Pompidou; Dr Ansquer and Prof. Mandelbrot, Hôpital Louis Mourrier; Prof. Fauconnier and Prof. Ville, Hôpital de Poissy; Prof. Bénifla, Hôpital Rothschild; Dr Poncelet and Prof. Cohen-Uzan, Hôpital Jean Verdier


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