Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy

Ghomi A, Ali Ghomi, Hantes J, Jeff Hantes, E C Lotze, Lotze EC, Eberhard C. Lotze
Journal of Minimally Invasive Gynecology · 2005 · vol. 12(3) , pp. 201–205 · doi:10.1016/j.jmig.2005.03.008 · PMID:15922975 · W2157842082
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This paper investigates the incidence of cyclical bleeding following laparoscopic supracervical hysterectomy.

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Abstract

Study objectiveThe aim of the study was to estimate the incidence of cyclical bleeding after laparoscopic supracervical hysterectomy (LSH) when the uterus is amputated at or below the level of internal cervical os.DesignProspective series of consecutive patients (Canadian Task Force classification II-3).SettingSingle surgery team, independent surgery center.PatientsWomen with symptomatic uterine leiomyomata, abnormal uterine bleeding, dysmenorrhea, or chronic pelvic pain.InterventionLaparoscopic supracervical hysterectomy (with concurrent bilateral salpingo-oophorectomy if required), along with laparoscopic biopsy sampling of the cervical stump.Measurements and main resultsFrom October 2002 through February 2004, we performed 67 consecutive LSH procedures. At the completion of uterine amputation, two biopsies were obtained from the cervix at 12 o'clock and 6 o'clock positions and submitted for histologic evaluation to identify the tissue type. We assumed the presence of endocervical tissue on cervical biopsy would indicate the uterine amputation took place at or below the level of internal os. All 67 patients were contacted 3- to 15-months postoperatively to inquire about bleeding status, and 64 (96%) responded. The overall bleeding incidence was 12/64 (19%). Among the subgroup with endocervical tissue on biopsy, 7/41 (17%) experienced cyclical bleeding. The continuous variables (i.e., age, body mass index [BMI], parity, uterine weight) and categorical variables (i.e., indications for surgery, status of endometriosis, adenomyosis, endocervical fulguration, cervical biopsy, history of cesarean section) were not statistically significant in association with the bleeding time.ConclusionOur data suggest the overall incidence of post-LSH cyclical bleeding is 19%. When the uterus is amputated at or below the level of internal os, the incidence is 17%. To our knowledge, this is the first study in the medical literature to report on cyclical bleeding after LSH when the uterine amputation is demonstrated to have occurred at or below the level of internal cervical os.

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MeSH descriptors

Hysterectomy Hysterectomy Menstruation Disturbances Adult Female Humans Hysterectomy Laparoscopy Male Menstruation Disturbances Middle Aged Prospective Studies

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