Factors associated with complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomy.

Song, Taejong; Kim, Tae-Joong; Kang, Heeseok; Lee, Yoo-Young; Choi, Chel Hun; Lee, Jeong-Won; Kim, Byoung-Gie; Bae, Duk-Soo

OBJECTIVE To identify risk factors for complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomy (LAVH). DESIGN Retrospective study. SETTING Tertiary referral hospital. POPULATION All 2012 consecutive women who underwent LAVH for non-malignant diseases in a single institution. METHODS Retrospective study. MAIN OUTCOME MEASURES Operative complications and conversion to laparotomy. RESULTS Most of the LAVHs were successful, but conversion to laparotomy was required in 97 women (4.8%) because of pelvic adhesion (n= 71), large uterine size (n= 18) or bowel injury (n= 8). There were 45 women (2.2%) with complications (bladder injury, 26; bowel injury, 9; vascular injury, 9; and ureteral injury, 1). A history of previous cesarean section (twice or more) was a significant risk factor for complications [odds ratio (OR) 3.38]. A body mass index ≥30 kg/m(2) (OR 2.98), history of previous myomectomy (OR 6.19) and uterine weight ≥500 g (OR 3.24) independently influenced the risk of conversion to laparotomy. CONCLUSIONS Risk factors identified in this study include a history of previous cesarean section (twice or more) and myomectomy, body mass index ≥30 kg/m(2) and uterine weight ≥500 g. The findings may be useful in counseling women preoperatively about the potential complications of LAVH.