Abdominal Hysterectomy - Vaginal Hysterectomy - Laparoscopically Assisted Vaginal Hysterectomy

The 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.

Design:

Prospective series of consecutive patients (Canadian Task Force classification II-3).

Setting:

Single surgery team, independent surgery center.

Patients:

Women with symptomatic uterine leiomyomata, abnormal uterine bleeding, dysmenorrhea, or chronic pelvic pain.

Intervention:

Laparoscopic supracervical hysterectomy (with concurrent bilateral salpingo-oophorectomy if required), along with laparoscopic biopsy sampling of the cervical stump.

Measurements and Main

Results:

From 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.

Conclusion:

Our 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.

Please click on the required question.

• 1 Are heavy periods a common problem?
• 2 What is in my menstrual flow?
• 3 What range of menstrual cycle length is considered to be normal?
• 4 How can menstrual blood loss be measured?
• 5 How can I tell if my periods are abnormally heavy?
• 6 What could be the cause of my very heavy menstrual periods?
• 7 I have been sterilised. Could this be the cause of my heavy periods?
• 8 Should I have tests to find the reason for my heavy periods?
• 9 How will my heavy period problems be investigated?
• 10 What is meant by anaemia due to heavy periods?
• 11 What is intermenstrual bleeding?
• 12 What is a hysteroscopy and D and C?
• 13 What is cervical cautery?
• 14 What happens after the D and C?
• 15 What treatments are available for my heavy periods?
• 16 What are the medical treatments available for heavy periods?
• 17 How do the various medical treatments for heavy periods work?
• 18 What would be reasonable initial treatment for a teenager or young woman with heavy periods?
• 19 What is a hysterectomy?
• 20 What are the indications for hysterectomy?
• 21 What are the risks (complications) of hysterectomy?
• 22 What is vault granulation?
• 23 What are the different types of hysterectomy?
• 24 Is it essential to remove the neck of the womb at hysterectomy?
• 25 Should my ovaries be removed or conserved during hysterectomy?
• 26 How long will I be in hospital when I have my hysterectomy?
• 27 I have had a hysterectomy. Do I still need to have smear tests?
• 28 What are the other surgical alternatives to hysterectomy?
• 29 How do endometrial ablation and hysterectomy compare?
• 30 Are there any psychological effects following hysterectomy?
• 31 How do we decide the best treatment for my period problems?
• 32 Could I have some recommended hysterectomy support groups?
• 33 Are there any support groups?
• Intermenstrual Bleeding - Bleeding between periods.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.