The Effect of a Previous Laparoscopic Surgery on the Risk for Peri- and Postoperative Complications of Vaginal Hysterectomy

Objectives: To investigate whether a previous laparoscopic surgery (LS) increases the risk of peri- and postoperative complications during vaginal hysterectomy (VH). Methods: A retrospective cohort study of patients who had undergone a VH for benign indications between 2014 and 2019 was conducted. The study population was divided into two groups, women with or without a previous laparoscopic surgery. Peri- and postoperative complications were assessed according to the Clavien-Dindo classification system within 30 days of surgery. Estimated blood loss, duration of surgery, and postoperative hospitalization days were also recorded. All analyses with a two-sided p-value of ≤ 0.05 were considered significant. Results: Of 240 women who underwent VH during the study period, 160 had no history of laparoscopic surgery, and the remainder (n = 80) had undergone a previous laparoscopy (study group). Women in the study group had a lower mean estimated blood loss during VH (p < 0.01) and a higher median of postoperative hospitalization days (p = 0.05). A previous LS was not found to be associated with a higher grade of peri- and postoperative complications according to the Clavien-Dindo classification (p > 0.05). We performed a sub-analysis dividing previous LS (gynecological vs. other) and found that 76.5% of patients with GYN LS had complications (grade I-IV) compared with 34.9% (p-value = 0.002). Conclusion: VH for benign indications has an acceptable complication rate and can be safely performed regardless of a previous LS. Previous pelvic LS may increase the risk for minor complications during VH.