ANALYSIS OF ANTERIOR VS. LATERAL APPROACH OF BLADDER DIS- SECTION DURING TOTAL LAPAROSCOPIC HYSTERECTOMY IN PREVI- OUS CAESAREAN: A COMPARATIVE STUDY

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Dr. Vidya V Bhat
Dr. Leela Sravanthi Veeradhi
Dr. Puneetha J

Abstract

Background: Total laparoscopic hysterectomy (TLH) in patients with a previous history of caesarean section presents with challenges due to the increased incidence of intraabdominal and bladder adhesions. Conventionally bladder dissection during TLH is done by the anterior approach. But, the presence of dense bladder adhesions poses an increased risk for blad- der injury. The lateral approach for bladder dissection is an alternative technique during TLH which helps to safely overcome difficulties during bladder adhesiolysis.


Objective: To analyse and compare the complication rates and feasibility between the anterior and lateral approaches of bladder flap dissection during TLH in patients with previous caesarean deliveries.


Materials and methods: This comparative study was conducted at a dedicated high-volume gynaecologic laparoscopy cen- tre. A total of 200 patients who underwent TLH for benign indications were included irrespective of the size of the uterus or the number of previous caesarean sections. Total 100 patients underwent anterior approach and 100 patients underwent lateral approach of bladder flap dissection.


Results: During anterior approach 48 out of 100 patients had increased intra-operative bleeding, whereas only 27 out of 100 patients had increased intra-operative bleeding during lateral approach (P=0.00216). The mean time taken to perform the anterior approach was 15.21 minutes, whereas to perform lateral approach it was only 6.84 minutes (p=<0.00001). In anterior approach 58 patients required 11-15 mins for bladder dissection, whereas 42 patients required 16-20 minutes while in lateral approach, 14 patients required 0-5 minutes for bladder dissection, whereas 86 patients required 6-10 minutes (p=<0.00001). Two bladder injuries were encountered during anterior approach whereas none during lateral approach.


Conclusion: The lateral approach of bladder dissection can be safely used as a superior technique in terms of easier feasibil- ity, reduced intra-operative bleeding, no bladder injuries and overall efficiency in terms of shorter operative time.

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