Bladder injury after LAVH: a prospective, randomized comparison of vaginal and laparoscopic approaches to colpotomy during LAVH

Abstract

Study objective: To compare results of a vaginal approach to colpotomy (type IA) and laparoscopic-assisted abdominal colpotomy (type ID) in performing a laparoscopic-assisted vaginal hysterectomy (LAVH).

Design: Prospective, randomized study (Canadian Task Force classification I).

Setting: Tertiary teaching hospital.

Patients: Five hundred forty-one women, 274 in group 1 (type 1D) and 267 in group 2 (type 1A).

Intervention: LAVH with follow-up for 3 months to 5 years.

Measurements and main results: There were no statistically significant differences in age, preoperative and postoperative hemoglobin values, or postoperative hospital stay between groups. Operating time and estimated blood loss were significantly reduced in group 2 (p <0.001 and <0.001, respectively). Women in group 1 had nine urinary tract injuries (3.28%), including eight cases of intraoperative bladder injury (2.91%) and one vesicovaginal fistula (0.36%), but no ureteral injury. The bladder injury rate in group 2 was 0.37%, which was significantly lower (p = 0.038). There were no significant differences in ureteral or bowel injuries, pelvic hematomas, or pelvic abscesses.

Conclusion: LAVH type IA achieved better results than type ID in preventing bladder injury.