Operative injuries during vaginal hysterectomy

Objective: To evaluate incidence, characteristics and consequences of urina ry and intestinal tract injuries during vaginal hysterectomy for benign con ditions. Study Design: From January 1970 to December 1996, 3076 vaginal hys terectomies with or without additional procedures, were performed for benig n conditions in our department. We retrospectively analyzed operative injur y cases. Results: Incidence of urinary and intestinal tract injuries were 1 .7 and 0.5%, respectively. Concerning urinary tract injuries, we observed o nly one ureteral lesion, all others being bladder lacerations (54 cases). T he bladder lacerations occured during the hysterectomy step of the surgery in 61% of cases and during the additional procedures in 39%. All bladder in juries were recognized and treated during the primary operation. We observe d four cases of vesico-vaginal fistula as a consequence of these injuries; all fistulas occured after bladder laceration during the hysterectomy step of the surgical procedure. Intestinal tract injuries (16 cases) were rectal lacerations occuring during the hysterectomy step of the surgery (31% of c ases) and during the additional procedures (69%). All rectal injuries were recognized and repaired during the primary operation and all healed without sequellae. Conclusion: Operative injuries during vaginal hysterectomy are relatively rare. They are easily recognized and treated during the primary operation without important sequellae. (C) 2001 Elsevier Science Ireland Lt d. All rights reserved.