Laparoscopic treatment of hemorrhage after vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH)

Background: This study examines the use of laparoscopy for the treatment of secondary hemorrhage following vaginal or laparoscopically assisted vagina l hysterectomies (LAVH). Methods: Over a 5-year period, the incidence and management of postoperativ e bleeding following vaginal hysterectomies or LAVH were registered prospec tively. Results: The overall incidence of hemorrhage after vaginal hysterectomies o r LAVH was 1.2% (17 of 1319). Over the 5-year period, it decreased from 2.4 % (five of 209) to 0.6% (two of 315). Surgical revision was initiated trans vaginally in nine patients and by laparoscopy in eight patients. Five of th e eight patients profited from the prompt use of laparoscopy; inconclusive vaginal exploration was followed by laparoscopy in another five patients. Conclusion: Hemorrhage following vaginal hysterectomy or LAVH can be treate d by laparoscopy in the majority of patients. Laparoscopy is recommended if the source of bleeding cannot be identified clearly by vaginal examination and/or if an intraabdominal bleeding source is suspected.