[Hysterectomy for benign lesions: what remains for the abdominal route?].

Objective: We conducted a prospective study to assess what indications remain for abdominal hysterectomy for benign conditions.

Patients And Methods: Four hundred fifty-three hysterectomies were performed for benign conditions between April 4, 1996 and December 14, 1998 in our unit. Abdominal hysterectomy was chosen for large uteri, when vaginal access was unusable, or in case of suspected post-operative pelvic adhesions.

Results: We performed 330 vaginal hysterectomies (72.85%), 71 laparoscopy-assisted vaginal hysterectomies (15.6%) and 52 abdominal hysterectomies (11.4%). In 10 cases, laparoconversion was required when a vaginal or a laparoscopy-assisted hysterectomy was complicated by pelvic adhesions or poor vaginal access. Mean operative time for abdominal hysterectomy was 130 minutes and mean blood loss was 504 ml. Mean uterus weight was 612 g and mean hospital stay 6.4 days. We had 6 complications (11.53%) (one bladder injury, one ilial injury and four cases of intraoperative hemorrhage).

Discussion: Our experience showed that the rate of complications is greater with laparoscopic hysterectomy due to patient selection and should be performed by trained surgeons.