Prior cesarean delivery and risk of conversion to laparotomy during laparoscopic hysterectomy

Objective: The goal of this study was to test the hypothesis that a history of previous cesarean delivery does not increase the risk of conversion to laparotomy in patients undergoing laparoscopic supracervical hysterectomy (LSH) for benign gynecologic indications. Design: This was a retrospective cohort study. Materials and Methods: A retrospective cohort study was conducted of 799 patients who underwent LSH for benign gynecologic indications between January 2003 and December 2009. Results: There were a total of 16 (2%) conversions. The patients who underwent conversion were 5 times more likely to have a uterus that weighed ≥250 g (odds ratio [OR]: 5.2; 95% confidence interval [CI]: 1.8-17.4) and 3 times more likely to have had previous cesarean delivery (OR: 3.0; 95% CI: 1.1-8.0). These patients were also significantly more likely to need concomitant adhesiolysis in addition to the primary procedure (OR: 3.5; 95% CI: 1.2-9.8). However, after controlling for confounders (body mass index, blood loss, concomitant adhesiolysis, previous cesarean delivery, and uterine weight) only the presence of previous cesarean delivery ≥3 cesearean deliveries (adjusted odds ratio [AOR]: 6.41; 95% CI: 1.24-33.48; p=0.03) and uterine weight ≥250 g (AOR: 6.51; 95% CI: 1.74-24.38; p=0.005) were associated with conversion to laparotomy. Conclusions: The rate of conversion to laparotomy during LSH increases with history of ≥3 previous cesarean deliveries and uterine weight ≥250 g. (J GYNECOL SURG 29:275)