# Secondary Hemorrhage After Total Laparoscopic Hysterectomy: An Observational Study

## TL;DR

This study identifies risk factors for secondary bleeding after a laparoscopic hysterectomy, focusing on elevated BMI and cervical issues.

## Contribution

The study provides new insights into risk factors for postoperative secondary hemorrhage after total laparoscopic hysterectomy.

## Key findings

- 12 out of 50 patients (24%) experienced secondary hemorrhage after TLH.
- Elevated BMI and cervical pathology were significantly associated with secondary hemorrhage.
- Age, childbirth history, and prior surgeries were not significant risk factors.

## Abstract

Background

Secondary hemorrhage post total laparoscopic hysterectomy (TLH) is defined as bleeding per vagina after 24 hours up to 6 weeks after the primary surgery. The purpose of the study is to determine the possible risk factors for secondary hemorrhage after TLH and how to manage it medically.

Methods

A prospective observational study with all patients who underwent TLH under the author from 1st January 2023 to 31st December 2023, for indications requiring hysterectomy and suffering bleeding per vaginum starting from 24 hours until 6 weeks after the primary surgery were included in this study. Patients with a known history of bleeding disorders or those on oral/ parenteral anticoagulant medications were excluded.

Results

A total of 50 patients underwent TLH during the study period and 12 (24%) had secondary hemorrhage after hysterectomy. A significant p-value was noted in elevated BMI (0.037) and cervical pathology (0.036). There was found to be no significance in age, last childbirth, prior pelvic surgeries, pelvic adhesions, and other pelvic pathologies.

Conclusion

With more preference given to TLH than other modalities of hysterectomy, caution should be exercised regarding the potential risk factors. In patients with elevated BMI as well as cervical pathologies, necessary precautions should be taken as elaborated in the Discussion section.