Laparoscopy vs. Laparotomy for Management of Postpartum Complications—A Retrospective Cohort Study

TL;DR

This study compares laparoscopy and laparotomy for postpartum complications, finding laparoscopy can be a viable alternative with shorter hospital stays.

Contribution

The study demonstrates laparoscopy's feasibility and benefits for selected postpartum surgical cases.

Findings

Laparoscopy and laparotomy had comparable operative times.

Laparoscopy resulted in shorter postoperative admissions.

Laparoscopy was mainly used for uterine scar defects, while laparotomy was used for suspected bleeding.

Abstract

Background: Postpartum complications requiring surgical intervention are challenging due to physiologic and anatomic changes. While laparotomy remains standard, laparoscopy is increasingly used. We compared outcomes of laparoscopic management of postpartum complications versus open management of postpartum complications. Methods: This retrospective cohort study included patients undergoing surgical intervention within three weeks postpartum at a single tertiary center between 2010 and 2023. Approach selection was primarily time-dependent, following an institutional practice change in 2020. Demographic, operative, and postoperative outcomes were compared. Results: Sixty-two participants with postpartum complications necessitating surgical intervention were included: 54 in the laparotomy group and 8 who underwent laparoscopy. Demographic characteristics were similar between groups. The main indication for laparoscopy was suspected uterine scar defects (p = 0.006), while laparotomy was obtained mainly in cases of suspected bleeding (p = 0.001). Both groups had comparable operative time, though the laparoscopy group had a shorter postoperative admission (p = 0.043). Conclusions: Laparoscopy is feasible for various postpartum complications. It offers comparable operative times to laparotomy with shorter postoperative admissions. Therefore, it is a promising alternative in selected cases when surgical expertise is available.