From the Guidelines
Hysterectomy complications vary significantly by surgical approach, with abdominal hysterectomies carrying the highest risk of morbidity and mortality, followed by laparoscopic and vaginal hysterectomies, which have lower risks but still pose significant complications, as reported in the most recent study 1.
Complications by Approach
The complications associated with abdominal, laparoscopic, and vaginal hysterectomies can be broken down as follows:
- Abdominal hysterectomies: larger incisions, more significant pain, longer recovery periods (4-6 weeks), increased infection risk, and more visible scarring, with potential for wound complications, greater blood loss, and higher rates of post-operative ileus 1.
- Laparoscopic hysterectomies: risks of trocar injuries to blood vessels or bowel, CO2 embolism, and shoulder pain from residual gas, with potential for urinary tract injuries, particularly to the ureter, due to limited visibility in some cases 1.
- Vaginal hysterectomies: generally fewer complications overall but may present challenges with limited surgical visibility, potentially leading to unrecognized bleeding or organ injury 1.
Common Risks
All approaches share common risks including:
- Bleeding
- Infection
- Damage to surrounding structures (bladder, ureters, bowel)
- Venous thromboembolism
- Anesthesia complications
- Post-operative issues like vaginal cuff dehiscence, urinary retention, and pelvic floor weakness can occur regardless of approach 1.
Long-term Effects
Cohort studies and registries have reported long-term effects of hysterectomy, including increased risk of cardiovascular disease 1, osteoporosis and bone fracture 1, and dementia 1.
Recommendation
The choice of surgical approach should be individualized based on the patient's specific condition, anatomy, surgical history, and surgeon expertise to minimize potential complications, with a preference for the least invasive route, as supported by the most recent evidence 1.