Complications of Hysterectomy

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Abstract
The following article reviews the major complications of hysterectomy, including infection, hemorrhage, and injury to adjacent organs. These complications are discussed for abdominal hysterectomy (AH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (LH). Many of the complication rates for AH and VH were determined by the Collaborative Review of Sterilization (CREST) project that ran from 1978 to 1981. The results of this landmark study were published in 1981 by Dicker et al.1 and have proven to be quite durable. They remain the most frequently quoted complication rates for traditional hysterectomy procedures. In this article, laparoscopic hysterectomy is a cumulative term that includes laparoscopically assisted vaginal hysterectomy, laparoscopic supracervical hysterectomy, and total laparoscopic hysterectomy. It is believed that the similarities of these procedures warrant their inclusion as a single entity. Complication rates for laparoscopic hysterectomy are drawn predominantly from two recently published reviews.2,3 There is a proliferation of reports on LH at present, and these rates therefore may change in the near future. The final portion of this article is devoted to more subjective problems of patients such as psychosexual dysfunction and bladder symptoms. These problems are much more difficult to quantify in clinical practice. Nevertheless, they certainly are considered complications by patients. Gynecologic surgeons commonly will deal with these issues in the postoperative period, and therefore a brief review is provided.