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Comment and Controversy

The reality of complications at complex vaginal hysterectomy

July 2002 · Vol. 14, No. 7

It is imperative that I clarify the section on complications in my Surgical Techniques article “Complex hysterectomy: opting for the vaginal approach” [April]. Due to a misinterpretation, it was incorrectly stated that “bladder perforation and ureteral damage (entrapment or severance) are common complications of complex vaginal hysterectomy.”

Although bladder perforations and ureteral damage are major concerns with complex vaginal hysterectomy, such mishaps are, in fact, uncommon because of the precise surgical techniques involved. In fact, the risk for these complications is greater with the abdominal approach because it is more difficult to access the lower urinary tract. It is fear of these potential complications that is common, not their actual occurrence.

In truth, the most common complication of complex vaginal hysterectomy is excessive bleeding. This can be avoided by adequately ligating the uterine vessels and injecting vasoconstrictive agents. Proper hemostasis generally eliminates hemorrhage as a complication. Again, the fear of excessive bleeding plus trepidation regarding mechanical accessibility drive the untrained surgeon to unnecessarily pursue the more arduous and less efficient hysterectomy route—via the abdomen.

Marvin H. Terry Grody, MD
Department of OBG
Robert Wood Johnson Medical School
Camden, NJ

The editors respond:

We would like to thank Dr. Grody for elucidating the complications of complex vaginal hysterectomy. Our intent was to alert readers that ureteral and bladder injury were possible complications, not that they occur commonly.

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Vaginal hysterectomy 
with basic instrumentation