Lateral Approach Technique to Minimize Bladder Injury During Abdominal Hysterectomy in Cases with Previous Cesarean Sections: An Observational Study

Objective: to evaluate the safety and efficacy of Lateral approach technique to avoid bladder injury during total abdominal hysterectomy in cases with previous Cesarean section. Methods:This prospective observational study included 150 patients with previous cesarean deliveries who were candidates for total abdominal hysterectomy due to various indications.Enrolled patients were divided in two groups; Group 1 included 75 patients to whome the urinary bladder was dissected from the uterus by classical central approach and Group 2 included 75 patients to whome the bladder was dissected from the uterus by lateral approach technique.The rate of intraoperative bladder injury, operative time and late urological complications were the main outcome measures.Data was collected and tabulated.Results: there was significant statistical difference between two groups as regarding urinary bladder injury (<0.05) with only one case of bladder injury in group 2 compared to 10 cases in group one.The duration of the procedure was shorter in group 2 (p<0.001).Group one Patients need excessive analgesia (<0.05 ), post-operative fever increased in group one (<0.001).Group one Patients need blood transfusion (<0.05 ) and hospital stay more than group 2 (<0.001). Conclusion:lateral approach technique for bladder dissection was safer and faster in preventing bladder injury during total abdominal hysterectomy compared to the classical central approach.Larger multicenter trials are warranted to enforce or refute these findings.