Background: The consequences of intraperitoneal dispersion and incomplete removal of morcellated benign uterine tissue are largely unknown. Research on this phenomenon has been limited to small studies. The goal of this study was to identify the indications for and incidence of repeat surgery, following the performance of uncontained uterine power morcellation for laparoscopic supracervical hysterectomy (LSH). In addition we reviewed the histopathology findings at the time of repeat surgery.
Methods: We performed a systematic retrospective chart review of all patients who underwent (LSH) at Kaiser Permanente Southern California Medical Centers between 2006-2013. We identified a total of 47,010 hysterectomies, of which, 5154 were LSH with uncontained power morcellation. Incident and subsequent operative reports and histopathology were reviewed. Descriptive statistics were performed for the cohort.
Results: The most common diagnosis for primary surgery was leiomyomata and abnormal uterine bleeding. Of the 5154 cases, 279 (5.41%) underwent subsequent surgery with a median of 24+25 months following the index surgery. The most common clinical complaint after primary surgery was pelvic pain (n=73, 26.2%) followed by urogynecological symptoms of prolapse and incontinence (n=77, 24%). The majority (n=92, 43.4%) of subsequent non-urogynecological reoperations resulted in benign pathology. Endometriosis was the most common gynecological diagnosis in 65/212 (30.7%) of patients undergoing reoperation and it was a new diagnosis in 86% (n=57/65) of these cases. The overall frequency of subsequent diagnoses was: endometriosis 65/5154 (1.26%), disseminated leiomyomatosis 18/5154 (0.35%) and malignancy 14/5154 (0.27%) including 3/5154 (0.06%) leiomyosarcoma.
Conclusion(s): Post-operative sequelae resulting in reoperation occurred in 5.4% of patients who had uncontained power morcellation. Morcellation appears to have resulted in new endometriosis in 30 % of patients who underwent a second surgery, this additional information may be beneficial during pre-operative counseling and planning. Further research is required to fully evaluate this finding