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CC BY-NC-ND 4.0 · Surg J (N Y) 2021; 07(S 01): S38-S45
DOI: 10.1055/s-0041-1728752
Precision Surgery in Obstetrics and Gynecology

Cesarean Hysterectomy for Placenta Previa Accreta Using Retrograde Abdominal Hysterectomy Approaching from the Posterior Vaginal Wall

Yuji Hiramatsu
1   Department of Obstetrics & Gynecology, Okayama City General Medical Center, Okayama, Japan
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Abstract

Hysterectomy for placenta percreta with bladder invasion is a difficult operation because of the high possibility of massive bleeding; therefore, surgery should be performed in a facility equipped with a sufficient number of trained staff. The degree of bladder invasion should be assessed correctly before the operation, and it is necessary to carefully consider how to address intraoperative complications and massive bleeding in the preoperative conference. The following should be prepared preoperatively: autologous blood and stored blood; ureteral catheter and insertion materials; materials to separate and tape the internal iliac artery and ureter; balloon for insertion into the common iliac artery or aorta and aortic clamps; and materials for compression suturing, such as B-Lynch suture. Sufficient informed patient consent is also required. During surgery, which may cause massive and sometimes life-threatening bleeding, the general rule is to begin at a safe site without adhesions and then treat the adhesion site. According to this rule, bladder dissection should be performed last in cases of placenta percreta with bladder invasion. As a surgical technique using this principle, we introduce retrograde hysterectomy approaching from the posterior vaginal wall.

Keywords

cesarean hysterectomy - placenta previa accreta - bladder invasion - retrograde abdominal hysterectomy - posterior vaginal wall


Publication History

Article published online:
12 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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