ISSN 2736-1594
International Journal of Obstetrics and Gynecology ISSN: 2736-1594 Vol. 11 (2), pp. 001-008, February, 2023. © International Scholars Journals
Full Length Research Paper
The use of a linear cutting stapler for hysterotomy during cesarean hysterectomy for patients with placenta accreta spectrum
1Hoang Yen Nguyen, MD, 2Yevgeniya Ioffe, MD, 2Linda Hong, MD,1Alyssa Sanchez, BS, 1Andrea Cragoe, MD,1Alexander Thomas, MD, 3Ruofan Yao, MPH, MD
1Department of Gynecology and Obstetrics, 2Department of Gynecologic Oncology,3Department of Maternal-Fetal Medicine
Loma Linda University School of Medicine, CA, Loma Linda University Children’s Hospital, Loma Linda, CA.
Accepted 13 October, 2022
Abstract
During a cesarean hysterectomy surgery for placenta accreta spectrum, two procedures contributed to the total surgical blood loss, the uterine hysterotomy portion for fetal delivery and the hysterectomy portion. Previous studies had aimed at decreasing blood loss with techniques targeting the hysterectomy portion. We aimed to evaluate the impact of performing hysterotomy utilizing a linear cutting stapler in minimizing blood loss during cesarean hysterectomy compared to the classical hysterotomy technique with scalpel in patients with suspected placenta accreta spectrum disorders. This was a single-center retrospective cohort study including a total of 95 patients undergoing cesarean hysterectomies over a period of 8 year between January 2014 and January 2022. 31 patients in the intervention group underwent hysterotomy performed with a linear cutting stapler. 64 patients in the control group underwent the classical hysterotomy performed with scalpel. The primary outcomes were quantitative total blood loss, units of red blood cell transfusion, length of postoperative stay, and intensive care unit admission. Compared to the classical hysterotomy group, the linear stapler hysterotomy group was associated with a significant reduction in surgical blood loss (1000mL vs 2553mL (p<0.001)), units of red blood cell transfused (1 vs 3 units (p<0.001)), and postoperative length of stay (3 vs 4 days (p<0.001)). The rates of surgical blood loss of >2000ml in the linear stapler hysterotomy group was 22.6% vs 48.4% (adjusted odd ratio 0.23 [0.06-0.79]). The rate of transfusion of >4unit of pRBC in the linear stapler hysterotomy group was 16.1% vs 48.4% (adjusted odd ratio 0.26 [0.07-0.97]). The method of performing hysterotomy utilizing a linear cutting stapler was associated with a significant reduction in surgical blood loss, units of red blood cell transfusions, and postoperative length of stay compared to the classical hysterotomy method via scalpel in patients undergoing cesarean hysterectomy for suspected placenta accreta spectrum.
Keywords: Placenta accreta, placental disorders, cesarean hysterectomy, linear stapler, hysterectomy, blood loss, blood transfusion.