Complicated laparoscopic hysterectomy following trachelectomy for cervical malignancy.

Abstract

Objective: To describe a complicated total laparoscopic hysterectomy, excision of endometriois, ureterolysis and rectopexy after previous radical trachelectomy. Design: Case report. Settings: Regional Community hospital. Patients: Woman undergoing total laparoscopic hysterectomy and excision of endometriosis for treatment of pelvic pain and high risk HPV in setting of previous radical trachelectomy for cervical adenocarcinoma. Interventions: Laparosopic hysterectomy, bilateral salpingectomy, excision of endometriosis, bilateral uretrolysis and rectopexy was performed. Measurements/Results: Radical trachelectomy or cervicectomy is a curative conservative procedure utilized in early cervical cancers where future fertility is desired. The cervix, upper 1–2 cm of the vagina, parametria (tissue adjacent to the cervix), and paracolpos are removed while the uterine body is preserved. A 39 year old woman with past history of cervical adenocarcinoma presented to a regional centre for management of dysmennorrhoea, dyspareunia and HPV 16 + detection on liquid based cervical cytological screening. The client elected to undergo hysterectomy with excision of endometriosis in view of her symptoms and past history of cervical malignancy. Histopathological examination showed squamous metaplasia of cervical transformation zone with focal HPV effect. There was no invasive tumour present. There was cervical and parametrial endometriosis diagnosed and pelvic washings showed cytomorphology in keeping with the excision. Conclusions: I discuss this challenging and uncommon clinical presentation, its operative management and patient outcomes.