Non decent vaginal hysterectomy: personal experience of 105 cases

Suman Mehla, Nimmi Chutani, Monika Gupta

Abstract


Background: Objective of current study was to evaluate the feasibility of performing vaginal hysterectomy for non-prolapsed uterus as a primary route.

Methods: A hospital based prospective study was conducted at department of obstetrics and gynaecology of SMS & R from 1st January 2011 to 31st August 2014. All the patients undergoing non-descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size, estimated blood loss, length of operation, complication and hospital stay were recorded.  

Results: A total of 105 cases were selected for non-descent vaginal hysterectomy. All 105 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 48.6%. All patients were parous. Uterus size was <8 weeks in 72 cases and >8 weeks in 33 cases. Commonest indication was AUB (45.7%). Mean duration of surgery was 90 minutes. Mean blood loss was 205 ml. The most common complication was post –operative pain in 21.9% of cases. Febrile morbidity was present in 9.5% of cases. Blood transfusion was required in 4 cases. Average duration of hospital stay was four days.

Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible, more economical and effective. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration. Today in the era of minimally invasive surgery, non-descent vaginal hysterectomy needs to be considered and seems to be a safe option. 


Keywords


Non-descent vaginal hysterectomy, Morcellation, Safety

Full Text:

Untitled

References


Sheth SS. Vaginal hysterectomy. In: Puri R, Malhotra N, eds. Operative Obstetrics and Gynaecology. 1st ed. New Delhi. Jaypee Brother’s Medical Publishers. 2009: 499-510.

Sheth SS, Paghdiwalla KP. Vaginal hysterectomy. In: Saraiya UB, Rao AK, Chateerjee A, eds. Principles and Practice of Obstetrics and Gynaecology. 2nd ed. New Delhi. Jaypee Brother’s Medical Publishers; 2003: 374-380.

ACOG Committee Opinion No. 444: Choosing the route of hysterectomy for benign disease. Obstet Gynaecol 2009 Nov;114(5):1156-8.

Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynaecol. 2007 Nov;110(5):1091-5.

Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009 Jul;(3):CD003677.

McCracken G, Hunter D, Morgan D, Price JH. Comparison of laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy and vaginal hysterectomy. Ulster Med J. 2006;75(1):54-8.

Precis I. An update in obstetrics and gynecology. In: Precis I, eds. CD-ROM. Washington, DC: American College of Obstetricians and Gynaecologists; 1989.

Kovac S. Hysterectomy outcomes in patients with similar indications. Obstet Gynaecol. 2000;95:787-93.

Nimaroff M, Dimino M, Maloney S. Laparoscopic-assisted vaginal hysterectomy of large myomatous uteri with supracervical amputation followed by tracelectomy. J Am Assoc Gynaecol Laparosc. 1996;3:585-7.

Dewan R, Agarwal S, Minocha B, Sen SK. Non-descent vaginal hysterectomy: an experience. J Obstet Gynaecol India. 2004;54(4):376-8.

Bharatnur S. Comparative study of abdominal versus vaginal hysterectomy in non-descent cases. Internet J Gynaecol Obstet. 2011;15(2):1528-39.

Bhadra B, Choudary AP, Tolassaria A, Nupur N. Non-descent vaginal hysterectomy (NDVH): personal experiences in 158 cases. AL Ameen J Med Sci. 2011;4(1):23-7.

Purohit RK, Tripathy PN, Patnaik AK. Vaginal hysterectomy using electrocautery and Purohit approach to uterine artery. J Obstet Gynaecol India. 2003;53:475-8.

Ottosen C, Lingeman G, Ottosen L. Three methods of hysterectomy: a randomized, prospective study of short term outline. BJCOG. 2000;107:1380-5.

Guvenal T, Ozsoy AZ, Kilcik MA, Yanik A. The availability of vaginal hysterectomy in benign gynaecological diseases: a prospective, non-randomized trial. J Obstet Gynaecol Res. 2010;36:832-7.

Singh A, Bansal S. Comparative study of morbidity and mortality associated with non-descent vaginal hysterectomy based on ultra sonographic determination of uterine volume. Int Surg. 2008;93(2):88-94.

Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynaecol Surv. 1995;50:795-805.

Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patient characteristic or physician preference. Am J Obstet Gynaecol. 1995;173(5):1452-60.