Comparative study between vaginal and abdominal hysterectomy in non-descent cases

Abstract

INTRODUCTIONHysterectomy, abdominal, vaginal or laparoscopic assisted vaginal hysterectomy is the most commonly performed elective major gynaecological surgery. 1 The current ratio of abdominal to vaginal hysterectomy is 3:1 for the treatment of benign disorders. The ratio should be reversed because fewer post-operative complications are associated with the vaginal route, which allows earlier recovery and return to work. 2Vaginal Hysterectomy is a technique that had already been introduced and performed centuries ago but with little success among gynaecologist probably because of an in experience or lack of enthusiasm among gynaecologist who performed the abdominal route believing it to be safer and easier procedure. In recent decade increased expertise has been achieved by the gynaecologist and better compliance has been reported by the patients. This has led to increased number of vaginal hysterectomies compared to abdominal hysterectomies.Vaginal surgery is least invasive and results in better quality of life. Many nulliparous women and many women who have undergone caesarian delivery do infact have sufficient vaginal capacity to allow vaginal hysterectomy. As long as surgeon can obtain adequate ABSTRACT Background: Hysterectomy is the major gynaecological surgery performed by gynaecologist all over the world. Various approaches have been tried by gynaecologist all over the world including abdominal, vaginal, laparoscopic, notes and robotic hysterectomy. Vaginal approach greatly reduces complications, decreases hospital stay, lowers hospital charges, post-operative discomfort and cosmetically better compared to abdominal and laparoscopic approaches. Vaginal hysterectomy in large sized uterus can be facilitated by bisection, myomectomy, debulking, coring and clamp less approach. The aim and objective of the study was to compare outcome of NDVH with outcome of TAH in terms of post-operative morbidity and duration of hospital stay. Methods: A total of 100 cases were selected with enlarged uterus of which 50 underwent NDVH and rest 50 underwent TAH. All patients were evaluated for operative time, intra-operative and post-operative complications and duration of hospital stay. Data were recorded and processed and standard statistical software were used. Results: Patients undergoing NDVH had an average operating time of 48.68 mins whereas for those undergoing TAH was 92.52 mins ('p'-value <0.001). Intra-operative complications were noted in 2% of patients undergoing NDVH whereas in 20% of patients undergoing TAH ('p'-value 0.016). Post-operative complications were noted in 34% of patients undergoing NDVH v/s 70% in TAH ('p'-value <0.001). Patients undergoing NDVH had a mean hospital stay of 5.96 days whereas 9.10 days in those undergoing TAH ('p'-value <0.001). Conclusions: NDVH is associated with decreased operative time, post-operative morbidity, early ambulation and early discharge from hospital compared to TAH.

Comparison of morbidity associated with non-descent vaginal hysterectomy and total abdominal hysterectomy

“…11 Chavhan RP et al, reported fever in 24% vs 16% cases, UTI in 4% vs 8% cases, paralytic ileus in 8% vs nil in TAH and NDVH group respectively. 23 Abrol S et al, reported fever in 26% vs 6% cases, UTI in 6% vs 2% cases,and paralytic ileus in 6% vs nil in TAH and NDVH group respectively. 24 In the present study, author found wound infection rate in the TAH group to be 6% with no cases in NDVH group.…”

“…25 Chavhan RP et al, stated that there is one case of bowel injury in TAH group. 23 Mehta K et al, reported one case of bladder injury in NDVH group and one case of bowel injury in TAH group and 4 cases of ureteric injury in TAH group. 11 In this study, the Mortality rate was also nil in both the study groups.…”

A comparative study between total abdominal hysterectomy and non-descent vaginal hysterectomy

“…On extensive review of literature and comparison of all the parameters with other studies, our results were comparable to other studies. 1,2,[4][5][6][7] NDVH was found to be safe and effective operative technique for benign gynaecological conditions and should be offered whenever possible, considering safety, better operative outcome and cost effectiveness.…”

“…They return to normal day to day activities faster, as the recovery time is shorter than those undergoing abdominal surgeries. 2 It also offers better functional capacity and improved pain assessment. The American college of Obstetricians and Gynecologists committee opinion recommends the vaginal https://doi.org/10.18231/j.ijogr.2020.032 2394-2746/© 2020 Innovative Publication, All rights reserved.…”

“…3 The once thought contraindications of vaginal hysterectomy like narrow pubic arch, immobile uterus, previous cesarean section, enlarged uterus can be successfully attempted by non descent vaginal hysterectomy. 2 The aim of the current study was to compare Total abdominal hysterectomy (TAH) and Non-descent vaginal hysterectomy (NDVH) with respect to duration of surgery, intra and post operative complications, hospital stay in women with benign disorders.…”