Comparative Study of Vaginal Hysterectomy and Total Abdominal Hysterectomy in Non-descent Uterus in a Rural Tertiary Care Center

Abstract

Aim To study the role of vaginal hysterectomy in non-descent uterus and to compare it with abdominal hysterectomy with respect to operative time, intraoperative blood loss and complications, ambulation, and postoperative complications. Materials and methods A prospective non-randomized study was carried out on 200 cases at a rural tertiary care center in B.G. Nagara, Karnataka, India for a period of 18 months after obtaining institutional ethical committee approval. One hundred patients underwent a vaginal hysterectomy, and there other 100 underwent an abdominal hysterectomy for similar indications. Results Mean age, parity, mode of delivery, BMI, uterine size, and anesthesia were similar between the groups. The most common indication was fibroid uterus (50%). It was found that the vaginal hysterectomy group was associated with significantly reduced mean operative duration and a decline in postoperative Hemoglobin when compared to the abdominal hysterectomy group. Patients who underwent vaginal hysterectomy had less postoperative pain and were ambulated earlier and discharged earlier. Also, postoperative complications were more common in those who underwent abdominal hysterectomy. Conclusion Vaginal hysterectomy is a safe and the least invasive route and is associated with lesser complications and should be chosen as the preferred method of hysterectomy, whenever feasible.

Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Hysterectomy: A Randomized Controlled Trial

“…The remaining 87 patients were randomly allocated into three groups (29 patients in each). All allocated patients were followed-up and analyzed statistically, Figure (1). Bradycardia, hypotension, and respiratory depression not occurred to any patients in our study.…”

“…Laparoscopic hysterectomy is a standard gynaecological surgical treatment used to treat a variety of gynaecological conditions [1] . It has distinct advantages over open surgical procedures such as decreased tissue damage, less blood loss, early ambulation, reduced analgesic requirements, avoiding big surgical incision, thereby, allowing quicker recovery, and shorter hospital stay with reduced healthcare expenditures.…”

Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

“…The size of the uterus can affect the ease of removal, and it is unclear whether an enlarged uterus is a contraindication for NDVH (1,4) . The large sized uterus more than 12 week was considered a traditional contraindication by most acting gynecologists who were surveyed for their opinion regrades routs for hysterectomy for benign gynecological diseases as stated in SGS's systematic review attributable to uncertainties about increased technical difficulty and risk of complications (31,33,34) , despite that a lot of pioneered gynecologists worldwide including American (2,3,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) , Canadian (45) , English (46)(47)(48)(49) , Indian (23,50,51) , Chinese (52) , Malaysian (53) ,south Africans (8,9,45,54) , French (4,(55)(56)(57) , polish (1,58) , Italian (59)(60)(61) , Greece (62) , Turkan (63)(64)(65) had been challenged the alleged uterine size as a contraindication for NDVH and they had succeeded in that task with great safety. Therefore, the goal of this retrospective research is to determine...…”