Evaluation of complications of abdominal and vaginal hysterectomy

Abstract

INTRODUCTIONHysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by abdominal and vaginal route. Vaginal hysterectomy (VH) has several advantages over abdominal hysterectomy (TAH), and may be appropriate for up to 80% of benign uterine conditions. 1,2 Evidence supports TAH only when documented pathologic conditions preclude the vaginal route. 3,4 Even recent study in United States shows 82% were TAH, only 13% were VH and 5% were laparoscopic assisted in teaching hospitals.5 Aim of our study is to compare between vaginal route versus abdominal route of hysterectomy in terms of intra operative and post operative complications. METHODSA retrospective study was done in department of Obstetrics and Gynaecology of Sri Manakula Vinayagar Medical College and Hospital in Puducherry, India from January 2010 to July 2012. Study was done in women who had undergone vaginal or abdominal hysterectomy in that period. Women in any age group who underwent vaginal or abdominal hysterectomy for benign conditions were included in the study. Women who underwent hysterectomy for uterine prolapse, indications that would generally require an abdominal approach such as endometriosis, pelvic inflammatory disease were excluded from the study. Vaginal hysterectomy was done in those with uterine size ≤ 14 weeks, unrestricted uterine mobility, and absence of adnexal pathology.Information such as clinical history, physical examination findings, haemoglobin level preoperatively, indication for ABSTRACT Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by vaginal and abdominal route. Gynaecologic surgeons worldwide continue to use the abdominal approach for a large majority of hysterectomies that could be performed vaginally despite well-documented evidence that vaginal hysterectomy has better outcome. Aim of our study is to compare vaginal route versus abdominal route of hysterectomy in terms of intra operative and post operative complications. Methods: A retrospective study was done in 229 women who had undergone hysterectomy (176 abdominal hysterectomies and 53 vaginal hysterectomies) from January 2010 to July 2012. Information on the indications, operative procedures, and complications were extracted and analysed. Results: The mean duration of surgery in VH group was 79.6 min and that of TAH group was 99.2 min. The mean blood loss was also more in case of TAH group than that of VH group (215ml vs. 167ml). Bladder injury occurred in 1 case in VH (1.9%) and in 4 cases in TAH (2.3%). Ureter injury occurred in 1(0.6%) case in TAH group. Wound infection developed in 10 cases of TAH group whereas only one case in VH group developed vault infection. Conclusions:Vaginal hysterectomy is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and post operative morbidity when compared to abdominal hysterectomy.

Non-descent vaginal hysterectomy versus total abdominal hysterectomy in fibroid uterus: a comparative study in tertiary care hospital in Uttarakhand, India

“…This is similar to the study by Shanthini et al who reported 5.7% incidence of wound infection in the TAH group. 15 Kovac et al reported similar outcome in their comparative study between abdominal and vaginal routes. 16 Bharatnur et al in their study showed that overall post-operative complications are more in abdominal hysterectomy group which is similar to our results.…”

A comparative evaluation of clinical outcome of trans-abdominal hysterectomy, total laparoscopic hysterectomy and vaginal hysterectomy in non-descent cases

“…These results were comparable to the study by Mahasani V et al 9 In the study by Fatima et al bladder injury occur in 4 cases (2.3%) of TAH and 1 case (1.9%) of VH, while ureteric injury occurred only in 1 case (0.6%) of TAH but no case in VH. 10 In the TLH group of our study hemorrhage occurred in 4 patients (13.3%), 1 patient (3.3%) had bladder injury and 1 patient (3.3%) had hemorrhage with ureteric injury ,which was comparable to study by Patel R et al (bladder injury occurred 2 cases of TLH). 7 In Sutasanasuang intra-operative complication rate in TAH was 16.67% which was found comparable to our study (20%).…”

“…In the studies by V. Mahasani et al (TAH 1 hour 20 minutes and NDVH 45 minutes) and Fatima et al (TAH= 99.2 minutes and VH= 79.6 minutes) operating time was less for the vaginal route compared to the abdominal. 9,10 Mean operating time in the TLH group was 142.3±33.7 minutes. In the study by Patel et al in laparoscopic hysterectomy took almost double the time as NDVH (LH 2 to 4 hours; NDVH 1 to 2 hour).…”

Total vaginal hysterectomy (TVH): outcome analysis of 108 cases at a tertiary centre

“…Kumari S et al noted bladder injury in 0.78% patients whereas Shanthini et al noted bladder injury in one (1.9 %) patient. 13,20 We noted bladder injury in three (2.8%) patients and bowel Postoperative complications were minimal which included febrile morbidity and UTI in 7.4% and 6.5% respectively which were tackled successfully. Six patients (5.6%) received blood transfusion either in intraoperative or post-operative patients.…”

“…Blood loss ranged from 30 ml-160 ml in different studies. 13,20 Visceral injuries like bladder and bowel injuries were reported differently in different studies. Kumari S et al noted bladder injury in 0.78% patients whereas Shanthini et al noted bladder injury in one (1.9 %) patient.…”