Indications and Contraindications of Vaginal Hysterectomy

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.

“…Safety and economic efficiency are crucial factors in determining hysterectomy route selection. In the latest hysterectomy route trend, VH has increased from 15/100,000 to 75/100,000 (66) . Despite that, VH is recommended by evidence for benign conditions to hysterectomy due to extensively documented health issues involving fewer morbidities, infections febrile episodes, shorter hospital stays, recuperation time and economic benefits versus TAH, TLH, RALH (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) .…”

“…The NDVH is underutilized and continues after introduction of industry based TLH, RALH even in high scientific communities (5)(6)(7) . This leads to, the United Healthcare company in USA to demand prior approval for all hysterectomies except those executed vaginally on an outpatient basis beginning April 2015 and, the FDA commended that surgeon no more use laparoscopic power morcellators for hysterectomy or myomectomy in most patients with uterine leiomyomas because of the hazard of disseminating occult cancer (66)(67)(68) . Also, lots of authors and communities has been succeeded in achieving higher rates of VH on expanses of TAH, as in Finland, VH rates improved from18% in 1996 to 44% in 2006 (20) , in Sweden from 4% in 1987 to 31% in 2003 (31) , in university of Witwatersrand, Johannesburg, south Africa where rates of TAH/VH changed from 9/1 in 2001 to 1/1 at 2014 (49,54) .…”

“…Also, lots of authors and communities has been succeeded in achieving higher rates of VH on expanses of TAH, as in Finland, VH rates improved from18% in 1996 to 44% in 2006 (20) , in Sweden from 4% in 1987 to 31% in 2003 (31) , in university of Witwatersrand, Johannesburg, south Africa where rates of TAH/VH changed from 9/1 in 2001 to 1/1 at 2014 (49,54) . Hence, it is crucial to ensure that gynecologists have proper training in performing VH for benign disorders (33,34) as well as possess a comprehensive understanding of the indications (66)(67)(68) , the real and the alleged contraindications with VH (20)(21)(22)(23)(24)(25) . The evidence supporting VH for fibroid uteri up to 12 weeks in size and uterine volume ranging from 250 to 300 cc .…”

“…We gathered the deemed important preoperative, intraoperative, and postoperative data from the medical records for each eligible patient. The preoperative data collection encompassed various demographic details, involving; age, height, weight, and body mass index (BMI), parity, medical history indicating the need for hysterectomy, comorbid conditions such as; diabetes mellitus, hypertensive morbidity, renal disorders, orthopedic issues, hepatic disorders, airway obstructive diseases, any previous abdominal or vaginal surgeries, the preoperative hospital admission to correct preoperative medical disorders as; anemia either with blood transfer (BT) or intravenous iron with or without subcutaneous erythropoietin, clinical uterine size in gestational weeks, ultrasounds (US) uterine dimensions either transabdominal (TAS) or transvaginal (TVS) as length , width , thickness and calculated uterine weight in grams (length, width, thickness at fundus × 0.52) (66) . The intra-operative data collected included surgical details, such as the duration of surgery, which was defined as the total operative room (OR) time from entrance the OR to discharge from OR to ordinary or intensive care unit, including the actual surgical time from vaginal skin incision to vaginal skin closure.…”