Non Decent Vaginal Hysterectomy- Personal Experience of 105 Cases

Abstract

Background: Objective of current study was to evaluate the feasibility of performing vaginal hysterectomy for nonprolapsed uterus as a primary route. Methods: A hospital based prospective study was conducted at department of obstetrics and gynaecology of SMS & R from 1 st January 2011 to 31 st 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 postoperative 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.

Non descent vaginal pan hysterectomy in benign ovarian tumour in elderly parous patients - an experience

“…In the non descend vaginal hysterectomy (NDVH) group, operating time in majority patient (n=95) was between 30-90 minutes and the remaining 5 patients it was 90-120 minutes which was comparable to the studies by Mehla S et al 10 and Shahana et al 11 The duration of surgery in maximum cases of total abdominal hysterectomy (TAH) ranged between 46 -90 minutes which was comparable to Mahasani V 12 et al (TAH 1 hour 20 minutes and NDVH 45 minutes). In the study by Patel et al 13 in laparoscopic hysterectomy took almost double the time as NDVH.…”

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

“…In NDVH group no patient was hospitalized for more than 7 days, which was comparable to Mehla S et al (5 days), Dewan R et al (3 days). 5,12 Mean duration of hospital stay in the TAH group was 5.03±3.77 days, in the NDVH group 3.5±1.075 days and in the TLH group it was 4.03±2.56 days which was comparable to the studies by Sutasanasuang S et al (TAH 5.3±4.3 days and TLH 3.2±1.1 days) and Singh A et al, (NDVH 3.71days and TAH 7.84 days). 11,13 At 6 month follow up there one case of incisional hernia was found in the TAH group but no complication in the TLH and NDVH group.…”

“…5,8 In the study by Mahasani V et al NDVH had almost one forth the blood loss as TAH group (NDVH 60ml and TAH 250 ml). 9 Mean blood loss in the TLH group was 142.2±72.9 ml.…”

“…5,6 In the TLH group commonest indication was dysfunctional uterine bleeding [18 patients (60%)] followed by fibroid (30.00%), which was comparable to study by Patel et al 7 In the NDVH group, operating time in 20 patients (66.7%) was between 50 to 100 minute and in the remaining 10 patients (33.3%) it was 110 to 150 minute (mean= 97.3±23.73 minutes) which was comparable to the studies by Mehla S et al (mean=90 minutes) and Shahana et al (mean=90 minutes in 66.66% cases). 5,8 Duration of surgery in the TAH group ranged between 70 minutes to 250 minutes (mean=126.5±49.8 minutes). 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.…”

“…These results were comparable to the studies by Mehla S et al (4 cases in NDVH) and Mahasani V et al (blood was required in 6 cases of the TAH group and none in the NDVH group). 5,9 Most common post-operative complication in our study was anaemia which complicated 6 cases of TAH, 2cases of TLH and only one case of NDVH. Second most common post-operative complication was febrile illness which complicated 3 cases each in the TLH and TAH group but only one case of NDVH.…”