Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study of 30 cases

Abstract

INTRODUCTIONHysterectomy is a commonly performed gynecological procedure.1 Nondescent vaginal hysterectomy (NDVH) is removal of uterus through vagina in absence of descent. Vaginal route is preferred for removing uteri, as it is natural route, scarless, gives safer and better results than abdominal route.2 Because of increased cesarean sections, women undergoing hysterectomies with cesarean sections are increasing.3 Earlier previous cesarean section was relative contraindication to vaginal hysterectomy due to uterovesical adhesions and risk for unintended cystostomy. [4][5] Skill, experience of surgeon is important in determining the route. This study will help in assessing safety, feasibility of NDVH in women with previous one, two and three cesarean section in absence of uterine prolapse. ABSTRACTBackground: Non-Descent Vaginal Hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. Objective of present study was to assess safety, feasibility of NDVH in patients with previous cesarean section. Methods: Retrospective study was conducted in department of Obstetrics and Gynecology of Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences, Dharwad, India from April 2008 to June 2016. Effort was made to perform hysterectomies vaginally in women with benign conditions with history of one, two or three caesarean sections. Information regarding age, parity, number of previous LSCS, uterine size, blood loss, duration of operation, difficulties in separating bladder, intra -operative, post-operative complications were recorded. Results: Total thirty cases were selected for NDVH with history of one, two and three cesarean sections. All successfully underwent NDVH, except one in which bladder injury occurred which was repaired at same time vaginally. Thirteen patients had previous one Lower Segment Cesarean Section (LSCS), sixteen had two LSCS and one had three LSCS. Commonest indication was abnormal uterine bleeding followed by leiomyoma of uterus. Mean duration of surgery was 97 min. Mean blood loss was 150 ml. Post-operative complications were minimal. Patient mobility, resumption of daily activities was fast. Mean hospital stay was 4-5 days. Conclusions: Vaginal hysterectomy is safe, cost effective method of hysterectomy in women with previous cesarean section scar requiring hysterectomy for benign conditions with fewer complications, shorter hospital stay and less morbidity.