Previous LSCS: NO more Contraindication for non Descent Vaginal Hysterectomy

Abstract

Introduction: Hysterectomy is the most common operation performed in Gynecology department worldwide. It is performed by different route and for different indications. NDVH has many advantages over other routes. But presence of previous lower segment cesarean section scar makes the Gynecologists hesitant to choose NDVH as route of operation. Present study aimed to study difficulty encountered and ease to overcome these difficulties while performing NDVH in previous LSCS scarred cases. Material and methods:This prospective study was conducted over 25 cases of previous LSCS, with clear cut indication of hysterectomy between 2015 October to 2017 February. Time taken in operation, difficulties encountered during operation, any complication, their management, blood loss estimation and number of units of blood transfused required were noted.Result: Out of 25 cases bladder was injured in one case. Laparotomy was not required in any case. Bisection only was done in 16 (64%) cases, bisection myomectomy in 5 (20%) cases, morcellation plus bisection in 4 (16%) cases. Amount of blood loss and operating time was proportional to the size of uterus. Conclusion:Non descent vaginal hysterectomy is safe, cost effective method in previous LSCS scarred uteri where hysterectomy is indicated for different benign conditions with less morbidity and shorter hospital stay.

An audit of gynaecological hysterectomies in the university of Uyo teaching hospital: Case for non-descent vaginal hysterectomy

“…This situation is however different from what obtains in other centres [13,[24][25][26][27] where nondecent vaginal hysterectomies are a common and preferred procedure. An indication for hysterectomy in the absence of contraindications to vaginal hysterectomy is enough reason to perform hysterectomy through the vaginal route even with a bulky uterus [26][27][28] The presence of a previous caesarean section scar is no longer viewed as a contraindication to nondescent vaginal hysterectomy and is practiced in some centres [29] The practice of non descent vaginal hysterectomy has been found to be safe, associated with shorter hospital stay and fewer complications and morbidity and its thus a cost effective method of hysterectomy in women with large uteri requiring hysterectomy for benign conditions [26] . In conclusion, this study has shown that the indication for vaginal hysterectomy is limited in view of the numerous advantages it offers over abdominal hysterectomy.…”