Scarless Hysterectomy- Extended Indications and Its Safety in Non-Descent Uteri

Abstract

BACKGROUNDHysterectomy is the most common surgery done in the gynaecological world. With the introduction of vaginal route for hysterectomy for non-descent uteri, gynaecologist have found a way of hysterectomy without any scar on abdomen, hence it is also called scarless hysterectomy. Aim-Assessment of characteristics of patient and the uterus as well as recognising the most common and uncommon indications for hysterectomy via vaginal route in non-descent uteri. MATERIALS AND METHODSTotal number of vaginal hysterectomies for non-prolapsed uteri for benign causes, done at tertiary hospital, in a period of 21 months from September 2012 to May 2014 were prospectively studied for their indication, accessibility and safety for the procedure. RESULTSAmongst 127 women who underwent vaginal hysterectomy for non-descent uteri, 46 (36.2%) were operated for dysfunctional uterine bleeding followed by adenomyosis in 32 (25.2%) followed by fibroid in 30 patients (23.6%) and endometriosis in 3 (2.3%) cases. 5 (3.9%) cases were having uterine size larger than 16 weeks. 13 (10.2%) of cases had previous caesarean section and 64 (50.4%) had bilateral tubal ligation. 3 (2.3%) women were nulliparous. Oophorectomy was done as an associated surgery in 14 (11.02%) cases. Vaginal route was changed to laparotomy in 1 (0.7%) case for intraoperative haemorrhage and pelvic adhesion. Rectovaginal fistula occurred in 1 (0.7%) case. No deaths were recorded within the study period. Mean duration of surgery was 45 min. + 23 min. Mean hospital stay was 72 hours + 24 hours. CONCLUSIONNon-descent scarless vaginal hysterectomy is safe with wide range of indications avoiding the need for open method or assisted laparoscopic method. More and more skill development programs in non-descent vaginal hysterectomy are required to increase the indications of non-descent vaginal hysterectomy in gynaecological world.