Changing trends in technique of hysterectomy in abnormal uterine bleeding: a comparison between non descent vaginal hysterectomy versus laparoscopic assisted vaginal hysterectomy
Keywords:Non descent vaginal hysterectomy, Laparoscopic assisted vaginal hysterectomy, Abnormal uterine bleeding, Visual analogue score
Background: Hysterectomy is the commonest gynaecological surgery over the world. However, in India there is a huge lack in data regarding this surgery. The common indications are abnormal uterine bleeding (AUB), prolapse, pelvic inflammatory disease (PID) and pelvic pain. This study focuses on pros and cons of different routes of hysterectomy to decide a better approach of management. Aims and objective of the study were to compare non descent vaginal hysterectomy (NDVH) to laparoscopic assisted vaginal hysterectomy (LAVH) to determine better route of hysterectomy.
Methods: A randomized prospective observational study conducted in Hind Institute of Medical Science, Barabanki over a period of 2 years on perimenopausal women undergoing hysterectomy for AUB for benign pathology. 100 patients were selected for the study and randomly divided in 2 groups NDVH and LAVH. Preoperative investigations, intra-operative and postoperative complications were compared.
Results: The mean duration of surgery was found to be significantly less in NDVH group 71.24 minutes as compared to LAVH group 103.1 minutes. (p value <0.001). Number of patients requiring Blood transfusion during or after surgery was higher in LAVH group (21) than in NDVH (15) (p value <0.05) suggesting more blood loss in LAVH. Patients undergoing NDVH were having significant less postoperative pain visual analogue score 3.8 as compared to 5.4 in LAVH group (p value <0.001) .5 patients in LAVH group were having postoperative abdomen discomfort as compared to only 1 in NDVH group (p value <0.05).
Conclusions: NDVH supersedes LAVH being faster, less expensive, less blood loss and cosmetically scarless surgery. However, LAVH should be kept in mind if there is associated adnexal pathology.
Bhatia N. Abnormal and Excessive Uterine Bleeding. In Neeraj Bhatia editor. Jeffcoate's Principles of Gynaecology. 5th Edition. London: Arnold Publishers. 2001;560.
Fleischer AC, Kalemeris GC, Entman SS. Sonographic depiction of the endometrium during normal cycles. Ultras Med Biol. 1986;12(4):271-7.
Manyonda I. Hysterectomy for benign gynaecological disease. Curr Obstet. 2003;13:159-65.
Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091-5.
Ray A, Pant L, Balsara R, Chaudhury R. Nondescent vaginal hysterectomy: a constantly improving surgical art. J Obstet Gynaecol India. 2011;61(2):182-8.
Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Am J Obstet Gynecol. 1982;144(7):841-8.
Reich H, De Caprio J, Mcglynn F. Laparoscopic Hysterectomy. J Gynecol Surg. 1989;5:213-6.
Dequesne J, Waddell G. Indications et Complications de l'hystérectomie par laparoscopie. Congrès Suisse de Gynécologie. Interlaken. 1980.
FIGO Committee on Gynecologic Practice. Management of Acute AUB in non pregnant reproductive age group women Committee opinion No. 557. 2013.
Royal College of Obstetrician and Gynecologist (RCOG). Clinical Guideline April 2004 Caesarean Section, Clinical Guideline April 2004 National Collaborating Centre for Women’s and Children’s Health; Published by the RCOG Press at the Royal College of Obstetricians and Gynecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG57. 2002;11:725.
Cardosi RJ, Hoffman MS. Determinimg the best route for hysterectomy. OBG Manag. 2002;14(7):31-8.
Summitt RL Jr, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstet Gynecol. 1992;80(6):895-901.
Soriano D, Goldstein A, Lecuru F, Daraï E. Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study. Acta Obstet Gynecol Scand. 2001;80(4):337-41.
Johnson N, Barlow D, Lethaby A. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2006;2:CD003677.
Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A, et al. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol. 2009;200(4):368.
Bronitsky C, Payne RJ, Stuckey S, Wilkins D. A comparison of laparoscopically assisted vaginal hysterectomy vs traditional total abdominal and vaginal hysterectomies. J Gynecol Surg. 1993;9(4):219-25.
Kovac SR. Guidelines to determine route of hysterectomy. Obstet Gynaecol. 1995;85:18-23.
Sheth Shirish S, Paghdiwalla Kurush P, Hajari Anju R. Vaginal route: a gynaecological route for much more than hysterectomy. Best Prac Res Clin Obstet Gynaecol. 2011;25:115-32.