Abdominal versus vaginal hysterectomy in non-descent cases

Authors

  • Kavitha Gayak Department of Obstetrics & Gynaecology, Konaseema Hospital and Resarch Foundation, Amalapuram, East Godavari, Andhra Pradesh, India
  • Athota Smitha Department of Obstetrics & Gynaecology, Konaseema Hospital and Resarch Foundation, Amalapuram, East Godavari, Andhra Pradesh, India
  • Jagannath Tripathy Department of Anaesthesia, Konaseema Hospital and Resarch Foundation, Amalapuram, East Godavari, Andhra Pradesh, India

Keywords:

Vaginal hysterectomy, Abdominal hysterectomy, Post-operative complications

Abstract

Background: Hysterectomy is the most frequently performed elective major operation in gynaecology by vaginal and abdominal route. Gynaecologic surgeons worldwide said that two are not competitive procedures but each one has its own place in the operative armamentarium. Present study is done to comparative risks of complications in abdominal route versus vaginal route of hysterectomy in intra operative and post-operative periods.  

Methods: It’s a retrospective study was  done from Dec 2013 - Dec 2014 for a period of one year in 82 women who had undergone hysterectomy, divided as group A with abdominal hysterectomies (44 cases) and group B with vaginal hysterectomies (38). Information on the indications, operative procedures, and complications were noted and analyzed.

Results: Intra-operative blood loss, mean operating time was more in group A than in group B. The mean duration of surgery in group B was 76 ± 12 min and that of group B was 101 ± 14 min. The mean blood loss was also more in case of group A than that of group B (219 ml vs. 172 ml). Bladder injury occurred in 1 case in group B (3%) and in 3 cases in group B (7%). Ureter injury occurred in 1 (2%) case in group A. Postoperative fever (20% & 8%), UTI (13% & 11%) and wound infection (10%, 0%). Only one patient underwent relaparotomy for internal bleeding via abdominal route was more common in group A as compared to group B. Only one patient underwent re-laparotomy for internal bleeding via abdominal route.  

Conclusions: Study results conclude  that patients requiring hysterectomy for benign non prolapse cases be offered the option of vaginal route which is quicker recovery, early mobilization, shorter hospitalization, less operative and post-operative morbidity, more economical and effective.  

 

References

Robert S. Kovac. Guidelines to determine the route of hysterectomy. Obstet Gynecol. 1995;85(1):18-22.

Richardson RE, Bournas N, Magos AL. Is laparoscopic hysterectomy a waste of time? Lancet. 1995;345:36-41.

Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;(3):CD003677.

Kovac SR. Clinical opinion: guidelines for hysterectomy. Am J Obstet Gynecol. 2004;191:635-40.

Wikox LS, Koonin LM, Pokras R, Strauss LT, Xiaz, Peterson HB. Hysterectomy in the United States 1988-1990. Obstet Gynecol. 1994;83:549-55.

Diker 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;144:841-6.

Tariq Miskry, Adam Magos. Randomized prospective double-blind comparison of abdominal versus vaginal hysterectomy in women without utero-vaginal prolapse. Acta Obstet Gynecol. 2003;82:351-8.

Bharatnur S. Comparative study of abdominal versus vaginal hysterectomy in non-descent cases. Internet J Gynecol Obstet. 2010;15(2):1528.

Nasira Sabiha Dawood, Rabia Mahmood, Nalia Haseeb. Comparison of vaginal and abdominal hysterectomy: peri- and post-operative outcome. J Ayub Med Coll Abbottabad. 2009;21(4):116-20.

Davies A, Vizza E, Bournas N, O’Connor H, Magos A. How to increase the proportion of hysterectomies performed vaginally. Am J Obstet Gynecol. 1998;179:1008-12.

Raymond C. Doueettee, Howard T. Sharp, Stephan C. Alder. Challenging generally accepted contraindications to vaginal hysterectomy. Am J Obstet Gynecol. 2001;184:1386-91.

Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patients’ characteristic or physician preference. Am J Obstet Gynecol. 1996;175(1):232-3.

Aniuliene R, Varzgaliene L, Varzgalis M. A comparative analysis of hysterectomies. Medicina (Kaunas). 2007;43:118-24.

Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv. 1995;50:795-805.

Taylor SM, Romero AA, Kammerer-Doak DN, Qualls C, Rogers RG. Abdominal hysterectomy for the enlarged myomatous uterus compared with vaginal hysterectomy with morcellation. Am J Obstet Gynecol. 2003;189:1579-83.

Ottosen Consultant, Lingman G, Ottosen L. Three methods for hysterectomy: a randomized, prospective study of short term outcome. BJOG. 2000;107:1380-5.

Lambaudie E, Occelli B, Boukerrou M, Crépin G, Cosson M. Vaginal hysterectomy in nulliparous women: indications and limitations. J Gynecol Obstet Biol Reprod. 2001;30:325-30.

Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B. Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Am J Obstet Gynecol. 2002;187:1561-5.

Sheth SS, Malpani AN. Vaginal hysterectomy following previous caesarean section. Int J Gynecol Obstet. 1995;50:165-9.

Magos A, Bournas N, Sinha R, Richardson RE, O’Connor H. Vaginal hysterectomy for the large uterus. Br J Obstet Gynaecol. 1996;103:246-51.

Penketh R, Griffiths A, Chawathe S. A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24-hour day case surgery setting vaginal hysterectomy. BJOG. 2007;114:430-6.

Barmparas G, Branco BC, Schnuriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg. 2010;14:1619-28.

Downloads

Published

2017-02-06

Issue

Section

Original Research Articles