Enlarged uterus through a natural orifice: worth an effort? A randomized controlled trial
Keywords:
NDVH, TAH, Coring, Bisection, MorcellationAbstract
Background: The objective was to compare the efficacy, safety and patient satisfaction of the Non-Descent Vaginal Hysterectomy (NDVH) with Total Abdominal Hysterectomy (TAH) in benign enlarged uterus.
Methods: This was a prospective Randomized comparative study. A total of 60 subjects were randomly divided into VH and TAH groups (Group A, group B), by sealed opaque envelope, each comprising 30 subjects. Subjects having uterus of more than 12 weeks size requiring hysterectomy for benign pathology and non-prolapsed uterus were included in the study. Corporal bisection, morcellation, myomectomy, coring and combination of these were used as debulking procedures.
Results: We could do all the VH successfully with no conversion to laparotomy and 100% success rate. The mean uterine size was 420.00 g ± 117.24 in group A and 454.33 g ± 52.50 in group B, mean operative time taken was more in group B as compared to group A, though not statistically significant (97 ± 4.46 min, 100 ± 7.27 min; P = 0.621).The mean blood loss, haemoglobin decrease and the Blood Transfusion was significantly lesser in VH group as compare to TAH group (251.13 ± 57.98 ml, 327.33 ± 58.54 ml; P = 0.000). There was no visceral injury in either group, though postoperative fever and wound infection were more in the TAH group than VH group.
Conclusions: VH is safe and should be offered as the first surgical choice in women with uterine enlargement due to benign reasons and non-prolapsed uterus where feasible, and should be included in training program for residents and postgraduates trainees. It is definitely a surgical challenge worth the effort.Metrics
References
Garry R, Fountain J, Mason S, Hawc J, Napp V, Abbott J, et al. The evaluate study: two parallel randomized trials, one comparing laparoscopic with abdominal hysterectomy, the comparing laparoscopic with vaginal hysterectomy. Br Med J. 2004;328:129-33.
Flory N, Bissonnette F, Binik YM. Psychosocial effects of hysterectomy: literature review. J Psychosom Res. 2005;59(3):117-29.
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 Jul;(3):CD003677.
American College of Obstetricians and Gynecologists. Choosing the route of hysterectomy for benign disease. ACOG Committee Opinion No. 444. Obstet Gynaecol. 2009;114:1156-8.
Nelson GH, Ashford C, Williamson R, Amburn SD. Method for calculating blood loss at vaginal delivery. South Med J. 1998;74:550-2.
Magos A, Bournas N, Sinha R, Richardson RE, O’Connor H. Vaginal hysterectomy for the large uterus. Br J Obstet Gynaecol. 1996 Mar;103(3):246-51.
Dewan Rupali, Agarwal Shivani, Manisha. Non-descent vaginal hysterectomy: an experience. J Obstet Gynaecol India. 2004 Jul/Aug;54(4):376-8.
Yilmaz Sahin. Vaginal hysterectomy and oophorectomy in women with 12-20 weeks’ size uterus. Acta Obstet Gynaecol Scand. 2007;86(11):1359-69.
Ray Alokananda, Pant Luna, Balsara Roshan, Chaudhury Rashmi. Non descent vaginal hysterectomy: a constant improving surgical art. J Obstet Gynaecol India. 2011 Apr;61(2):182-8.
Banasree Bhadra, Arun Paul Choudhury, Amit Tolasari, Nandi Nupur. Non descent vaginal hysterectomy (NDVH): personal experience in 158 cases. Al Ameen J Med Sci. 2011;4(1):23-7.
Hwang JL, Seow KM, Tsai YL, Huang LW, Hsieh BC, Lee C. Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger then 6cm in diameter or uterus weighting at least 450g: a prospective randomized study. Acta Obstet Gynaecol Scand. 2002;81:1132-8.
Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, et al. Abdominal or hysterectomy for enlarged uterus: a randomized clinical trial. Am J Obstet Gynaecol. 2002;187:1561-5.
Sunanda Bhartanur. Comparative study of abdominal versus vaginal hysterectomy in non-descent cases. Intern J Gynaecol Obstet. 2011;15(2):DOI: 10.5580/293f.
Silva-Filho AL, Werneck RA, de Magalhães RS, Belo AV, Triginelli SA. Abdominal vs. vaginal hysterectomy: a comparative study of the postoperative quality of life and satisfaction. Arch Gynaecol Obstet. 2006 Apr;274(1):21-4.
