DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182358

Non-descent vaginal hysterectomy in women with previous caesarean section scar: our experience

G. D. Maiti, Ashok Pillai, Tony Jose, P. R. Lele

Abstract


Background: Hysterectomy is one of the common gynaecological major surgeries performed worldwide. In spite of technological advancement with laparoscopic and robotic hysterectomy conventional hysterectomy through vaginal route of nonprolapse uterus popularly known as, Non-Descent Vaginal Hysterectomy (NDVH) remains a justifiable cost effective, cosmetically appealing option especially in resource-crunched developing country. NDVH in post caesarean scarred uterus too a technically challenged procedure requiring skills and expertise.

Assessment of technical feasibility and safety of non-descent vaginal hysterectomy in women with previous caesarean section scar were studied.

Methods: The study was a prospective observational study of 72 patients with LSCS scar requiring hysterectomy for benign conditions were selected based on the inclusion and exclusion criteria carried out from June 2012 to May 2017. Operating time, blood loss, surgical techniques, intra/postoperative challenges, conversion to laparotomy or laparoscopic assistance and length of hospital stay were recorded for each case. Patients were followed up till 03 months of surgery.

Results: Vaginal hysterectomy was successful in all cases. Morcellation, bisection or myomectomy, were done in 86% cases. Two patients had bladder injury, which was repaired vaginally, two cases required support of laparoscopy.  No patients needed blood transfusion. None of the patients were converted to laparotomy.

Conclusions: Vaginal hysterectomy is a safe and effective procedure for benign non-prolapsed uteri in women with previous caesarean section scar when uterine size is less than 14 weeks. Standby operating laparoscopy provides added advantages to surgeon in doubtful or difficult cases to avoid conversion laparotomy.


Keywords


Hysterectomy, NDVH, Post LSCS scarred uterus, Vaginal hysterectomy

Full Text:

PDF

References


Singh KC, Barman SD, Rinku Sengupta. Choice of hysterectomy for benign disease, department of obstetrics and gynaecology, university college of medical sciences, Delhi J Obstet Gynecol. 2004;54:365-70.

Sutton C. Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol. 1997;11:1-22.

Kovac RS. Hysterectomy outcome in patients with similar indications. J Obstet Gynecol. 2000;95:787-93.

Silva-Filho AL, Reis FM, Noviello MB, Santos-Filho AS, Cândido EB, Triginelli SA. Factors influencing the operative time and complications of vaginal hysterectomy of a nonprolapsed uterus. Female Pel Medi Reconst Surg. 2004;10:257-62.

Ray A, Pant L, Balsara R, Chaudhury R. Nondescent vaginal hysterectomy: a constantly improving surgical art. J Obstet Gynecol India. 2011;61:182-8.

Meikle SF, Nugent EW, Orleans M. Complications and recovery from laparoscopic–assisted vaginal hysterectomy compared with abdominal and vaginal hysterectomy. Obstet Gynecol.1997;89:304-11.

Purohit RK, Sharma JG, Singh S, Giri DK. Vaginal hysterectomy by electrosurgery for benign indications associated with previous caesarean section. J Gynecol Surg. 2013;29:7-12.

Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM. Is previous cesarean section a risk for incidental cystotomy at the time of hysterectomy?: A case-controlled study. American J Obstet Gynecol. 2005 1;193:2041-4.

Naina kumar, Surekha Tayade. Role of vaginal hysterectomy in previous caesarean section scar women. Int J Reprod Obstet Gynaecol. 2015;4:785-9.

Paparella P, Sizzi O, Rossetti A, De Benedittis F, Paparella R. Vaginal hysterectomy in generally considered contraindications to vaginal surgery. Arch Gynecol Obstet. 2004;270:104-9.

Unger JB. Vaginal hysterectomy for the woman with moderately enlarged uterus weighing 200 to 700 grams. Am J Obstet Gynecol.1999;180:1337-44.

Thomas G. Stovall. Hysterectomy. Berek and Novak’s Gynecology14th Ed. 2007;22:805.

Mehta ST, Trivedi YN, Bhalodia P. Role of non-descent vaginal hysterectomy in advancing gynaecological practice. J Medi Sci. 2014;3:55-8.

Bhadra B, Choudary AP, Tolassaria A, Nupur N. Non-Descent Vaginal hysterectomy (NDVH): Personal experiences in 158 cases. AL Ameen J Med Sci. 2011;4:23-7,

Ray A, Pant L, Balsara R, Chaudhury R. Nondescent vaginal hysterectomy: a constantly improving surgical art. J Obstet Gynecol India. 2011;61:182-8.

Unger JB, Meeks GR. Vaginal hysterectomy in women with history of previous cesarean delivery. Am J Obstet Gynecol. 1998;179:1473-8.

Doucette RC, Sharp HT, Alder sc. Challenging generally accepted contraindication to vaginal hysterectomy. Am J Obstet Gynecol. 2001;184:1386-9.

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

Gimbel H, Sittnes A, Tatar A: Hysterectomy on benign indication in Denmark 1988-1998. Trend analysis: acta. Obstetrics Gynaecol Scand 2001:80:267-72.

Lash AF. A method for reducing the size of the uterus in vaginal hysterectomy. Am J Obstetrics Gynecol. 1941;42:452-8.

Mathevet P, Valencia P, Cousin C, Mellier G, Dargent D. Operative injuries during vaginal hysterectomy. European J Obstet Gynecol Reprod Biol. 2001;97:71-5.

Schwarz R. Choice of the surgical route in hysterectomy. Gynakologische Rundschau. 1990;30:248-52.

Del GF, Soligo M, Rossi A, Del CF. Vaginal and abdominal hysterectomy: comparison and perspectives. Apropos of 385 consecutive cases. Minerva ginecologica. 1996 May;48(5):181-91.

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