Indications and contraindications of vaginal hysterectomy for non-prolapsed uterus

Abstract

OBJECTIVE: To study the indications and contraindications of vaginal hysterectomy for non-prolapsed uterus. METHODS: Totally 2086 patients underwent vaginal hysterectomy during the period of June 1992-June 2003 were analysed and the surgery quality and incidence of complications among patients with different sizes of uteri, with or without history of pelvic or abdominal surgery, with history of vaginal delivery and adnexectomy were compared. RESULTS: (1) The patients with uteri > 16 weeks of gestation were associated with longer operating time [(73 +/- 25) vs (42 +/- 16) min)], more blood loss [(237 +/- 86) vs (101 +/- 58) ml] and higher rate of pelvic infection (1.69% vs 0.78%) when compared to the patients with uteri < or = 16 weeks. The differences were statistically significant (P < 0.01). (2) There was no significant difference in the operating time and intraoperative blood loss between the patients with and without history of pelvic or abdominal surgery (P > 0.05), however, the surgery group had higher side injury rate during operation. In addition, 119 patients complicated with ovarian cyst underwent vaginal ovarian cystectomy successfully. CONCLUSION: Vaginal hysterectomy for patients with uteri < or = 16 weeks of gestation is safe and feasible. The procedure is relatively difficult for uteri > 16 weeks and should be determined according to the operator's experience and the patient's condition. A history of pelvic or abdominal operation increases the side injury rate in vaginal hysterectomy. The successful rate of vaginal hysterectomy in patients with uteri < or = 16 weeks of gestation is not affected by the history of vaginal delivery. During vaginal hysterectomy, ovarian cystectomy is feasible for the ovarian cyst < or = 6 cm. Skillful operator and use of appropriate instrument expand the indication of vaginal hysterectomy.