Hysterectomy by vaginal route,” not a pressure

Abstract

Vaginal route of hysterectomy is a safe procedure with less morbidity and hospital stay. So there is a need to expand the indication for vaginal hysterectomy beyond uterovaginal prolapse. Aim: To determine the feasibility and outcome of nondescent vaginal hysterectomy (NDVH) and to assess pre and postoperative complications, duration of surgery, and length of hospital stay. Materials and methods: A prospective observational study was conducted between 2012 and 2014 at a tertiary care center. Two hundred fifty-six patients satisfying the selection criteria of hysterectomy for benign gynecological conditions, uterus size <16 weeks and excluding stage IV endometriosis, genital tract malignancy, and uterine prolapse were included. Nondescent vaginal hysterectomy was performed by the standard technique and the following parameters were recorded: age, parity, indication for surgery, duration of surgery, intra operative and postoperative complications, and hospital stay. The data were analyzed using SPSS version 16.0 by frequency and percentage analysis using Chi-squared test. Results: All 256 patients were analyzed. The mean age was 44.4 ± 6.1 years, fibroid uterus was the commonest indication, 89.4% had a uterine size ≤12 weeks, and 59% had uterine volume <200 cm3. The mean duration of surgery was 83.5 ± 11.0 minutes; salpingo-oophorectomy was performed in 25.8% of the patients. Intraoperatively 1.2% had bladder injury and 0.4% required conversion to laparotomy for pelvic hematoma. The mean duration of hospital stay was 4.9 ± 2.2 days and the mean pain score in NRS pain scale was 3.0 ± 0.3. Intraoperative blood transfusion was required in 1.9% of the patients only. Conclusion: Nondescent vaginal hysterectomy is a safe and feasible procedure for benign gynecological disorders. Clinical significance: Nondescent vaginal hysterectomy is a boon in this techno-savvy era by reducing the morbidity and promising early return to work.