Evaluation of complications of abdominal and vaginal hysterectomy

Abstract

INTRODUCTION Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by abdominal and vaginal route. Vaginal hysterectomy (VH) has several advantages over abdominal hysterectomy (TAH), and may be appropriate for up to 80% of benign uterine conditions. 1,2 Evidence supports TAH only when documented pathologic conditions preclude the vaginal route. 3,4 Even recent study in United States shows 82% were TAH, only 13% were VH and 5% were laparoscopic assisted in teaching hospitals. 5 Aim of our study is to compare between vaginal route versus abdominal route of hysterectomy in terms of intra operative and post operative complications. METHODS A retrospective study was done in department of Obstetrics and Gynaecology of Sri Manakula Vinayagar Medical College and Hospital in Puducherry, India from January 2010 to July 2012. Study was done in women who had undergone vaginal or abdominal hysterectomy in that period. Women in any age group who underwent vaginal or abdominal hysterectomy for benign conditions were included in the study. Women who underwent hysterectomy for uterine prolapse, indications that would generally require an abdominal approach such as endometriosis, pelvic inflammatory disease were excluded from the study. Vaginal hysterectomy was done in those with uterine size ≤ 14 weeks, unrestricted uterine mobility, and absence of adnexal pathology. Information such as clinical history, physical examination findings, haemoglobin level preoperatively, indication for ABSTRACT Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by vaginal and abdominal route. Gynaecologic surgeons worldwide continue to use the abdominal approach for a large majority of hysterectomies that could be performed vaginally despite well-documented evidence that vaginal hysterectomy has better outcome. Aim of our study is to compare vaginal route versus abdominal route of hysterectomy in terms of intra operative and post operative complications. Methods: A retrospective study was done in 229 women who had undergone hysterectomy (176 abdominal hysterectomies and 53 vaginal hysterectomies) from January 2010 to July 2012. Information on the indications, operative procedures, and complications were extracted and analysed. Results: The mean duration of surgery in VH group was 79.6 min and that of TAH group was 99.2 min. The mean blood loss was also more in case of TAH group than that of VH group (215ml vs. 167ml). Bladder injury occurred in 1 case in VH (1.9%) and in 4 cases in TAH (2.3%). Ureter injury occurred in 1(0.6%) case in TAH group. Wound infection developed in 10 cases of TAH group whereas only one case in VH group developed vault infection. Conclusions: Vaginal hysterectomy is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and post operative morbidity when compared to abdominal hysterectomy.