Nondescent vaginal hysterectomy, a changing practice in Indian scenario for scar less surgery
Abstract
Introduction: Hysterectomy is the most common operation performed next only to caesarean operation by gynaecologist. This decade has seen resurgence of hysterectomy by vaginal route for indication other than prolapse, may be due to better compliance by the patients.
Aims and objective: This prospective observational study was conducted to assess safety, morbidity, and feasibility of nondescent vaginal hysterectomy.
Method: All patients who fulfilled the criteria for the study were included in the study. NDVH was performed in the cases with adequate vaginal access, good uterine mobility and uterine size not exceeding 18 weeks. Different morcellation techniques were employed for bigger size uterus.
Result: Total 50 patients underwent nondescent vaginal hysterectomy. 28 out of 50 patients were in 40 -49 years of age group. 98% of them were multiparous. Dysfunctional uterine bleeding (44%) was the most common indication followed by Pelvic inflammatory disease (26%). Morcellation techniques were employed in 33 cases (66%). Mean operating time was 79.6 minutes with average blood loss 110 ml and average duration of pain disappearance was on 4th day and hospital stay 6 days. Complications were minimal.
Conclusion: Vaginal hysterectomy in non descended uterus is feasible, safe, associated with less morbidity and better compliance by patients.
Downloads
References
2. Sheth SS. Progress in Obstetrics and Gynaecology Churchill Living stone Edinburgh London. Vaginal hysterectomy. In: John Studd (Ed). 1993. pp. 317–340.
3.Tariq Miskry, Adam Magos. Randomized prospective double-blind comparison of abdominal versus vaginal hysterectomy in women without utero-vaginal prolapse. Acta Obstet
Gynecol. 2003;82:351-8. [PubMed]
4. Mazdisnian F, Kurzel RB, Coe S, Bosuk M, Montz F. Vaginal hysterectomy by uterine morcellation: an efficient, non-morbid procedure. Obstet Gynecol. 1995 Jul;86(1):60-4. [PubMed]
5. Sheth SS. Guidelines on Hysterectomy. J Obstet Gynaecol lnd 1998;48:195-9.
6. Poindexter YM, Sangi-Haghpeykar H, Poindexter AN 3rd, Thomakos N, Young RL, Fine PM, Miller HJ. Previous cesarean section. A contraindication to vaginal hysterectomy? J Reprod Med. 2001 Sep;46(9):840-4. [PubMed]
7. Unger JB. Vaginal hysterectomy for the woman with a moderately enlarged uterus weighing 200 to 700 grams. Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1337-44. [PubMed]
8. Das S., Sheth S. Uterine Volume: An Aid to Determine the Route and Technique of Hysterectomy. J Obstet Gynaecol India. 2004;54:68–72.
9. 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. [PubMed]
10. Davies A, Vizza E, Bournas N, O'Connor H, Magos A. How to increase the proportion of hysterectomies performed vaginally. Am J Obstet Gynecol. 1998 Oct;179(4):1008-12.
11. Rathindra Nath Ray, S Roy , P. Das et al. A Comparative study of nondescent Vaginal hysterectomy with Abdominal hysterectomy in relation with morbidity and outcome in DUB patients. Int. J. Curr. Microbiol. App. Sci (2015) 4(3): 327-333.
12. S.Robert Kovac, Sheela Barhan, Margit Lister, Lori Tucker, Mardi Bishop, Adrija Das. Guidelines for the selection of the route of hysterectomy: Application in a resident clinic population. American Journal of Obstetrics and Gynecology. Dec 2002, Vol. 187: 1521-1527.
OAI - Open Archives Initiative
