Vaginal Hysterectomy and Oophorectomy in Women With 12–20 Weeks’ Size Uterus

Vaginal hysterectomy has become increasingly popular, in part because of low mortality and complication rates, a shorter hospital stay, and better quality-of-life outcomes. Uterine size is the major factor in deciding whether this procedure is feasible. Traditionally, a uterine weight no greater than 280 gm, as at 12 weeks’ gestation, has been a condition of vaginal hysterectomy. This prospective comparative study enrolled 241 consecutive women with benign disease, 158 of whom had a uterine weight <280 gm, and 83 had an estimated uterine weight exceeding 280 gm. A uterine size greater than that of a 20-week gestation contraindicated vaginal hysterectomy, as did a fixed uterus, a suspicious adnexal mass, and moderate to severe endometriosis. The author performed all operations. The most common indication in both groups was the presence of uterine leiomyomas. All 241 vaginal hysterectomies were completed successfully, and no patient had intraoperative or postoperative complications that mandated hospital admission. Mean operating time was significantly longer with a larger uterus (108 vs. 69 minutes), and there was an overall significant positive linear correlation between uterine weight and operating time. The rate of intraoperative hemorrhage was significantly higher with a uterus weighing 280 gm or more (8.4% vs. 1.2%), as was the change in hemoglobin. Rates of bilateral oophorectomy were similar in the 2 groups. One patient, whose uterus weighed <280 gm, had a bladder injury. The groups did not differ significantly with regard to the frequency of intraoperative and postoperative complications, febrile morbidity, or length of the postoperative hospital stay. These findings demonstrate that, despite a longer operating time and intraoperative blood loss, vaginal hysterectomy can be safely performed in women with a large uterus.