Nondescent vaginal hysterectomy: a constantly improving surgical art

Objective This study was undertaken to check the feasibility of the vaginal route as the primary route for all hysterectomies, in the absence of uterine prolapse, for benign conditions.

During 2005 to 2007 an effort was made to perform as many hysterectomies vaginally with or without oophorectomy in women with benign or premalignant conditions in the absence of prolapse. Severe endometriosis, immobility of the uterus, uterine size more than 18 weeks and malignancy were excluded. Patients were classified into two groups — Group I — uterine size up to 12 weeks, with no risk factors and Group II — uterine size 12–18 weeks or with confounding factors like, mild to moderate endometriosis, nulliparity or LSCS in the past. The outcome was compared between the two groups and abdominal hysterectomies done for benign conditions. Statistical analysis was done by SE(d) between mean and proportion.

A total of 164 cases nondescent vaginal hysterectomies were done. Of these, 92 (56.1%) were in group I and 72 (43.9%) in group II. The operation time in Group II was significantly more than in group I (81.3 minutes with SD of 31.4 s. 62.6 minutes SE(d) between 2 means-7.49). Debulking techniques were required in 58.7% of the cases in group II compared to 2.1% in group I. Both the groups had one conversion each. The peroperative blood loss, pain score, hospital stay and return to normal activity, was comparable in both the groups of vaginal hysterectomy (VH) and significantly superior to those undergoing abdominal hysterectomies for benign conditions.

The vaginal approach is possible in most benign conditions requiring hysterectomy and is superior to the abdominal route with respect to recovery and complication rates. Similar content being viewed by others

Paparella P, Sizzi O, Rossetti A et al. Vaginal hysterectomy in generally considered contraindications to vaginal surgery. Arch Gynecol Obstet 2004;270:104–109. Meikle SF, Nugent EW, Orleans M. Complications and recovery from laparoscopic-assisted vaginal hysterectomy compared with abdominal and vaginal hysterectomy. Obstet Gynecol 1997;89:304–311. Dewan R, Agarwal S, Manisha et al. Non-descent Vaginal Hysterectomy — An experience. J Obstet Gynaecol India 2004;54:376–378. Otah KS, Khalil M. Changing the route of hysterectomy: The results of a policy of attempting the vaginal approach in all cases of Dysfunctional Uterine Bleeding. Eur J Obstet Gynecol Reprod Biol 2006;125:243–247. Ottosen C, Lingman G, Ottosen L. Three methods of hysterectomy: A randomized, prospective study of short term outcome. BJOG 2000;107:1380–1385. Taylor SM, Romero AA, Kammerer-Doak DN et al. Abdominal hysterectomy for the enlarged myomatous uterus compared with vaginal hysterectomy with morcellation. Am J Obstet Gynecol 2003;189:1579–1583. Das S, Sheth S. Uterine Volume: An Aid to Determine the Route and Technique of Hysterectomy. J Obstet Gynaecol India 2004;54:68–72. Purohit RK. Purohit technique of vaginal hysterectomy: a new approach. BJOG 2003;110:1115–1119. Goel N, Rajaram S, Ghumman S. Step by step non-descent vaginal hysterectomy. (Chapter 12 — Analysis of Data: 75 Consecutive Cases). Delhi, Jaypee, 2005:138–146. Unger JB, Meeks GR. Vaginal hysterectomy in women with history of previous cesarean delivery. Am J Obstet Gynecol 1998;179:1473–1478. Sheth SS, Malpani AN. Vaginal hysterectomy following previous cesarean section. Int J Gynaecol Obstet 1995;50:165–169. Bhattacharya MS, Shinde SD, Narwekar MR. Complications of vaginal hysterectomy (analysis of 1105 cases). J Postgrad Med 1978;24:221–225. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Ray, A., Pant, L., Balsara, R. et al. Nondescent vaginal hysterectomy: a constantly improving surgical art. J Obstet Gynecol India 61, 182–188 (2011). https://doi.org/10.1007/s13224-011-0021-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s13224-011-0021-z