Personal experience of Non Descent Vaginal Hysterectomy (NDVH) in a District Hospital - A Study of 60 cases.

Objective(S): To share our experience and explore the safety & feasibility of NDVH in 60 cases. Methods: This prospective observational study was conducted from Jan 2016 to Dec 2017 in Obstetrics and Gynaecology Department of Sylhet shaheed Shamsuddin Ahmed Hospital, Sylhet. Sixty patients requiring hysterectomy for benign nonprolapsed gynaecological disorders were the target population. Prerequisite for non-descend vaginal hysterectomy were uterine size not exceeding 20 weeks, adequate vaginal access with uterine mobility. Main outcome measures were i) Procedures of removal of large uterus ii) Time taken to complete the operation iii) Blood loss during operation iv) Postoperative hospital stay. v) Postoperative complications. Results: Vaginal hysterectomy was completed successfully in 100% cases. All patients were multiparous and in 41-45 years age group (37%). Commonest indication was AUB (37%), Second indication was fibroid uterus (35%) and next indication was adenomyosis (13%). In most of the case uterus was 10-12 weeks size (37%), in 28% cases uterine size was less than 8 weeks, 14-16 weeks size in 27% cases and uterus was more than 16 weeks size in 8% cases. Morcellation techniques like bisection, myomectomy, wedge resection and debulking were done to remove bigger sized uterus. Mean operating time was 45 minutes. Mean blood loss was 60ml. Average hospital stay was 3 day. Complications were minimum which included UTI and febrile morbidity. At 12 weeks postoperative follow up 72% patient had no adverse complain though 18% cases was drop out. Conclusions: Vaginal hysterectomy is safe feasible, scarless and patient friendly approach for benign gynaecological disorders other than prolapsed uterus. In this era of minimally invasive surgery, non-descend vaginal hysterectomy is to be considered as a safe option.