Vaginal Hysterectomy (Nonprolapsed) and Its Impact on a Patient with Gynecologic Menstrual Disorders: Experience in a Tertiary Care Hospital in Bangladesh

Introduction: Hysterectomy is a common gynecologic operation in woman all over the world. Alhough there are numerous benefits of vaginal over abdominal hysterectomy, all large-scale surveys of hysterectomy practice have shown that 70%–80% of all hysterectomies are performed abdominally. The rationale for this study is the statement that the vaginal route is to be preferred every time the anatomic conditions allow it and every time the nature of the lesions to be treated does not contraindicate it. Aims: The aims of this study were to evaluate the feasibility and complication rate of vaginal hysterectomy in women with enlarged uteri and other traditionally considered contraindications to abdominal surgery. Materials and Methods: Three hundred consecutive women with an enlarged uterus weighing between 280 and 2000 g and/or with the following commonly considered contraindications to vaginal surgery: previous pelvic surgery; history of severe pelvic inflammatory disease; moderate or severe endometriosis; concomitant adnexal masses or other indications to adnexectomy; or limited access to a narrowed vaginal cavity. Medical records of the patients examined included the following demographic details; uterine weight, indication for operation, operation time, cost, estimated blood loss, hospital stay, intra- and postoperative complication rates, patients' recovery time, and histopathology. Results: The indications for hysterectomy were fibroids 170 cases, dysfunctional uterine bleeding (DUB) in 74 cases, mild pelvic inflammatory disease (PID) in 30 cases, endometriosis in 20 cases, and cervical intraepithelial neoplasia (CIN) I mild dysplasia in 6 cases. No patient had uterovaginal prolapse. The mean age of the patients was 42.7 ± 5.8 years (range, 38–60). The mean uterine weight was 265.70 ± 76.9 g (range, 150–2000 g). The mean operative time was 54.8 ± 12.03 minutes, increasing up to 120 minutes (mean, 53.60 ± 28.28 SD). No patients required a transfusion for surgical blood loss. Conclusions: The current analysis shows that there would be a major impact on the vaginal hysterectomy rate if gynecologists were trained to perform vaginal surgery when there is no significant uterine prolapse, when the uterus is enlarged, and when oophorectomy is indicated. (J GYNECOL SURG 27:129)