The feasibility of widened indications for transvaginal hysterectomy

Objective To assess the outcome of the widened indications for transvaginal hysterectomy in clinical practice. Methods Retrospective analysis of 417 cases underwent transvaginal hysterectomy in our hospital between Dec. 1998 and Dec. 2001. Indications, operative duration, operative blood loss, operative injures, morbidities and complications were evaluated. Results Among the 417 patients, 242 patients received transvaginal hysterectomy alone, the other 175 patients received transvaginal hysterectomy along with other procedures: bilateral appendices resections (36) , one side appendices resections (22) , fallopian-tube resections (12), ovarian cyst resections (25), repairs of anterior and posterior vaginal wall (73) , endometriosis (14) in which 3 patients had infiltration of rectal muscle underwent repairs of the anterior rectal wall, 1 accidental ureter injury owing to the severe adhesion of the endometriosis subsequently underwent ureter-bladder implantation and recovered well, only 4 patients underwent hysterectomy though abdominal and vaginal approaches. There were two post-operative complications: 1 case of adhesion of partial vaginal wall, the other suffered from deep vein embolism of the lower extremities. The mean operative time was 51. 74±30. 62 min (range from 12 to 240 min). The average blood loss was 97. 77±88. 37 ml (range from 20 to 500 ml). Pre-operative hemoglobin was 118.63 g/L, post-operative hemoglobin was 116. 28 g/L (P = 0. 109 97≥0. 05). The mean post-operative hospital stay was 6. 6 days (range from 4 to 28 days). The morbidity rate was 4. 83%. There were no late post-operative complications during the 3 months post-operative follow-up period. Conclusion Vaginal hysterectomy for patients with enlarge uterus, previous pelvic operations and pelvic endometriosis is a safe and effective procedure.