1Assistant Professor & Senior Gynaecologist, Dep of Obstetric and Gynecology, PGIMER & Dr RML Hospital, New Delhi, India
2Senior Resident, Deptt. of Obstetric and Gynecology, PGIMER & Dr RML Hospital, New Delhi, India
3Professor & Consultant, Deptt of Obstetric and Gynecology, PGIMER & Dr RML Hospital, New Delhi, India
*Corresponding author Upma Saxena, Assistant Professor& Senior Gynecologist M-14 (Residence)Greater Kailash Part 2, New Delhi-110048, India. email: upma_saxena@hotmail.com
Online published on 18 February, 2016.
To analyze indications, surgical approach and complications of hysterectomy done for benign gynaecological diseases.
The retrospective study was carried on 502 women with benign gynaecological diseases who underwent hysterectomy at a tertiary level teaching hospital over a period of 24 months. Patients medical records of hysterectomy analysed for indications of surgery, surgical approach, success of decided approach, operating time, blood loss, postoperative hospital stay and complications.
The most common indications for hysterectomy were uterine leiomyoma in 43% (n=216), pelvic organ prolapse (POP) in 34.7% (n=174), abnormal uterine bleeding (AUB) in 7.4% (n=37), endometriosis in 4.8%(n=24), benign ovarian cyst in 4.58%(n=23), post menopausal bleeding(PMB) in 2.6% (n=13), adenomyosis in 1.8% (n=9) and cervical intraepithelial Lesion (CIN) III in 1.2% (n=6). Out of 502 hysterectomies, abdominal hysterectomy (AH) was performed in 54.6%(n=274), vaginal hysterectomy (VH) in 34.7%(n= 174), non descent vaginal hysterectomy (NDVH) in 8%(n=40)and laparoscopic hysterectomy (LH)in 2.8% (n=14). In the present study, NDVH was found to be superior because it had statistically significant (p<.05) lesser operative time and blood loss compared to AH and LH. NDVH group also had statistically significant(p<.05) lesser postoperative hospital stay, febrile morbidity and complications compared to AH.
Fibroid is the commonest indication for hysterectomy. NDVH is superior to AH and LH and so it is preferred surgical approach for all hysterectomies where it is technically feasible. LH should only be considered to avoid AH, where NDVH not possible, as it is associated with more urinary tract injuries.
Abdominal hysterectomy(AH), Vaginal hysterectomy (VH), Laparoscopic hysterectomy (LH), Laparoscopic assisted vaginal hysterectomy(LAVH), Total laparoscopic hysterectomy(TLH)
