Comparison of Vaginal Hysterectomy for Non Descent Uterus with Abdominal Hysterectomy

The purpose of this study was to compare the advantages of vaginal hysterectomy for nondescent uterus over abdominal hysterectomy.

The cases were collected from Women and Children Hospital, Bapuji Hospital and Chigateri General Hospital attached to JJM Medical College, Davangere, and Karnataka, India.

This is a comparative study between 75 vaginal hysterectomies for nondescent uterus with 99 abdominal hysterectomy cases. All patients who required hysterectomy for benign gynaecological conditions like dysfunctional uterine bleeding (DUB), fibroid uterus, adenomyosis, chronic cervicitis were included in the study, which were collected over a period of one year (July 2002 to June 2003). Intraoperative findings like descent of the uterus under anesthesia, type of anesthesia, duration of surgery, blood loss were noted. Outcomes in immediate postoperative period which included catheterization, early mobilization, and allowance on regular diet, patient's complaints & complications, duration of post operative stay were noted. The accessibility of the vaginal passage, disease confined to the uterus and the surgeons experience are the major determining factors for the choice of the route of hysterectomy.

Total number of cases who underwent hysterectomy during the study period were 174. Vaginal route was employed in 75 cases & abdominal in 99 cases. There were no major differences in patient's age, slightly higher parity in vaginal hysterectomy group. Two cases were done under local anesthesia in vaginal hysterectomy group. DUB was the commonest indication 32(42.7%), 12 cases had uterine size up to 12–16 weeks pregnant uterus size, morcellation techniques were employed in all cases. Operating time was significantly lower for vaginal route compared to abdominal route (38±14 minutes vs 61±12 minutes, P-value<.001). Blood loss was not significantly different between the two groups. Significant advantages of vaginal hysterectomy were noncatheterisation in 52(69.3%) cases, early mobilization (allowed out of bed within 6–8 hours), regular diet within 12 hours in 49(65.3%) cases, reduced length of hospital stay(4±1.1 vs 7.1±1.7, P <.001) and cost. Complications were minimal in vaginal hysterectomy group.

Vaginal hysterectomy is least invasive route with less morbidity & most rapid post operative recovery & less hospital stay compared to abdominal route.