P. Thulasi1, Rebecca Ratnam2
To assess safety and feasibility of non-descent vaginal hysterectomy for benign gynaecological disease.
A prospective study was conducted at the Department of Obstetrics and Gynaecology of P K Das Institute of Medical Sciences from January 2013 to December 2013. An effort was made to perform hysterectomies vaginally in women with benign or premalignant conditions in the absence of prolapse. A suspected adnexal pathology, endometriosis, immobility of uterus, uterus size more than 16 weeks was excluded from the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus, morcellation techniques like bisection, debulking, coring, myomectomy, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size, estimated blood loss, length of operation, intraoperative and postoperative complications and hospital stay were recorded.
A total of 100 cases were selected for non-descent vaginal hysterectomy. Among them, 97 cases successfully underwent non-descent vaginal hysterectomy. Majority of the patients (55%) were in age group 40-45 yrs. Four patients were nulligravida and eight patients had previous LSCS. Uterine size was ≤ 12 weeks in 84 cases and > 12-16 weeks in 16 cases. Commonest indication was leiomyoma of uterus (43%). Mean duration of surgery was 70±20.5 minutes. Mean blood loss was 150±65 mL. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in two cases because of adhesions and in one case there was difficulty in reaching the fundal myoma which prevented the uterine descent. Intra–operatively, one case had bladder injury (1%) that had previous 2 LSCS. Postoperatively, complications were minimal which included postoperative fever (11%), UTI (8%) and vaginal cuff infection was (4%). Mean hospital stay was 3.5 days.
Vaginal hysterectomy is safe, feasible in most of the women requiring hysterectomy for benign conditions with less complications and shorter hospital stay.