Comparative clinical study of laparoscopic assisted vaginal hysterectomy and non-descent vaginal hysterectomy

Background: Laparoscopic assisted vaginal hysterectomy (LAVH) is increasingly becoming popular. It's really a technique made to replace abdominal hysterectomy. The need of the hour is the minimal invasive surgery, early discharge from the hospital, early resumption of work, avoidance of disfiguring scar on the abdomen and cost-effectiveness of the procedure which are as important as cure of the disease. The objective of this study is to compare the effectiveness and safety of laparoscopic and vaginal hysterectomies for non-descent uteri (NDVH).Methods: The study was undertaken in the department of obstetrics and gynecology, Amrita Institute of Medical Sciences, Kochi for the period of one year. About 50 women in each group undergoing LAVH and NDVH for benign pelvic conditions were studied preoperatively, intra-operatively and post-operatively in detail for indications, operative time, intraoperative blood loss, duration of stay in hospital.Results: The mean operative time in LAVH was 240.6 minutes and in NDVH 168.3 minutes. Minimum duration of stay was in LAVH 3 days and in NDVH 4 days. Mean duration of stay in both groups was 6.4 days. Maximum duration of stay-15 days in both groups.Conclusions: LAVH is a better approach for a larger uterus whereas NDVH is preferable for a small uterus, not only for shorter operative time and minimal wound, but also for much lower costs.

Study of route of hysterectomy

Background: The objective is to study complication rate, advantages and outcome of different route of hysterectomy.Methods: A prospective study of 175 women over a period of 1 year i.e. from 01/01/2011 to 31/12/2011 SSG hospital, Vadodara. Depending on the patient profile, experience of surgeon optimum route of hysterectomy was decided.Results mean operating time in AH group was 68.4±14.4min, which was 80±10.3min, 115.8±40.6min and 148.8±25.5min in NDVH, LAVH and TLH group respectively. TLH was performed by consultants. Febrile morbidity was significantly high in AH (23%). Bladder and ureteral injuries were seen in 4% and 3% cases of NDVH and AH group. Wound complications were seen in AH (10%), whereas vault complications were higher in TLH. The hospital stay was shortest in TLH. Women with TLH had early ambulation, early resumption to normal diet, early return to routine work and better sexual function.Conclusions: Women with excessively enlarged uteri, significant pelvic pathology, or cancer are obvious candidates for AH. On the other hand, VH is frequently chosen for the small uterus in a multiparous woman with a large pelvis and no prior pelvic inflammatory disease or surgery. Although TLH, LAVH have significantly lower complication rate than AH, but overall cost is higher owing to the high operating room charges. The final selection of hysterectomy route should be based on surgeon’s experience and indication for surgery.

To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy

Introduction: Hysterectomy is a very common surgery and can be performed by abdominal, vaginal or laparoscopic method though the abdominal route is more popular. Vaginal hysterectomy has distinct health and economic benefits. We designed this study to compare the outcomes in TAH and non-descent vaginal hysterectomy and to determine which route of hysterectomy is superior, safe and effective. Aims of the study: To determine the safety and effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy and to compare both in terms of duration of surgery, blood loss, intra operative complications, postoperative complications and duration of hospital stay. Materials and methods: This was a prospective, study done on total of 100 patients were divided randomly into two groups. One group underwent total abdominal hysterectomy and the other underwent vaginal hysterectomy. Both groups were compared for patient demographics, indications for surgery, size of uterus, duration of surgery, blood loss, need for blood transfusions, complications and duration of hospital stay. Results: Fibroid was the most common indication in both the groups. Most of the patients had 6 – 8 weeks size uterus. Mean intra operative blood loss in TAH group was slightly more than NDVH group. The need for blood transfusion was similar. The mean duration of surgery was 100.2 minutes in TAH group and 83 minutes in NDVH group. Fever was the most common complication in both groups. Abdominal wound infection and secondary suturing was seen in TAH group. The mean postoperative stay was 8.1 days in TAH group and 5.8 days in NDVH group. P. Divya Daniel, D. Anupama. To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy. IAIM, 2017; 4(10): 77-86. Page 78 Conclusion: NDVH is associated with less duration of surgery, less blood loss, less postoperative stay than TAH. There was no difference between the need for blood transfusion between the two groups. Therefore, vaginal hysterectomy is safe and feasible in most of the women requiring hysterectomy for benign conditions and should therefore be attempted.