Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

Background: Vaginal hysterectomy is less commonly performed for benign pathologies if the uterine size exceeds 12 weeks in the belief that complications could be higher in this group. The aim of this prospective study was to compare surgical outcomes and safety of vaginal hysterectomy in women with non-prolapsed uteri of >12 weeks size to those with uteri of<12 weeks removed vaginally for similar indications.Methods: In this prospective cohort study, 92 patients were included who underwent NDVH for benign uterine conditions between May 2016 to December 2018. The index group comprised 32 women who underwent vaginal hysterectomy for non-prolapse uterus with uterine enlargement (>12 weeks), while the control group consisted of 60 women with uteri <12 weeks. Demographic data, duration of surgery, blood loss, intraoperative and postoperative complications were compared.Results: Women in the two groups had statistically similar mean age, Body Mass Index and parity (44 vs 42.77 years, 20.8 vs 21.56 kg m3 and 3.26 vs 3.83, respectively; p > 0.05). The mean operative time was significantly longer in the index group (62.47min; vs 48.17 min; p <0.0001). Women with enlarged uteri had greater mean estimated blood loss (123.2 ml vs 75.9 ml; p < 0.0001) but the mean length of hospital stay was similar (5.531 days vs 5.177 days; p > 0.05). Intra- and post-operative complications such as blood transfusion and pelvic sepsis, post-operative febrile illness and systemic infections were comparable in both groups.Conclusions: Vaginal hysterectomy in larger non-prolapsed uteri takes longer to perform and is associated with more blood loss compared to uteri <12 weeks but is not associated with a significant increase in complication rates.

Vaginal Removal of Non Prolapsed Uterus with Benign Pathology.

Vaginal hysterectomy was the first minimally invasive surgical approach for benign gynecologic conditions, a number of other approaches for hysterectomy have been introduced, yet when compared with vaginal hysterectomy these approaches do not offer significant benefits for similar indications. Objectives : (1) To know the benign gynecological conditions that can be treated by vaginal hysterectomy. (2) To find out the operative difficulties of vaginal hysterectomy done in non-prolapsed uterus. (3) To know the morbidity and mortality of vaginal hysterectomy. Methodology : This is a prospective study conducted at our Hospital from 1st December 2010 to 30th Nov. 2011. Hundred consecutive cases of non-descent vaginal hysterectomy for benign pathology of uterus were studied. Results : In our study maximum hysterectomies were done in the age group 41-50 (49%) followed by 31- 40 (40%) least were in age more than 50 years. Mean parity of the cases undergoing hysterectomy were 2.47. In 77% patients, complaints were menorrhagia. The maximum hysterectomies, 41% for fibroid uterus were done, followed by 39% for DUB. One patient had intraoperative bladder injury. Mean operating time for the hysterectomies was 53.21 minutes. No mortality was seen, 12% post-operative complications were present. The mean post-operative stay in the hospital was 5.95 days. Conclusion : Vaginal hysterectomy is both feasible and optimal for many patients who long have been considered inappropriate candidates for vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic approach for benign conditions of the uterus.

Analysis of the complication of transvaginal hysterectomy of patients with non-prolapsed uterus / 中国综合临床

Objective To explore the advantages and disadvantages of transvaginal hysterectomy for patients with non-prolapsed uterus,and explore the cause and preventive measurements of the complications of transvaginal hysterectomy.Methods The complications of transvaginal hysterectomy ( group TVH ) in 110 patients with non-prolapsed uterus and of transabdominal hysterectomy ( group TAH ) in 120 patients were compared with each other.These patients were chosen randomly from June 2006 to April 2010.Results In the TVH group,rectum hurt occurred in one patient,prolapse of fallopian tube in one patient and celiac internal bleeding in one patient.The preoperative diagnosis were not consistent with the postoperative diagnosis in four patients.Two patients encountered with postoperative residual end bleeding and four patients with vaginal residual end polyps.In the TAH group,three patients had postoperative diagnosis inconsistent with their preoperative diagnosis.In addition,there were four abdominal wall incision liquefaction ( including two phase suture in two patients),three postoperative bronchial lung infection and two residual end polyps.No celiac internal bleeding and visceral injury occurred in this group.Conclusion TVH has a higher risk of visceral injury and postoperative bleeding than TAH.These complications should be avoided when treating the patients with TVH technique.

The applications of vaginal hysterectomy of non-prolapsed uterus lesion in primary hospital / 中国基层医药

ObjectiveTo explore the application value and techniques of vaginal hysterectomy of non-prolapsed uterus lesion in primary hospital. Methods140 cases who suffered from uterine fibroid without adhesion,glandular fibroids,functional bleeding without uterine prolapse and malignant disease were selected and divided into observation group(80 cases with vaginal hysterectomy)and control group(60 cases with routine abdominal hysterectomy).Then the clinical treatment effect was analyzed. ResultsCompared with control group,peri-operative bleeding (150 ±23)ml vs(243 ±41)ml,operation time(65 ± 14.0)min vs(90 ± 27.0)min,body temperature recovery time (3 ±0.5)d vs(4 ±0.8)d,anus exhaust time(14 ± 1.8)h vs(26 ±2.7)h,the length of time(5 ±0.8)d vs(11 ±2.9)d in observation group were all reduced,differences were significant(all P＜0.01)and no case was transferred to opening appendectomy. ConclusionFor these disease including uterine fibroids with no adhesion,glandular fibroid uterine bleeding,the vaginal hysterectomy was safe and feasible,and had the advantage of smaller trauma,less bleeding,shorter hospitalization time,faster recovery etc.It was worthy to be popularized in primary hospital.

Clinical analysis of efficacy between Laparoscopic hysterectomy and abdominal hysterectomy / 中国基层医药

Objective To evaluate and compare the advantages and disadvantages and the clinical applica- _ tion between abdominal hysterectomy (AH) and laparoscopically hysterectomy ( LAH) on the benign lesions of Non-prolapsed Uterus. Methods 400 patients with benign lesions of Non-prolapsed Uterus were divided into two groups. They were AH group (202 cases) and LAH group (198 cases). The effects of clinical treatment of the two groups were compared. Results In LAH group anal exhaust time,postoperative morbidity,length of stay were less than those in AH group,the difference was statistically significant(P <0. 05 ). The cost of LAH group was higher,and all symptoms were relieved after opreation. In LAH group,the average recovery time of the surgery to return to work time was(21 ± 7) d, but in AH group that was( 36 ± 8 ) d. The differences of recovery rime between two groups were statistically significantly ( P < 0.05). In two groups B-myoma were not found obvious by follow-up. Conclusion Different surgical patterns of hysterectomy had their distinctive advantages. The key point of a successful operation was to avoid complications of the operation.

Analysis of clinical out come between vaginal and abdominal hysterectomy for non-prolapsed uterus / 中国基层医药

Objective To compare the postoperative recovery of vaginal and abdominal hysterectomies of non-prolapsed uterus ,in order to offer the advantages, surgical indications and contraindieations ,surgical characteristic and diflieuhy of transvaginal hysterectomies of non-prolapsed uterus. Methods To retrospectively analyze 480 cases transvaginal hysterectomies (TVH) and 440 cases transabdominal hysterectomies (TAH) with similar indications in the corresponding period, and compare the operation duration ,blood lost during the procedure, postoperative analgesic, morbidity, recovery time of the function of intestine, activity time of getting up and hospitalization between those surgi-ca] techniques. Results There were no intraoperation and postoperative complications in group TVH. In group TAH: more blood was lost(P <0.01) ,the function of intestine recovered more slowly(P <0.01) ,more analgesic needed, more morbidity noted (P < 0.01), activity time of getting up is much longer(P < 0.01). The hospital stay after opera-tion was much shorter in group TVH(P <0.01). No statistical difference was found between the two groups in terms of the duration(P 0.05). Conclusion TVH is minimal invasive surgery that include small trauma,reduced pain, no abdomen scar and quick recovery. So the patients are happy to accept it.

Comparision of Vaginal Hysterectomy and Abdominal Hysterectomy for a Nonprolapsed, Benign Uterine Disease in Women Without Vaginal Delivery / 대한산부인과학회잡지

OBJECTIVE: This study was designed to compare the vaginal hysterectomy and abdominal hysterectomy for a non-prolapsed, benign uterus in women without vaginal delivery. METHODS: A retrospective study in Hallym-university hospital analysed 182 total hysterectomies in women without vaginal delivery performed from January 2000 to December 2001. Vaginal route was used for 98 (53.8%) patients and 84 (46.2%) had laparotomies. RESULTS: The mean uterine weight was 217 g in vaginal route, 270 g in abdominal route. Mean operation time was 70 minutes in vaginal route, 125 minutes in abdominal route. There was one serious re-operation due to hemorrhge in each group and other complication was not much different at each gruops. The hospital stay was 6.2 days in vaginal route and 8.4 days in abdominal route. CONCLUSION: Vaginal hysterectomy for a non-prolapsed uterus is indicated for women without vaginal delivery and is feasible to performance. Vaginal hyterectomy is less morbidity, shorter hospitalization and faster convalescence. So training in vaginal surgury should allow safe performance of the procedure at most center.