Current criteria for selection of abdominal versus vaginal hysterectomy at civil hospital, Karachi

ABSTRACT

To determine the frequency of abdominal and vaginal hysterectomies and to evaluate the categorization of hysterectomy cases for abdominal or vaginal route at Civil Hospital Karachi. A cross-sectional, 12-month [2008] prospective comparative study was designed at Civil Hospital Karachi involving abdominal hysterectomy [AH] and vaginal hysterectomy [VH]. Data were extracted on a specially designed proforma including fields for age, parity, menopausal status, indication and route for hysterectomy, uterine size, and previous history of caesarean section, puerperal sepsis, tubal ligation, and laparotomy for gynecological indications. In this study, 107 [18.3%] abdominal and vaginal hysterectomies were done for benign gynecological causes. There was no case of laparoscopically assisted VH [LAVH]. Mean age [57.61 years] and parity [8] for VH were greater than those of AH [48.11 years] and 5, respectively. VH was predominantly done on atrophic uteri [25 [75.76%]]. AH was performed on 20 [27.02%] bulky uteri; in 53 [71.63%], the uterus was larger. Uterovaginal prolapse was the sole [100%] indication for VH with concomitant dysfunctional uterine bleeding [DUB] in 4 [12.13%] cases. The main indications for AH were fibroids in 28 [37.84%], DUB in 30 [40.54%], followed by adenomyosis and endometriosis in 10 cases [31.51%] each. Factors predisposing to pelvic adhesion and uterine immobility were present in 16 patients [18.85%] who underwent AH and 3 [9.09%] with VH. AH was commonly performed on less parous and perimenopausal women with larger uteri while VH was chosen for elderly, more parous women with atrophic and prolapsed uterus