Vaginal Hysterectomy Following Previous Pelvic Operation 212 Cases: Clinical Analysis and Operative Technical Study / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: To determine whether hysterectomy by the vaginal route is safe and feasible in patients with previous pelvic operation. METHODS: A retrospective study of the records of Hallym University Hospistal patients who underwent vaginal hysterectomy performed by the senior author. Between January 1990 and January 1997, 212 patients who had previous pelvic operation were studied with special reference to operative difficulties, previous operation type, intraoperative complications, surgical time, hospital stay. RESULTS: 1. Patients characteristics was that ; The average age was 44.5+/-6.6 years old, the average parity was 2.3 , the average stay of hospitalization was 7.5+/-0.89 days, the frequency of Morcellation was in 24.5%, the average surgical time including associated procedure was 82+/-16.2 minutes, the average uterine weight was 164+/-85.1gm. 2. The most common previous pelvic operation was cesarean section(95 cases). 3. The most common indication was uterine myoma(51.9%). 4. Surgical technique used to gain access to the pouch of Douglas was done anteriorly; 52 patients of previous cesarean section(24.5%) and 112 patients of others operation(52.8%) were easily opened by blunt dissection, 43 patients of previous cesarean section(20.3%) and 5 patients of others operation(2.4%) were required sharp dissection. posterioly ; 190 patients(89.6%) were easily opened by blunt dissection, 22 patients(10.4%) were required sharp dissection. 5. Significant complications were bladder injury(1 case) , postoperative transfusion due to bleeding(6 cases). No cases of postoperative laparotomy was done and other minor compications were fever(15 cases), bladder retention(11 cases), others. CONCLUSIONS: It was possible to perform vaginal hysterectomy safely in patients with previous pelvic operation. Vaginal hysterectomy remains the method of choice for removal of the uterus of the previous pelvic operations in the absence of other contraindications.