Abstract
Introduction: Hysterectomy is the commonest major gynaecological surgery performed in women. Currently there are three main types of hysterectomy operations –abdominal hysterectomy (AH), vaginal hysterectomy (VH) and non descent vaginal hysterectomy (NDVH).
Objective: To compare abdominal route versus vaginal route of hysterectomy in terms of intraoperative and postoperative complications.
Material and Methods: A prospective study was conducted in the department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Shimla over a period of one year. Number of hysterectomies enrolled for the study were 479. Category I (TAH) accounted for maximum number of cases i.e. 281 (58.6%) followed by category II (VH) which accounted for 136 (28.3%) cases followed by 62 (12.9%) cases in category III (NDVH).
Observations: Mean durations of surgery in category I, II and III were 74.01 ± 22.2 minutes, 69.19 ± 19.01 minutes and 67.5 ± 23.12 minutes respectively and this was significantly more in Category I (TAH) when compared to category II( VH) and category III (NDVH). Postoperative complications like fever, wound infection, UTI were also significantly more in category I (TAH) as compared to category II (VH) and III (NDVH) (p value <0.05).
Conclusion: Many advantages of NDVH over abdominal hysterectomy were no scar, no adhesions, less complications, shorter hospital stay and fast recovery. So vaginal route should be the preferred route for hysterectomy wherever possible.
Keywords: AH-Abdominal hysterectomy, NDVH-non descent vaginal hysterectomy, VH-vaginal hysterectomy
References
- Rock JA, JonesIII HW. Abdominal Hysterectomy. Telinde’s Operative Gynaecology 10th New Delhi: Wolters Kluwer (India) Pvt. Ltd. 2013:727-28.
- De Frances CJ, Hall MJ. 2005 National Hospital Discharge Survey. Adv Data. 2007 July 12; 385:1–19.
- Edozien LC. Hysterectomy for benign conditions. BMJ.2005; 330 (7506): 1457–8.
- Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews.2009;3:1-183.
- Magos A, Bournas N, Sinha R, Richardson RE, O’Connor H. Vaginal hysterectomy for the largeuterus. British Journal of Obstetrics and Gynaecology. March 1996;103: 246-51.
- Miskry T, Magos A. Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse. Acta Obstet Gynecol Scand. 2003;82: 351-8.
- Dawood NS, Mahmood R, Haseeb N. Comparison of vaginal and abdominal hysterectomy: peri-operative and post-operative outcome.J Ayub Med Coll Abbottabad.2009; 21(4):116-20.
- Geetha K, Seethalakshmi B, Jamila H. Retrospective Study of Total Abdominal Hysterectomy versus Vaginal Hysterec-tomy. Journal of Evolution of Medical and Dental Sciences. 2014;3(11):2768-73.
- Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B et al.Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Am J Obstet Gynecol. 2002;187:1561-5.
- Bhadra B, Choudhury AP, Tolasaria A, NupurN. Non Descent Vaginal Hysterec-tomy (NDVH): Personal Experience in 158 Cases.Al Ameen J Med Sci. 2011;4(1 ):23 -7.
- Shanthini NF, Poomalar GK, Jayasree M, Bupathy A.Evaluation of complications of abdominal and vaginal hysterectomy.Int J ReprodContraceptObstet Gynecol. 2012 Dec;1(1):7-11.
- Mahasani V, Suchdeva R, Aggarwal A. Hysterectomy – Which Approach?. People’s Journal of Scientific Research. Jan2014;7(1):17-21.
- Batista CS, Osako T, Clemente EM, Batista FCA, Osako MTJ. Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy. International Journal of Women’s Health. 2012;4:505-10.
- Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. Am J Obstet Gynecol.1984;144(7):841-8.
- Kovac SR. Hysterectomy Outcomes in Patients With Similar Indications. Obstetrics & Gynecology. June 2000;95 (6):787-93.
- Ottosen C, Lingman G, Ottosen L.Three methods for hysterectomy: a randomised, prospective study of short term outcome. British Journal of Obstetrics and Gynaeco-logy. November 2000;107:1380-5.
Corresponding Author
Dr Rama Thakur
Phone no. 9418253316, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.