Comparative Study of Vaginal Hysterectomy and Total Abdominal Hysterectomy in Non-descent Uterus

Abstract

AIM

To compare outcome of the study of the Vaginal Hysterectomy (VH) in non-descent uterus and that of total Abdominal Hysterectomy (AH) with respect to demographic profile like age group & parity & presenting symptoms, indications, diagnosis, mode of delivery, operative time, operative complications, blood transfusion need, postoperative complications, ambulation, type anaesthesia & complications of anaesthesia and post operative hospital stay.

MATERIALS & METHODS

The study was carried out at Dhiraj Hospital at Vadodara, Gujarat. Total of 100 cases admitted to the Gynaecology unit requiring hysterectomy for benign diseases were randomly selected out of which 50 cases underwent vaginal hysterectomy for non-descent uterus and 50 cases underwent abdominal hysterectomy for the same indications during the study period between January 2023 to February 2024.

RESULT

• Majority of the patients operated for hysterectomy belonged to 41-50 years of age. Mean age of abdominal hysterectomy and vaginal hysterectomy are 43.2 and 45.6 respectively. Majority of the patients came to the hospital with complain of excessive menses.
• Most of the patients who underwent hysterectomy are multiparous and mean parity in the AH group is 3.05 and VH Group is 3.13
• The most common indication in both the group is DUB (43%) of the cases, followed by Adenomyosis (31%), Fibroid Uterus (19%) and PID (7%).
• 82% of the patients are delivered vaginally and 13% of these patients has previous caesarean delivery and operated without any major complication. Selected cases of previous CS were successfully operated vaginally without any major complication.
• Anaemia (30%) is the most common medical condition associated in this study. As patients coming for hysterectomy are of perimenopausal age group and usually present with the complain of menorrhagia therefore they develop anaemia.
• Mean duration of surgery in vaginal group (62 minute) is lower than the abdominal group (70 minutes). Patients of vaginal group ambulated earlier than the abdominal group.
• Total 20% of cases were given blood transfusion pre, intra, or post operatively to reduce intraoperative and post operative morbidity and mortality in required cases.
• Overall, 97% of the patients operated under spinal anaesthesia and 8% of these patients developed spinal headache.
• Rate of intraoperative complication is high in abdominal group as compared to vaginal group. Most common indication in the abdominal group is adhesions. Intraoperative bladder injury is seen in 2 cases of abdominal group and 1 case of vaginal group which was managed successfully.
• Most common post operative complication is fever in 4.5% of cases. Rate of post operative complication is less in vaginal group as compared to abdominal group. There were 3 cases of wound infection which required re-suturing.
• Most of the patients discharged between 4-6 days post operatively. Mean postoperative stay in the vaginal group is 4.1 day and abdominal group is 5.1 days.
• There was no case of mortality in this study showing that hysterectomy was a safe procedure nowadays with minimal complications.

CONCLUSION

Vaginal hysterectomy is a safe, least invasive & most economical route, with lesser complications and should be chosen as the preferred method of hysterectomy, over total abdominal hysterectomy, whenever feasible.