REVIEW OF ONE HUNDRED CONSECUTIVE ABDOMINAL HYSTERECTOMIES: THEIR SUITABILITY FOR VAGINAL HYSTERECTOMY
Abstract
Background: Abdominal hysterectomy is one of the most common major operations in gynaecology. However, it is associated with considerable morbidity and relatively slow recovery. The superiority of hysterectomy by the vaginal route is not denied. It is associated with a significant fewer complications than abdominal hysterectomy. This study was done with the aim to determine what proportion of hysterectomies performed via abdominal route could have been performed vaginally or with laparoscopic assistance. Methods: Case notes of one hundred consecutive patients who had an abdominal hysterectomy were obtained from the records department. Out of 100 cases only 85 case notes were made available for analysis. Results: A total of 74 cases for benign disorder were studied; 50% of the cases were over the age of 40 years and 82% of the patients were multiparous. The uterine size was less than 12 weeks in 67 cases. About 44.6% of cases were found to have menorrhagia without any organic pathology. For the majority of cases it was not apparent from the cases notes as to the degree of uterine descent. Three patients required blood transfusion in the preoperative group and 7 cases in the postoperative group. Primary haemorrhage was noted in 3 cases. Three patients needed readmission for secondary haemorrhage due to vault hematoma formation and in one case a hematoma of rectus sheath was noted which needed drainage. Paralytic ileus was noted in 2 cases and one case had intestinal obstruction. Most of the patients were allowed home within 7 days. One patient stayed for 17 days due to intestinal obstruction requiring laparotomies and gut resection. Majority of the cases were done by the consultants. Conclusion: By considering the specific guidelines for vaginal hysterectomy, every patient who need hysterectomy should be assessed for vaginal hysterectomy, provided there is no contraindication for it. Preoperative assessment under anaesthesia should be an integral part of management of a patient needing hysterectomy.Keywords: Abdominal hysterectomy, vaginal hysterectomy, Menorrhagia, Dysfunctional uterine bleedingReferences
Langenbeck JCM. Geschichte einer von mir glucklich verrichteten exirpation der ganzen ganbermuter. Bibioth Chir Opth 1817;1:557.
Bebcock WW.The technique for vaginal hysterectomy. Surg Gynecol Obstet 1932;54:193–9.
Studd J, Tan SL, Chervenak FA. (2006). Progress in obstetrics and gynaecology (Vol. 17). Elsevier Health Sciences.
Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009;8:CD003677.
Reich H, Maher PJ, Wood C. Laparoscopic hysterectomy. Baillieres Clin Obstet Gynecol 1994;8(4):799–815
ACOG Committee Opinion No.444: Choosing the route of hysterectomy for benign disease. Obstet Gynecol 2009;114:1156–8.
Kovac SR. Guidelines to determine the route of hysterectomy. Obstet Gynecol 1995:85(1):18–23
National Institute of Clinical Excellence Guidelines[ CG44] Published date:2007
Kovac SR, Barhan S, Lister M, Tucker L, Bishop M, Das A. Guidelines for the selection of the route of hysterectomy: Application in a resident clinic population, Am J Obstet Gynecol 2002;187(6):1521–7.
NICE interventional procedure guidance[IPG239] Laparoscopic techniques for hysterectomy published date: November 2007
Doganay M, Yildiz Y, Tonguc E, Var T, Karayalcin R, Eryilmaz OG, et al. Abdominal, Vaginal and total laparoscopic hysterectomy: perioperative morbidity. Arch Gynecol Obstet 2011;284(2):385–9.
Sheth SS, Malpani AN. Vaginal hysterectomy following previous caesarean section. Int J Gynaecol Obstet 1995;50(2):165–9.
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(6):1561–5.
Chalermchockchareonkit A, Tekasakul P, Chaisilwattana P, Sirimai K, Wahab N. Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis. Int J Gynecol Obstet 2012;116 (2):109–11
Kongwattanakul K, Khampitak K. Comparison of Laparoscopically Assisted Vaginal Hysterectomy and Abdominal Hysterectomy: a Randomized Controlled Trial J Minim Invasive Gynecol 2012;19(1):89–94
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
