Transactions of the Sixty-Eighth Annual Meeting of the Central Association of Obstetricians and Gynecologists
Challenging generally accepted contraindications to vaginal hysterectomy

Presented at the Sixty-eighth Annual Meeting of The Central Association of Obstetricians and Gynecologists, Chicago, Illinois, October 18-21, 2000.
https://doi.org/10.1067/mob.2001.115047Get rights and content

Abstract

Objective: A number of preexisting clinical conditions are generally accepted as contraindications to vaginal hysterectomy. The purpose of this study was to evaluate the validity of this concept. Study Design: The study vaginal hysterectomy group consisted of 250 consecutive patients undergoing vaginal hysterectomy. These patients (1) had a large uterus (>180 g), (2) either were nulliparous or had no previous vaginal delivery, or (3) had a previous cesarean delivery or pelvic laparotomy. Three control groups used for comparison underwent (1) laparoscopically assisted vaginal hysterectomy, (2) vaginal hysterectomy, or (3) abdominal hysterectomy. The records for all patients were analyzed for age, weight, parity, primary diagnosis, uterine size, operative time, blood loss, analgesia, hospital stay, resumption of diet, incidence of morcellation, and surgical complications. Sample size calculations were based on previous studies of complications associated with vaginal hysterectomy (α = .05; β = .20). Results: Hysterectomy was successfully completed by the intended vaginal route in all study patients. Major and minor complications (3.2%) were significantly less (P < .001) than in the other groups as follows: vaginal hysterectomy, 10.4%; laparoscopically assisted vaginal hysterectomy, 11.6%; and abdominal hysterectomy, 13.6%. The decrease in hematocrit was 5.7% in the study vaginal hysterectomy group compared with 6.2% for vaginal hysterectomy, 6.5% for abdominal hysterectomy (P = .009), and 6.6% for laparoscopically assisted vaginal hysterectomy (P = .002). Hospital stay was shorter for the study group (2.1 days) than for vaginal hysterectomy (2.3 days; P < .001) and abdominal hysterectomy (2.7 days; P < .001). Operative time was shorter in the study vaginal hysterectomy group (49 minutes) than with laparoscopically assisted vaginal hysterectomy (76 minutes; P < .001) or abdominal hysterectomy (61 minutes; P < .001), although morcellation was carried out more frequently in the study group (34%) than with vaginal hysterectomy (4%) or laparoscopically assisted vaginal hysterectomy (11%). Conclusion: Our data indicate that a large uterus, nulliparity, previous cesarean delivery, and pelvic laparotomy rarely constitute contraindications to vaginal hysterectomy. (Am J Obstet Gynecol 2001;184:1386-91.)

Section snippets

Material and methods

After institutional review board approval, 250 consecutive vaginal hysterectomies for benign disease performed between 1994 and 1999 at Lakeview Hospital in Bountiful, Utah (n = 225), and the University of Utah Health Sciences Center (n = 25) were reviewed.

The study VH group consisted of patients undergoing VH (1) for a large uterus (>180 g), (2) nulliparity/no vaginal delivery, or (3) previous cesarean or pelvic laparotomy. These “contraindications” to VH are the three most commonly accepted

Results

As shown in Table I, the groups are very similar with regard to age. The standard VH group had greater mean parity (3.9) and lower mean weight (70.2 kg), whereas the study VH group had the greater mean uterine weight (222.1 g). The primary indications for surgery are listed in Table II.

. Primary indications for surgery

IndicationStudy VH (n = 250)VH (n = 250)LAVH (n = 250)TAH (n = 250)
No.%No.%No.%No.%
Bleeding11244.86224.88032.07530.0
Fibroids8835.22811.25923.66526.0
Prolapse0010040.0156.031.2
Pain

Comment

TAH is associated with increased rates of transfusion, unexplained fever, urinary tract and operative site infections, and thromboembolic events in comparison with VH.4 In our study the complication rate for TAH (13.6%) was twice that of the mean (6.8%) for both the study group (3.2%) and the standard VH group (10.4%). Our results show that VH can be performed safely in patients with a large uterus, nulliparity/no vaginal delivery, or previous cesarean or pelvic laparotomy. The complication

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  • A randomized control trial comparing vaginal and laparoscopically-assisted vaginal hysterectomy in the absence of uterine prolapse in a South African tertiary institution

    2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
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    Hysterectomy remains one of the most common operative procedures for benign gynaecological diseases [1,2]. Even though vaginal hysterectomy (VH) or laparoscopic hysterectomy (LH) should be the preferred, based on their well-documented benefits [3–7], the practice of abdominal hysterectomy (AH) predominates [8,9]. It can be explained, in part, by personal choice, but a lack of training and experience may also result in the surgeon’s reluctance to perform VH.

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Reprint requests: Raymond C. Doucette, MD, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, 50 N Medical Dr, Suite 2B200, Salt Lake City, UT 84132.

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