Transactions of the Sixty-Eighth Annual Meeting of the Central Association of Obstetricians and GynecologistsChallenging generally accepted contraindications to vaginal hysterectomy☆
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.
Indication Study VH (n = 250) VH (n = 250) LAVH (n = 250) TAH (n = 250) No. % No. % No. % No. % Bleeding 112 44.8 62 24.8 80 32.0 75 30.0 Fibroids 88 35.2 28 11.2 59 23.6 65 26.0 Prolapse 0 0 100 40.0 15 6.0 3 1.2 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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Cited by (99)
The routes of hysterectomy: A survey of current practices amongst members of the International Society for Gynaecologic Endoscopy (ISGE)
2023, European Journal of Obstetrics and Gynecology and Reproductive BiologyVariation in Vaginal Hysterectomy Rates in an Integrated Healthcare System
2022, Journal of Minimally Invasive GynecologyA 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 BiologyCitation Excerpt :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.
Formal institutional guidelines promotes the vaginal approach to hysterectomy in patients with benign disease and non-prolapsed uterus
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyPerioperative Outcomes of Total Vaginal Hysterectomy in Women with Prior Cesarean Delivery
2020, Journal of Minimally Invasive GynecologyEvidence-based practical guidelines of the International Society for Gynecologic Endoscopy (ISGE) for vaginal hysterectomy
2020, European Journal of Obstetrics and Gynecology and Reproductive Biology
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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.