Vaginal Hysterectomy for Non Descent Uterus- A Prospective Multicentric Study

Introduction: Vaginal route of hysterectomy is being reinvented in the present era due to the advantage of reduced operating time, lesser hospital stay, reduced morbidities and better patient satisfaction. Therefore, the objective of this study was to evaluate the effectiveness of vaginal hysterectomy as a primary route for all indicated cases, in absence of uterovaginal prolapse. Materials and Methods: In this study, 863 cases of non-descent vaginal hysterectomy for uterine size between normal to 18weeks gravid size were included and operated after complete evaluation with a valid consent. Operating time, blood loss, haemoglobin levels and hospital stay were estimated. An Intra operative and post-operative complication if any was noted. Patient was asked to report to the outpatient department after two and six weeks for follow up. Results: The commonest age group in the study was between 41-50 years comprising of 43.80% of the cases followed by 30-40 years (28.04%). The most common indication in the study was Dysfunctional uterine Bleeding (48.9%) followed by Fibroid Uterus (33.8%), Adenomyosis (10%) and Chronic Pelvic Inflammatory disease (3.24%). 6-10weeks gravid size was most commonly operated upon constituting 53% of cases. The average operating time was between 20-60 minutes, with an average blood loss between 50 to 150 ml, with an average hospital stay of 3-4 days. A total of 83 cases (9.61%) developed complications with urinary tract infection in 24 cases (2.78%), wound infection in 47 cases (5.44%), vaginal bleeding in 12 cases (1.39%). Conclusion: For properly selected cases vaginal hysterectomy is the preferred route in the hands of experienced surgeons. The need of the hour is minimally invasive surgery, early discharge from the hospital, early resumption of work, avoidance of disfiguring scar on the abdomen and cost-effectiveness of the procedure are as important as cure of the disease. Vaginal hysterectomy fulfils these criteria to absolute satisfaction. Citation: Chaitra Ramachandra, Ramlingappa, Deepa, Shankaregowda(2016). Vaginal Hysterectomy for Non Descent UterusA Prospective Multicentric Study Page 2 of 3 www.scientonline.org Womens Health Gynecol Volume 2 • Issue 5 • 034 All these patients were admitted in gynaecology department after general examination, per abdominal examination, local examination, per speculum and per vaginal examination for size and position of uterus, degree of descent,mobility of uterus, associated with cystocoele, rectocele, decubitus ulcer.The patients were thoroughly investigated by routine investigation e.g. CBC, RFT, LFT, BL.GP, PAP test, chest x-ray, ECG in wards for their fitness for surgery and other diseases if associated. A good bowel preparation would help gain exposure and avoid bowel injury. Operative site was cleaned and draped, cervix was held with a vulsellum. A circumferential incision was taken around the cervix, pubo-vesical ligament cut and bladder pushed up. Anterior and Posterior peritoneum were opened, ligaments and uterine vessels were cut and transfixed. If uterine exteriorisation was found to be difficult; morcellation, bisection or combination of both were used. Suturing the cardinal and uterosacral ligaments to the vaginal cuff at the time of hysterectomy was done to prevent vault prolapse. Small vaginal pack was placed at the end of the surgery. Operating time was calculated from the beginning to the incision at cervico-vaginal junction to the placement of small vaginal pack. Blood loss was calculated by weighing the cotton swabs, mops before and after the surgery. Patient received antibiotics and analgesics as per hospital protocol. Haemoglobin was estimated on day-3 and patients were discharged between day 3 to day 5. Hospital stay was defined as number of days in hospital excluding the operating day. Patient was asked to report to the outpatient department after two and six weeks for follow up. All the patients were observed post-operatively for development of complications like urinary tract infection, primary or secondary haemorrhage, vault sepsis, urinary tract fistula.