Vaginal hysterectomies in patients without uterine prolapse: a local perspective.

OBJECTIVE To review the results of vaginal hysterectomies in patients without uterine prolapse. DESIGN Retrospective chart review. SETTING University affiliated hospital, Hong Kong. PATIENTS Patients who had vaginal hysterectomies in the absence of uterine prolapse, from 1999 to 2005 inclusive. MAIN OUTCOME MEASURES The number, indications, operative procedures, and complications of such hysterectomies. RESULTS A total of 94 patients who underwent vaginal hysterectomy fulfilled the inclusion criteria. They accounted for 4.3 to 8.2% of all hysterectomies performed annually for benign diseases in the department, over the inclusive period 2000 to 2004. The incidences of complications, except bladder injuries, were comparable to those reported in other studies. The incidence of vault haematoma decreased as each surgeon's experience increased and more attention was paid to 'bleeders' at the 'four and eight o'clock areas' and more cephalic regions of the vaginal incision. Increased size of the uterus was an important determinant of the risk of complications. CONCLUSIONS Vaginal hysterectomy is an underutilised approach in Hong Kong. With more experience and better patient selection, complication rates can be further reduced. Further evaluation is suggested for the role of bleeders at 'four and eight o'clock regions' as potential causes of vault haematoma.