The Validity of Generally Accepted Contraindications for Total Vaginal Hysterectomy

Noh, Dong Kyu; Lee, Seon Kyung

Abstract

OBJECTIVE
A number of preexisting clinical conditions are generally accepted as contraindications for total vaginal hysterectomy. The purpose of this study was to evaluate the validity of these contraindications.
METHODS
The TVH-A group consisted of 230 patients who have undergone vaginal hysterectomy. These patients (1) had a large uterus (>280 gm), (2) were either nulliparous or had no previous vaginal delivery, or (3) had a history of previous abdominal or vaginal operation. The TVH-B group was composed of patients who did not present with any contraindications when they underwent vaginal hysterectomy. Patients of the TAH group underwent abdominal hysterectomy. The records for all patients were analyzed according to age, weight, parity, primary diagnosis, uterine weight, duration of operation, blood loss, analgesia, hospital stay, and postsurgical complications.
RESULTS
No significant difference in age and weight was observed between the three groups. The average number of vaginal deliveries performed was lower in the TVH-A group. Uterine myoma, carcinoma in situ, and adenomyosis were common preoperative diagnoses in all groups. The most common contraindication for total vaginal hysterectomy in the TVH-A group was history of previous operation (54.8%); large uterus (44.8%) and nulliparity (21.3%) ranked second and third, respectively. Durations of operation, hospital stay, and pain were longer, bleeding volume was greater, and incidence of postoperative complications was higher in the TAH group than in the other groups (p<0.01). Previous cesarean delivery did not affect various operative characteristics among women undergoing vaginal hysterectomy (p<0.01).
CONCLUSION
Our data indicate that a history of previous operation, large uterus, and nulliparity rarely constitute contraindications to vaginal hysterectomy.