Vaginal Removal of The Adnexae at The Time of Vaginal Hysterectomy

Kim, J R; Kang, J B; Kim, H B; Lee, K Y; Kang, S W

Abstract

OBJECTIVE
The purpose of this study is evaluation of the method, complications, operation time, and operability of vaginal removal of the adnexae after vaginal hysterectomy. Study design: This study was attempted to analyze 105 women underwent vaginal removal of the adnexae in association with vaginal hysterectomy at Department of Obstetrics and Gynecology, School of Medicine, Hallym University, Kangnam Sacred Heart Hospital, from Jan. 1991 to Dec. 1995.
RESULTS
Both salpingoophorectomy was performed in 5 patients, unilateral salpingo-ophorectomy (92: left-42, right-50), oophorectomy without salpingectomy (7) were done. And eighty four patients underwent posterior vaginal repair, twenty-one patient underwent anterior-posterior vaginal repair. Most common indications of adnexectomies were macroscopic lesions of the ovaries (cysts, inflammatory change, etc.), and other indications were elective oophorectomy (18), bleeding pedicle (3). Pathologic findings of the ovaries were normal (18), benign cystic tumor (69), benign solid cyst (14), endometriosis, inflammatory change, etc (4). The complications were fever (12), urinary tract infection (1), vaginal stump infection (2), postoperative transfusion (7), re-laparotomy (2). Most complications were associated with vaginal hysterectomy. But there was no evidence that a ureter injury that was major complication of vaginal adnexectomy, was in any of the patients. The average time for vaginal hysterectomy with bilateral salpingoophorectomy was 96 minutes and unilateral salpingoophorectomy was 94 minutes including anterior or posterior and combined vaginal repair time. The average hospitalization was 7~8 days.
CONCLUSION
There appears to be little or no risk involved in removing the adnexae through the vagina during vaginal hysterectomy. However, vaginal adnexectomy requires special skill and judgment and should be performed only by gynecologists who are trained and experienced in vaginal surgery.