Clinical Study for the Feasibility of Total Vaginal Hysterectomy on the Cases with Contraindication

Kim, Kyoung Won; Kim, Do Gyun; Sim, Jae Chul

Abstract

OBJECTIVE
The purpose of this study was to evaluate the feasibility of vaginal hysterectomy on contraindicated cases. MATERIAL AND METHODS: We examined the medical records of 154 patients who underwent vaginal hysterectomy and 139 patients who underwent abdominal hysterectomy from March 1999 to March 2002. Among vaginal hysterectomy group, 77 patients (Group I) were found to have more than one contraindication for vaginal hysterectomy such as large uterus (>280 g), nulliparous or no previous vaginal delivery, and previous pelvic laparotomy. Remaining 77 patients (Group II) had no contraindications for vaginal hysterectomy. These two groups were compared with 139 abdominal hysterectomy patients (Group III) regarding preoperative surgical indication, uterus size, operative time, bleeding volume, hospital stay, pain duration and postoperative complications.
RESULTS
1. The Group II patients were older than the other groups (Group I 45.9 years; Group II 53.4 years; Group III 45.9 years) and had history of higher parity by vaginal delivery (Group I 2.5; Group II 3.5; Group III 2.1). 2. The most common indication of hysterectomy was myoma in Group I (59.7%) and Group III (71.9%) and uterine prolapse in Group II (41.6%). 3. The average bleeding volume during the operation was greater in Group III (308.6 ml) than Group I (123.4 ml) and Group II (116.2 ml)(p<0.01). 4. The operative time was longer in Group III (105.4 min) than the other groups (P<0.01). 5. Hospital stay was shorter in Group I (7.6 days) and II (7.6 days) than Group III (8.8 days)(P<0.01). 6. The pain duration was shorter in Group I (1.53 days) and Group II (1.59 days) than in Group III (2.23 days)(P<0.01). 7. The incidence of postoperative major and minor complications was significantly higher in Group III (38.8%) than the other groups (Group I 24.6%; Group II 19.5%)(P<0.01).
CONCLUSION
The vaginal hysterectomy is still safe and effective procedure for the patients who have contraindications such as a large uterus, nulliparity or no previous vaginal delivery and previous laparotomy except the cases with immobility of uterus by severe pelvic adhesion.