A survey of vaginal hysterectomy ending in laparotomy

We did a retrospective study of 1,736 vaginal hysterectomies at Handa City Hospital from 1990 to 1999 with special reference to those 24 cases ending in laparotomy. The duration of operation, estimated blood loss, and uterine (with adnexal) weight of the failed vaginal hysterectomies were 139.1+/-42.9 min, 1,176.8+/-699.8 mL, 564.5+/-357.6 g, respectively. These values were significantly higher than those for the successful vaginal hysterectomies. Adhesions were seen in 14 cases (58.3%). Blood transfusion was required in 9 cases (37.5%). The most frequent cause for laparotomy was adhesions, followed by non-descent of the uterus. The decision to convert a vaginal hysterectomy into an abdominal procedure should be prompt because delay means the increased blood loss and a greater need for blood transfusions.