A Comparison Between Non-Descent Vaginal Hysterectomy and Total Abdominal Hysterectomy

Hysterectomy is one of the most common gyneacological surgeries performed worldwide. The vaginal technique has been introduced and performed centuries back, but has been less successful due to lack of experience and enthusiasm among Gynaecologists, due to a misconception that the abdominal route is safer and easier.

To evaluate the most efficient route of hysterectomy in women with mobile nonprolapsed uteri of 12 weeks or lesser by comparing the intra and postoperative complications of vaginal and abdominal hysterectomies.

A prospective, randomized controlled trial was performed wherein, 300 consecutive patients requiring hysterectomy for benign diseases were analysed over a period of 2 years (December 2012-November 2014). Group A (n = 150) underwent vaginal hysterectomy (non descent vaginal hysterectomy, NDVH) which was compared with group B (n = 150) who had abdominal hysterectomy. The primary outcome measures were operative time, intraoperative blood loss, postoperative analgesia, hospital stay, postoperative mobility, blood transfusion, wound infection, febrile morbidity and postoperative systemic infections. Secondary outcome measures were conversion of vaginal to abdominal route and re-laparotomy.

Baseline characteristics were similar between the two groups. There were no intraoperative complications in either group. Regarding operation duration, intraoperative blood loss, postoperative pain, postoperative blood transfusion, mobilization in post operative ward, postoperative wound infection, febrile morbidity, duration of hospital stay, p-value was significant in vaginal hysterectomy compared to abdominal hysterectomy. Regarding postoperative systemic infections, p-value was not significant. None of the cases in the vaginal group were converted to abdominal route and none of the cases in the whole study group underwent re-laparotomy.

The present study concludes that patients requiring hysterectomy for benign non prolapse cases may be offered the option of vaginal hysterectomy which has quicker recovery, shorter hospitalization, lesser operative and postoperative morbidity compared to abdominal route.