Total Vaginal Hysterectomy Can Provide a Feasible Surgical Approach for Benign Conditions: A Study on Enlarged...

Background: The total vaginal hysterectomy (TVH) technique has been performed for many gynecological surgeries but is less used than total abdominal hysterectomy (TAH). The purpose of this study was to analyze the outcomes in patients who underwent either TVH or TAH for enlarged diffuse uterine adenomyosis (ADS). Methods: In this retrospective study, 160 hysterectomies with bilateral adnexectomy were scheduled for premenopausal women with diffuse ADS between 2020 and 2024 at a tertiary care center in Romania. The diagnosis was established based on clinical symptomatology, color Doppler transvaginal ultrasound, transabdominal ultrasonography and magnetic resonance imaging with histopathological confirmation of diffuse uterine ADS post-operatively from the hysterectomy specimen. All surgical procedures were performed by the same surgeon. The patients were divided into two groups: the TVH group (n = 80) and the TAH group (n = 80). Patient characteristics, including age, uterine weight, body mass index (BMI), parity, operative time, intraoperative blood loss, length of hospital stay, medical history, surgical history, intra- and postoperative complications, and the presence of adhesions, were evaluated. Results: No differences were observed between the two groups with regard to uterine weight, BMI, or parity. However, the TVH group was associated with significantly younger age, shorter operative time, lower intraoperative blood loss, and a reduced length of hospital stay (p < 0.001). Additionally, both medical and surgical histories were more frequently observed in the TAH group than in the TVH group. However, intra- (i.e., 3.75%) and postoperative complications (i.e., 13.75% vs. 3.75%) were slightly more frequent in the TAH group, as well as adhesions (i.e., 17.50% vs. 8.75%). Uterine hemisection, tactical myomectomy, or morcellation were frequently employed in the TVH group, being required in 77.5% of cases. Conclusions: In our cohort of patients with enlarged diffuse uterine ADS, TVH was associated with younger age, shorter operative time, reduced intraoperative blood loss, and a shorter length hospital stay compared with TAH, without an observed increase in perioperative complications. These results support the use of TVH as a feasible surgical approach for selected enlarged diffuse uterine ADS.