NON DESCENT VAGINAL HYSTERECTOMY VERSUS TOTAL ABDOMINAL HYSTERECTOMY A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Among the most common procedures performed by the gynecologist all over the world including India is Hysterectomy. It is one of the most common elective surgeries in hysterectomy as operative modality. Factors influencing route of hysterectomy include accessibility and size of uterus, extent of adnexal pathology, surgeon training and experience. There are different routes of removal of uterus which is being used with abdominal hysterectomy is no doubt more popular route than vaginal route. An advance in anaesthesia, availability of transfusion services and antibiotics has made hysterectomy becoming the most common procedure in nonpregnancy related major surgical procedures. Many literature supports that vaginal hysterectomy is the cost effective and safe procedure for the removal of uterus also most regularly abdominal route is chosen. In this new era of minimally invasive surgery, a resurgence of interest and importance of VH for non-descent indications i.e. non-decent vaginal hysterectomy (NDVH) as the scar less hysterectomy has occurred as has many benefits over abdominal hysterectomy such as lesser post-operative morbidity, cosmetic advantages, better and rapid recovery. The objectives of the study was to compare and assess factors like operative duration of surgery, intra operative and post-operative complications, intra operative blood loss, postoperative requirement of analgesia , post-operative ambulating time and duration of post-operative hospital stay and to put forward best route of hysterectomy in non- descent cases. Compared to all other routes vaginal hysterectomy yields better outcome with less complications. The study was done on 50 cases fulfilling the inclusion criteria. Patients were randomly segregated in two groups- abdominal hysterectomy and NDVH (non-decent vaginal hysterectomy). Intra operative blood loss, Operative time and post-operative morbidity and hospital stay were less in NDVH groups. Nondecent vaginal hysterectomy is a better substitute to abdominal hysterectomy in cases with benign disorders of the uterus, with good mobility and adequate vaginal access.