Outcomes of Hysterectomy in Women with Prior Cesarean Section: Retrospective Analysis of Non-Descent Vaginal Hysterectomy (NDVH) Versus Abdominal Hysterectomy (TAH) in Benha University Hospital

Abstract

Objective: To compare perioperative outcomes in women with one or more Cesarean section (CS) who underwent Total vaginal hysterectomy (TVH) compared to who underwent total abdominal hysterectomy (TAH) for non-prolapse indications. Materials and Methods: A retrospective observational cohort analysis included 335 women with previous ≥ one CS underwent hysterectomy (HR) performed between January 2015 and March 2023 in Benha university hospital and private center comparing the outcomes between non-descent vaginal hysterectomy (NDVH) and TAH. The NDVH group (study group) included 155 women with previous ≥ one CS who underwent TVH for non-prolapse indications. The TAH group (control group) included 180 women with previous ≥ one CS who underwent TAH for non-prolapse indications. Both groups were evaluated statistically to detect differences in pre-, intra-, and post-operative demographic characteristics as well as clinical parameters and complications. Results: Both index and study groups participants had were comparable as regards age, parity, pre-operative mean hemoglobin levels, associated comorbidities, previous CS numbers and similar indications for hysterectomy, but higher statistical preoperative HBA1c and shorter preoperative hospital administration( p<0.0001 ) supporting the NDVH group over the TAH group. There were no difference between the study and the control groups respecting operative time ,blood loss , removed uterine weight, intra-operative complications, need for blood transfusion and rates of incidental cystotomy ( p>0.05 ).while there was a high statistical differences ( p<0.0001 ) toward outcomes of NDVH over TAH including need for additional general anesthesia intraoperatively, shorter postoperative hospital stay, wound complications, less consumption of analgesic and lower amount as well as shorter need for postoperative venous thromboembolic prophylaxis (VTE) ,earlier ambulation, earlier to pass flatus ,earlier return to daily activity and the lower need to reoperate for wound related complication. Conclusion : In women with previous ≥ one CS with non-prolapsed uteri who in need later on their life for hysterectomy, NDVH is a safe choice, and the real gynecologists shouldn’t considered any more the previous CS even repeated CS as a contraindication to utilize the vaginal route for hysterectomy, even more recommending the NDVH practice as the perioperative parameters are appeasing NDVH over TAH especially regarding wound related complication.