A Comparative Study of Nondescent Vaginal Hysterectomy versus Total Abdominal Hysterectomy

Background: Hysterectomy is the most common operation performed for benign uterine conditions. It can be done through abdominal, vaginal and laparoscopic routes 1,2.The American college of Obstetricians and Gynaecologists recommends the vaginal approach as the route of choice of hysterectomy for benign disease whenever feasible 9 .Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom vaginal hysterectomy is not indicated or feasible. Objective(S): To compare the surgical outcome of total abdominal hysterectomy (TAH) and non-descend vaginal hysterectomy (NDVH). Methods: This is a cross sectional and comparative study that was conducted from January 2014 to December 2015 in Obstetrics and Gynaecology Department of Sylhet Shaheed Shamsuddin Ahmed Hospital, Sylhet. A Total of 120 patients with benign gynaecological disorder who underwent hysterectomy were included. Among them 60 cases underwent NDVH and 60 cases underwent TAH for similar indication. Main Outcome measures are: i) Duration of operation (min) ii) intra and post-operative complications iii) blood loss (ml) during operation iv) Analgesic requirements v) post-operative hospital stay. Results: Most of the patients in both NDVH and TAH belonged to age group of 41-50 years. Majority of them were multiparousin both the groups. Medical co morbidities were Diabetes mellitus, Hypertension, Hypothyroidism and most common surgical co morbidities were history of lower segment cesarean section (LSCS), bilateral tubal ligation, laparotomy for benign ovarian pathology. Common indication for hysterectomy in NDVH was abnormal uterine bleeding (AUB) (37%) and in TAH was (18%), fibroid uterus 35% cases in NDVH and 37% in TAH. Mean operative time of NDVH group was 51.08±12.59 minutes while that of women in TAH group was 69.25±11.12 minutes. This difference was found to be statistically significant (p<0.05 when df 118). The mean blood loss in NDVH group was 61.08±18.82 ml while in TAH group was 105.50±38.42 ml, this is also statistically significant (p<0.05). Analgesic required in NDVH group 5.91±0.97 doses and in TAH was11.58±2.67 doses which is statistically significant(p<0.05).11(18%) patients developed wound infection in TAH group, but none of the patients of NDVH group developed wound infection which is significant. Post-operative hospital stay in NDVH group was 3.02±1.43 days and those in TAH group was 7.7±3.40 days this is also statistically significant. Conclusions: NDVH is safe, feasible and effective procedure and associated with less blood loss during surgery, decrease operative time, less intra-operative and post-operative complications with shorter hospital stay as compared total abdominal hysterectomy. Hence NDVH is a better option for females requiring hysterectomy for benign conditions.