A clinical study of elective hysterectomies for benign lesions

Background: Hysterectomy is widely used for treating a variety of gynecologic conditions. Most hysterectomies are elective and are performed to treat benign indications. Hence the present study was undertaken to determine the benign indication of hysterectomy, choice of surgical approach, safety and clinical aspect of hysterectomy as a surgical procedure and to correlate the findings with histopathological reports of the specimen.Methods: The present series represents a clinical study of 120 cases of elective hysterectomies for benign lesions. Out of which 73 were done by abdominal and 47 by vaginal route. Finally, all operated specimen were subjected to histological examination.Results: The main indications for elective hysterectomy were leiomyoma 53 (44.2%), prolapse 47 (39.2%) and dysfunctional uterine bleeding 11 (9.2%). Type of operation performed were mainly total abdominal hysterectomy with bilateral salphingo-oophorectomy in 60% cases and vaginal hysterectomy with anterior and posterior repair in 38.3% cases. The mean duration of surgery and average blood loss was more in vaginal procedure (90 min and 100ml) compared to abdominal (70 min and 80ml) respectively. Vaginal hysterectomy was associated with less morbidity and a smoother convalescence than abdominal hysterectomy. In 81.2% cases of abdominal hysterectomies correspondence of indication with histopathological report (HPR) were found, in vaginal 74.5% cases corresponded their histopathological report with their symptoms and investigations. Associated adnexal pathology was found in 8.3% cases. There was no mortality during the whole study period.Conclusions: Hysterectomy for benign pelvic lesions is a safe procedure and an important component of health care for women.

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Clinico–pathological study of hysterectomy in benign lesions: a study of 379 hysterectomies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170559 ◽

2017 ◽

Vol 6 (3) ◽

pp. 934

Author(s):

Dharmendra Singh Fathepuriya ◽

Leena Verma ◽

Seema Sharma

Keyword(s):

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Randomized Study ◽

Abdominal Hysterectomy ◽

Reproductive Organ ◽

Benign Lesions ◽

Pathological Study ◽

Dysfunctional Uterine Bleeding ◽

Related Symptom ◽

The Mean

Background: Uterus is a very vital reproductive organ and is subjected to many benign and malignant diseases. Hysterectomy is one of the most frequently performed procedures all over the world. Aims and Objectives of the work was to study the clinical benign indications of hysterectomy specimens and to correlate the findings with the histopathological reports.Methods: A prospective and randomized study was performed in 379 cases of elective hysterectomies for benign lesions.Results: Abdominal hysterectomy was performed in 64.6% cases while vaginal hysterectomy accounted for 35.3% cases. The mean age for hysterectomy was 45 years with a range from 14 to 78 years. Patients mostly presented with menstrual irregularities (34.3%) followed by prolapse uterus (30%). The principle indication of elective hysterectomy was leiomyoma and was present in 197(51.9%) patients, followed by prolapse uterus in 134 (35.3%) and dysfunctional uterine bleeding (DUB) in 26 (6.8%) patients. Maximum numbers of cases of leiomyoma, uterine prolapse and DUB were found in age group of 41-50 yrs.Conclusions: The number of abdominal hysterectomy was more than vaginal hysterectomy. Most common presenting feature was menstrual related symptom followed by prolapsed. The main indication for elective hysterectomy was leiomyoma, prolapsed and DUB.

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Hysterectomy by Vaginal Route: Not a Pressure

The Journal of South Asian Federation of Menopause Societies ◽

10.5005/jp-journals-10032-1096 ◽

2017 ◽

Vol 5 (1) ◽

pp. 8-10

Author(s):

Radha Vembu ◽

Sithara Dharmalingam

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Rating Scale ◽

Tertiary Care ◽

Safe Procedure ◽

Vaginal Route ◽

Early Return ◽

Duration Of Surgery ◽

The Mean

ABSTRACT Introduction Vaginal route of hysterectomy is a safe procedure with less morbidity and hospital stay. So, there is a need to expand the indication for vaginal hysterectomy beyond uterovaginal prolapse. Aims To determine the feasibility and outcome of nondescent vaginal hysterectomy (NDVH) and to assess the pre- and postoperative complications, duration of surgery, and hospital stay. Materials and methods A prospective observational study was conducted between 2012 and 2014 at a tertiary care center. A total of 256 patients satisfying the selection criteria of hysterectomy for benign gynecological conditions, uterus size <16 weeks, and excluding stage IV endometriosis, genital tract malignancy, and uterine prolapse were included. The NDVH was performed by the standard technique, and the following parameters of age, parity, indication for surgery, duration of surgery, intraoperative and postoperative complications, and hospital stay were recorded. The data were analyzed using Statistical Package for the Social Sciences version 16.0 by frequency and percentage analysis and Chi-square test. Results All 256 patients were analyzed. The mean age was 44.4 ± 6.1 years; fibroid uterus was the commonest indication. About 89.4% had a uterine size ≤12 weeks and 59% had uterine volume <200 cm3. The mean duration of surgery was 83.5 ± 11.0 minutes; salpingo-oophorectomy was performed in 25.8% of the patients. Intraoperatively, 1.2% had bladder injury and 0.4% required conversion to laparotomy for pelvic hematoma. The mean duration of hospital stay was 4.9 ± 2.2 days, and the mean pain score in numerical rating scale pain scale was 3.0 ± 0.3. Intraoperative blood transfusion was required in 1.9% of the patients only. Conclusion The NDVH is a safe and feasible procedure for benign gynecological disorders. Clinical significance The NDVH is a boon in this techno-savvy era by reducing the morbidity and promising early return to work. How to cite this article Vembu R, Dharmalingam S. Hysterectomy by Vaginal Route: Not a Pressure. J South Asian Feder Menopause Soc 2017;5(1):8-10.

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HYSTERECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.02.2015 ◽

2012 ◽

Vol 19 (02) ◽

pp. 214-221

Author(s):

M. IKRAM ◽

SHAZIA JABEEN ◽

M. SAEED

Keyword(s):

Blood Loss ◽

Vaginal Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Laparoscopic Assisted Vaginal Hysterectomy ◽

Group A ◽

Wound Discharge ◽

The Mean ◽

Group B ◽

Laparoscopic Assisted

Abdominal hysterectomy, the procedure by which almost 90% of hysterectomies are currently being done. Laparoscopicassisted vaginal hysterectomy has been introduced as an alternative to abdominal hysterectomy, and is thought to allow a more rapid return tonormal activity. Laparoscopic assisted vaginal hysterectomy has less postoperative morbidity and quicker recovery than abdominalhysterectomy. Objective: To compare the laparoscopic assisted vaginal hysterectomy with total abdominal hysterectomy in term of operativetime, per operative blood loss and post-operative wound infection. Study Design: Randomized trial. Setting: This study was carried out in thedepartment of obstetrics and gynaecology, Shaikh Zayed Hospital, Lahore. Period: Six months (15th September, 2008 to 15th March 2009).Patients and methods: Eighty patients fulfilling the inclusion criteria were selected for this study. Patients were equally divided in two groups;group A (laparoscopic assisted vaginal hysterectomy) and group B (total abdominal hysterectomy). Operative time (in minutes), blood loss (inml) as estimated and post-operative wound infection was assessed by presence or absence of wound discharge, redness and edema aroundthe incision on 3rd, 5th and 7th post-operative day. Results: The mean ages of women in group A was 49.13+4.26 and 45.68+4.54 years ingroup B. The maximum number of parity between 3-4 was 19 in group A and 20 in group B. Mean weights of cases in group A was 65.60+10.45kilograms and 70.77+15.59 kilograms in groups B. The per-operative time in group A was 105.13+6.55 minutes and 83.38+14.82 minutes ingroup B. The mean blood loss in group A was 178.0+43.51 ml and 228.25+72.49 ml in group B. The wound discharge was not found in group A,while in group B, 4 cases (10%) on 3rd post-operative day, 6 cases (15%) on 5th post-operative day and 11 cases 27.5% on 7th post-operative.Conclusions: Laparoscopic assisted vaginal hysterectomy has a quicker post-operative recovery but at the expense of a bit long duration ofsurgery. Laparoscopic vaginal assisted hysterectomy is a feasible option in a selected group of patients who would otherwise require anabdominal hysterectomy. The drug requirement to control pain and level of pain experienced by patients were also significantly less.

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Indications and types of hysterectomy in the National Referral Hospital of Bhutan, 2020

Bhutan Health Journal ◽

10.47811/bhj.125 ◽

2021 ◽

Vol 7 (2) ◽

pp. 19-23

Author(s):

Namkha Dorji ◽

Kencho Zangmo ◽

Sangay Tshering ◽

Renuka Mongar ◽

Sonam Sonam

Keyword(s):

Hospital Stay ◽

Vaginal Hysterectomy ◽

Laparoscopic Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Skin Incision ◽

Referral Hospital ◽

Gynecological Surgery ◽

Duration Of Surgery ◽

National Referral Hospital

Introduction: Hysterectomy, the removal of uterus, is a major gynecological surgery performed in Bhutan. It is performed for both benign and malignant gynecological conditions. This study was conducted to assess the socio-demographic profiles, types of hysterectomies and their indications, and duration of surgery and duration of peri-operative hospital stay among women who had hysterectomy at the national referral hospital of Bhutan. Method: This was a retrospective study conducted at the Jigme Dorji Wangchuck National Referral Hospital, Thimphu. Data of women, who had hysterectomy from 1st January to 31st December, 2020 was extracted into a structured questionnaire by investigators from the patients record maintained at the record section, JDWNRH. Ethical approval was sought from the Research Ethics Board of Health. Data were entered into EpiData 3.1 and was analyzed using descriptive commands of STATA 13.1 Result: Hysterectomy comprised of 9.8% of gynecological surgery in 2020. The commonest route of approach was total abdominal hysterectomy which comprised of 81.7% of hysterectomies. It was found out that 92.9% of hysterectomies were performed under general anesthesia and 97.4% of the surgeries were done as elective or planned cases. The mean (+SD) duration of surgery from skin incision to closure was shortest for vaginal hysterectomy (68.8 + 17.6 minutes) and longest for total laparoscopic hysterectomy (210 + 35.2 minutes). The duration of peri-operative hospital stay was shortest for vaginal hysterectomy. Conclusion: Total abdominal hysterectomy was the common approach despite vaginal hysterectomy being performed under regional anesthesia with shorter duration of surgery and shorter hospital stays.

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Comparison of Different Surgical Approaches for Hysterectomy: A Single-Institution Experience

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.806 ◽

2018 ◽

pp. 1

Author(s):

Yusuf Aytac Tohma ◽

Mehmet Tunc ◽

Emre Gunakan ◽

Irem Kucukyildiz ◽

Latife Atasoy Karakas ◽

...

Keyword(s):

Vaginal Hysterectomy ◽

Single Port ◽

Laparoscopic Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Single Institution ◽

Single Port Access ◽

Port Access ◽

Significant Difference ◽

Duration Of Surgery

Objective: We aimed to compare surgical outcomes and postoperative complications among different hysterectomy approaches such as total abdominal hysterectomy, vaginal hysterectomy, multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy.Study Design: This retrospective, single institution, case control study was carried out at the Obstetrics and Gynecology Department of Baskent University in Ankara, Turkey. We evaluated 86 consecutive patients who underwent hysterectomy for benign gynecological conditions.Results: A total of 86 women underwent hysterectomy: 20 (23.3%) total abdominal hysterectomy, 20 (23.3%) vaginal hysterectomy, 27 (31.3%) multiport access laparoscopic hysterectomy, and 19 (22.1%) single-port access laparoscopic hysterectomy using a transumbilical single-port system. There was no significant difference in uterine size between groups (Z=5.705; p=0.127). A statistically significant (p<0.001) difference in operation time (duration of surgery) was observed among the following groups. The duration of surgery for the multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy groups was similar, with these two laparoscopic procedures requiring significantly more time than total abdominal hysterectomy and vaginal hysterectomy procedures. There was no statistically significant difference in between hemoglobin levels before and after operation between groups. There was no statistically significant difference between groups in intraoperative and postoperative complications. Six patients experienced complications, one intraoperative and five postoperative. Intraoperative complication was ureter injury in single-port access laparoscopic hysterectomy group. The postoperative complication rate was 5.8% (5 cases) in 86 patients. Perirectal abscess in one patient and wound infection in two patients occurred in total abdominal hysterectomy group (15%). Urinary tract infection in one patient and vaginal cuff cellulitis in one patient occurred in vaginal hysterectomy group (4%). No complications were reported in multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy groups. Post-surgery, all patients who underwent single-port access laparoscopic hysterectomy reported that they were satisfied with their incision and cosmetic results.Conclusions: When technically feasible, multiport access laparoscopic hysterectomy, and single-port access laparoscopic hysterectomy may be performed instead f total abdominal hysterectomy because of rapid recovery and shorter hospitalization however there are longer operating time.

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Comparison of morbidity associated with non-descent vaginal hysterectomy and total abdominal hysterectomy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181355 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1554

Author(s):

Ranjita Ghadei ◽

Gupteswar Mishra

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Intraoperative Blood Loss ◽

Duration Of Hospital Stay ◽

Duration Of Surgery ◽

Stay Time ◽

Normal Work

Background: In the present scenario of importance non-invasive surgery, there is increase in interest and requirement of vaginal hysterectomy for non-prolapsed uterus, i.e. non-descent vaginal hysterectomy (NDVH) due to its scarless surgery. it has much more advantages than that of abdominal hysterectomy in term of cosmesis, lesser duration of surgery, lesser intraoperative complication, lesser post-operative morbidity and early resumption to work. The aim of the present study is to asses and compare various factors like duration of surgery, intraoperative blood loss, intraoperative and postoperative complication postoperative morbidities, pain perception on 3rd post-operative day, post-operative ambulation, duration of hospital stay, time taken to resume normal work, follow up complains and afterall to decide the appropriate route of hysterectomy for benign conditions.Methods: Hundreds of patients were selected as per the criteria. They were divided into two groups NDVH (non-descent vaginal hysterectomy) and TAH (total abdominal hysterectomy) according to the inclusion criteria. Above mentioned factors are compared between the two groups.Results: Duration of surgery, intraoperative blood loss, intraoperative complications, post-operative morbidities and complications, duration of hospital stay, time required to resume normal work are less in NDVH group.Conclusions: Non-descent vaginal hysterectomy is a better alternative to abdominal hysterectomy for benign conditions.

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A comparative study of laparoscopic assisted vaginal hysterectomy versus total abdominal hysterectomy in benign gynaecological conditions

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211134 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1540

Author(s):

Pandala Sravanthi ◽

D. Shivani ◽

Naga Jyothi Gunturu

Keyword(s):

Blood Loss ◽

Return To Work ◽

Vaginal Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Early Recovery ◽

Laparoscopic Assisted Vaginal Hysterectomy ◽

Duration Of Surgery ◽

Discharge From Hospital ◽

Laparoscopic Assisted

Background: Laparoscopic assisted vaginal hysterectomy (LAVH) has become an alternative to Total Abdominal Hysterectomy (TAH) in cases difficult to manage via vaginal route. To compare the TAH and LAVH for benign uterine pathology.Methods: This prospective study conducted with the outcomes of Laparoscopic assisted vaginal hysterectomy with Total abdominal hysterectomy over a period of 2 years in 100 patients who are undergoing hysterectomies for benign uterine pathology. 50 underwent TAH and 50 underwent Laparoscopic Assisted Vaginal hysterectomy.Results: The average duration of surgery in TAH group is 50 minutes and it is 75 minutes in LAVH group (P<0.05). In TAH group, blood loss was more (250-500ml) in 28% of patients, where as it was <250 ml in 92% of patients in LAVH group. Mean blood loss is 238 ml and 130 ml in TAH and LAVH group (P<0.01). Only 3 (6%) patients in LAVH group required blood transfusion (P>0.05). Recovery and return to work after discharge from hospital was early with LAVH group as early. Recovery and return to work after discharge from hospital was early with LAVH group as early as 2 weeks in 46% of patients. In TAH group, it was late by 4 weeks in 52% of patients and by 6 weeks in 10% of patients.Conclusions: Thus, it can be concluded that LAVH is safe with less blood loss, shorter duration of hospital stay, early recovery to work, and other intra-operative and post-operative complications.

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The correlation between Corrected Flow Time (FTc) Based on Esophageal Doppler Monitoring and Pleth Variability Index (PVI) in the Fluid Therapy in Patients undergoing Total Abdominal Hysterectomy

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v8i1.8243 ◽

2022 ◽

Author(s):

Alireza Saliminia ◽

Fatemeh Golpayegani

Keyword(s):

Fluid Therapy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Blood Gas ◽

Total Fluid Intake ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Significant Difference ◽

Duration Of Surgery ◽

The Mean

Background: The occurrence of bleeding during major surgeries is common and requires timely and accurate management in the prevention and treatment of hypovolemia and hemodynamic instability during and after surgery. This study evaluated the correlation and agreement between the two protocols determining the status of the hypovolemia during hysterectomy. Methods: This study was a randomized single-blinded clinical trial. The study population included 30 patients undergoing Total Abdominal Hysterectomy in Shariati Hospital in Tehran between 2015 and 2016. The patients were randomly assigned to two groups using a randomized table of numbers, so that in the FTc group, fluid therapy was performed based on the FTc index and in the PVI group based on the PVI index. The changes in FTc and PVI values were recorded every 5 minutes and the changes in the two indicators from the beginning to the end of the treatment were evaluated. At the beginning and end of the surgery, an arterial blood gas analysis (ABG) was also performed. The amount of bleeding during operation and urinary output were recorded in two groups. Results: There was no significant difference across the two groups in total fluid intake during surgery, mean volume of blood loss, mean urine output, and duration of surgery. The arterial blood gas status was also similar in both groups at the beginning and the end of the operation. We found a strong adverse correlation between FTC and PVI indices at the different time points evaluated within the surgery. In total, there was a strong correlation between the mean FTC and the mean PVI during the first hour (r=-0.765, P < 0.001) and the second hour (r=-0.941, -P < 0.001) of operation. Considering the cut-off point of 350msec for the FTC and 13% for the PVI in predicting hypovolemia, the agreement between the two protocols in fluid therapy during the first hour after surgery was 79.8% and 76.6%. Conclusion: There is a strong and significant correlation between the two FTC (with a cut off of 350) and PVI (with a cut point of 13%) to predict need for fluid therapy.

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