Comparison of Intra-Operative and Post-Operative Complications between Non-Descent Vaginal Hysterectomy and Total Abdominal Hysterectomy

Gulshan Ara,Sayma Afroz

doi:10.3329/jemc.v8i3.38361

Abstract

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologists and can be done through abdominal and vaginal routes. Vaginal hysterectomy technique has been introduced and performed centuries back, but is less popular due to lack of experience and misconception that the abdominal route is easier and safer. Worldwide gynaecologists continue to use abdominal route for hysterectomy that could be performed vaginally which is less invasive and has minimal complications.Objective: To compare the complications during intra-operative and post-operative period between vaginal hysterectomy and abdominal hysterectomy in non-descent uterus.Materials and Methods: This prospective randomised study was performed in Enam Medical College & Hospital, Savar, Dhaka during a period of one year. Sixty consecutive patients requiring hysterectomy for benign diseases were included in this study. Group A (n=30) underwent vaginal hysterectomy (non-descent vaginal hysterectomy) and were compared with Group B (n=30) who underwent abdominal hysterectomy. The primary outcome measures were operative time, intra-operative blood loss, post-operative complications like wound infection, febrile morbidity, post-operative systemic infection and hospital stay. Secondary outcome measures were conversion of vaginal to abdominal route and re-laparotomy. Data were collected in structured questionnaire and analysed by computer using R programming version 3.4.3.Results: Baseline characteristics were similar in two groups. There were no intra-operative complications in either group. Intra-operative blood loss was significantly more in Group B than in Group A. The overall complication rate was significantly higher with abdominal hysterectomy with a rate of 56.67% against 30% for vaginal hysterectomy. Wound infection (23.33%) was significantly higher in Group B as compared to Group A (0%). Post-operative hospital stay was significantly higher in Group B (7.03 days) than in Group A (4.57 days).Conclusion: Considering intra-operative blood loss, post-operative complications and hospital stay, vaginal route was found safer than abdominal route in this study.J Enam Med Col 2018; 8(3): 128-134

Highlights

Hysterectomy is the second most common operation performed by the gynaecologists[1,2], only to caesarean section
Considering intra-operative blood loss, post-operative complications and hospital stay, vaginal route was found safer than abdominal route in this study
The present study examined outcomes of patients who underwent non-descent vaginal hysterectomy or abdominal hysterectomy in the Department of Obstetrics and Gynaecology, Enam Medical College & Hospital, Savar, Dhaka

Summary

Introduction

Hysterectomy is the second most common operation performed by the gynaecologists[1,2], only to caesarean section. Abdominal hysterectomy is associated with some limitations such as abdominal trauma, intra-operative and post-operative complications and slow post-operative recovery as it is one of the most invasive procedures.[3] Compared with traditional open gynaecological surgeries, minimally. September 2018 invasive gynaecological surgery provides less postoperative pain, more rapid recovery and shorter hospital stay.[4] Laparoscopic route is associated with increased operation time and increased rate of intraoperative injuries.[5] Traditional abdominal and vaginal hysterectomies represent the most and least invasive techniques respectively. Post-operative hospital stay was significantly higher in Group B (7.03 days) than in Group A (4.57 days). Conclusion: Considering intra-operative blood loss, post-operative complications and hospital stay, vaginal route was found safer than abdominal route in this study

Objectives

Methods

Results

Conclusion