Panhysterectomy: Clinical analysis of 150 cases from the vaginal and the abdominal approach

Abstract

Vaginal panhysterectomy is by no means as popular as it once was, but the operation has many advantages: It can be performed under local, spinal or gas anesthesia, and the time required for the operation is, in general, shorter, even though a perineorrhaphy be included, than that consumed in abdominal panhysterectomy, since suturing the abdominal wall is eliminated. Uniting the broad ligaments in the midline offers excellent vesical support, and thus excludes any cystocele or possible recurrence of prolapse. Vaginal panhysterectomy avoids secondary complications such as abdominal hernias, parietal adhesions, and infections; there is no abdominal scar, and the convalescence and hospital stay are generally reported shortened, even though such was not the case in this series. As already brought out, we feel that vaginal panhysterectomy offers an operative scope more extensive than the average surgeon is willing to admit, yet its field of operation is limited, and cases should not be selected in which this procedure will defeat its own purpose through the introduction of trauma and mechanical difficulties. Although easily borne by the patient, vaginal panhysterectomy may be much more trying on the surgeon than the abdominal panhysterectomy. The type of operation proposed should be that ideally best fitted to the patient, and not to the operator. The analysis of these figures is not a condemnation of abdominal panhysterectomy, an operation which is fully accepted and standardized, but an attempt to give full credit to the vaginal approach, an operation whose scope is not fully appreciated.