Vaginal Hysterectomy for Elective Sterilization

Abstract

The records of 595 patients undergoing elective sterilization by vaginal hysterectomy between 1971-1974 at any army medical center were reviewed for age gravidity parity pathologic diagnosis complications additional procedures performed and length of postoperative stay. Average age gravidity and parity were 31 3.7 and 3.0 respectively. 27% had a pathologic diagnosis (12% fibroids 4.8% adenomyosis 4.4% dysplasia or carcinoma in situ of the cervix). This was not unexpected as many women selected hysterectomy because of minor menstrual irregularity or pelvic discomfort. The incidence of such findings increased with age but was unrelated to gravidity or parity. The overall complication rate was 23% comparing favorably with most series reported in the literature. There was no morbidity and only 1 patient had a pulmonary embolus. The febrile morbidity rate was 12.4% 29.7% of which was caused by urinary tract infection 25.6% by hematoma 17.6% by pelvic cellulitis 2.7% by cuff abscess and 4% by other problems. Incidence of complications was not correlated with age gravidity or parity. Additional procedures including posterior and anterior repair and salpingo-oophorectomy were performed in 9.7% of patients. All women were placed on prophylactic antibiotics prior to surgery and it is considered important to continue to monitor infection rates in case an antibiotic-resistant bacteria emerges. 8.4% of patients had bleeding complications which were found to increase when adnexal pathology was present or additional procedures performed. The average postoperative day of discharge was 5.56 for the entire series 6.7 for those with infectious complications and 7.34 for patients with bleeding complications.