International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Patel TL et al. Int J Reprod Contracept Obstet Gynecol. 2019 Jan;8(1):308-312

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20185445
Original Research Article

Comparative study of non-descent vaginal hysterectomy with

abdominal hysterectomy
Tejal L. Patel*, Rinkal R. Patel, Vaibhavi Vaghela

Department of Obstetrics and Gynecology, Civil Hospital, B. J. Medical College, Ahmedabad, Gujarat, India

Received: 26 November 2018

Accepted: 05 December 2018

*Correspondence:
Dr. Tejal L. Patel,
E-mail: rinkalpatel9457@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Hysterectomy is one of the most common operation performed in Obstetrics and Gynecology next to
caesarean section. Due to its advantages vaginal hysterectomy are more and more performed now. Only drawback is
lack of expertise. Present study focuses on comparison between outcomes in abdominal versus vaginal hysterectomy
and to determine which route of hysterectomy is superior, safer and effective.
Methods: The study is a prospective study conducted in the department of obstetrics and Gynecology. Civil hospital,
Ahmedabad between the period of Jan 2016 to 2017. Of 100 patients. Fifty patients who underwent hysterectomy by
vaginal route are taken as study group A, and the remaining 50 patients who underwent by the abdominal route are
taken as study group B.
Results: Majority of women undergoing hysterectomy were in age group of 30-50 years; postmenopausal age group
women were less;13 NDVH and 5 in AH. Majority of the women were multipara in both age groups. Menorrhagia
was found to be major indication with 42 in NDVH and 40 in AH. There is much significant difference in the
postoperative pain in both groups with less in NDVH group. There is not much significant difference in blood loss in
both the groups. Postoperative complications were more with AH.
Conclusions: Thus, it can be concluded that NDVH is feasible, safe and provide more patient comfort without
increasing the duration of surgery and other post-operative complications.

Keywords: Abdominal hysterectomy, Hysterectomy, Non-descent vaginal hysterectomy

INTRODUCTION The name hysterectomy was coined for its role in the
treatment of hysteria. The condition of premenstrual
Hysterectomy is one of the oldest operations performed tension was not well understood as we know it today. It
in the female pelvis. It dates back to the era before was understood to be a form of hysteria.
anaesthesia and antibiotics. It has under gone many
modifications in technique and indication over time. Removal of the uterus and ovaries was said to treat the
condition and thus the name hysterectomy was found
Even today it still undergoes evolution in surgical appropriate, as it was believed that women with intact
technique and indication, like any other scientific uteruses had more hysteria and premenstrual tension than
discovery, will forever go through stages of perfection. those without the uterus.

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Due to its advantages vaginal hysterectomies are more Pain during postoperative period: Pain scoring was done
and more performed now, only drawback is lack of on numeric scale from 1 to 10 cm. Fever during the
expertise. In 1990, ACOG has established the Guidelines postoperative period: This was assessed and charted 4
for choosing the route of hysterectomy stating that hourly. Fever is defined as temperature more than or
vaginal hysterectomy can be performed in patient with equal to 38 degree Celsius on 2 occasions 4 hours apart
mobile uterus whose uterine size is no larger than 12 excluding the first post-operative day.
weeks size.1,2
Wound infection: The presence of wound indurations or
ACOG also acknowledges that the choice of approach evidence of any frank infection if present were assessed,
should be based on the surgical indication, the patient’s the patients were followed up till the date of discharge.
anatomical condition, data supporting the approach, Any form of infection like respiratory tract infection,
informed patient preference, and the surgeon’s expertise urinary tract infection were looked for and compared.
and training. Duration of hospital stay was noted in both groups and
compared. Patients were followed up till the date of
ACOG guidelines have focused on women with mobile discharge. The data was analyzed using Microsoft excel
non-prolapsed uterus no larger than 12 weeks benign software version.
conditions confined to the uterus, to compare outcomes in
abdominal versus vaginal hysterectomy and to determine RESULTS
which route of hysterectomy is superior, safer and
effective. Abdominal approach is associated with a higher 100 patients requiring hysterectomy for benign
incidence of complications, longer lengths of stay than gynaecological disorders without prolapse During the
vaginal hysterectomy. period of Jun 2016 to Dec 2017 were included in the
study. All patients underwent physical, ultrasound and
METHODS biopsy examinations. Of the 100 patients, 50 patients who
underwent hysterectomy by vaginal route were taken as
The study was a Retrospective study conducted in the study group A, and the remaining 50 patients who
Department of Obstetrics and Gynaecology, Civil underwent by the abdominal route were taken as study
Hospital, Ahmedabad between the period of Jun 2016 to group B. Table 1 results highlighted that in NDVH
Dec 2017. 100 patients requiring hysterectomy for benign group, 60% of the patients fall in the age group range
gynaecological disorders without prolapse were included between 41-50 years, 34% in the range of 30-40 years
in the study. All patients underwent physical, ultrasound and 6% in the range of 51-60 years. In the AH group 40%
and biopsy examinations. Of the 100 patients, 50 patients patients were between 41-50 years, 50% between 30-40
who underwent hysterectomy by vaginal route were taken years and 10% in the range between 51-60 years. From
as study group A, and the remaining 50 patients who these results it showed that majority of the patients in
underwent by the abdominal route were taken as study both groups were between 41-50 years.
group B.
Table 1: Age group
Inclusion criteria
Age Group (years) NDVH (N = 50) AH (N = 50)
• Uterine benign diseases such as fibroids, No. % No. %
adenomyosis and CIN. 30-40 17 34 25 50
• Gynaecological symptoms that justified total 41-50 30 60 20 40
hysterectomy. 51-60 03 06 05 10
• Patients without fertility requirement.
• Patients who gave informed consent to participate. Table 2 result depicted that 98% of the patients in NDVH
group were multipara with 2% primipara patients and
Exclusion criteria 96% of the patients in AH group were multipara with 2 %
primipara and 2 % nullipara.
• Uterine size more than 12 weeks of gravid uterus.
• Highly restricted uterine mobility. Table 2: Parity
• Malignancy.
• Patients with fertility requirement. Parity NDVH (N = 50) AH (N = 50)
No. % No. %
Time taken for surgery: This included the time duration Nulli 0 0 01 2
of surgery from the time of incision till the end of the Primi 04 8 01 2
procedure and was noted by the assistant. Multi 46 92 48 96

Intraoperative injury and blood loss: Any injury to bowel, Table 3 depicted that in NDVH group, there were 3 cases
bladder or ureter was noted. of Previous Caesarean section, 11 cases of Lap TL, 13
cases of Abdo TL, 1 case of appendicectomy. In the AH

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group, there were 6 cases of Previous Caesarean section, Postoperative complications were more with AH. 26% of
9 cases of Lap TL, 15 cases of Abdo TL, 2 cases of patients who underwent AH had fever, 6% had wound
appendicectomy, 1 case of Lap Cholecystectomy. gap and infection.

Table 3: Previous surgeries. Table 6: Post-operative stay.

Previous Post-operative stay NDVH AH

NDVH (N = 50) AH (N = 50)
surgery No. % No. %
No. % No. % ≤4 days 40 80% 0 0
Caesarean section 03 06 06 12 4-8 days 10 20% 35 70%
Appendicectomy 01 02 02 04 >8 days 00 0% 15 30%
Lap.
0 00 01 02
cholecystectomy Table 7: Post-operative pain.
Lap.TL 11 22 09 18
Abdo TL 13 26 15 30 Postoperative pain NDVH AH
Scale 1-10 (Mean) 1.96 6.16
Above table 4 results suggested that operative time was
less with NDVH as compared to AH. In NDVH group, No incidence of wound infection was found in NDVH
88% cases had time less than or equal to 60 minutes and group. Fever occurred more in AH group as compared to
12% of cases had time between 61 to 120 minutes. In AH the NDVH group. There was no significant difference in
group, 54% cases had time less than or equal to 60 Postop blood transfusion in both the groups (Table 8).
minutes and 46% of cases had time between 61 to 120.
Table 10: Post-operative complication
Table 4: Time taken for surgery.
Complications NDVH (N = 50) AH (N = 50)
Time (hours) NDVH (N = 50) AH (N = 50) No. % No. %
No. % No. % Urinary retention 04 08 01 02
≤1 44 88 24 44 Fever 05 10 13 26
1-2 06 12 26 56 Wound complication 0 0 03 06
Need for transfusion 04 08 06 12
Above table 5 result showed that Menorrhagia seems to
be major indication with 42 in NDVH and 40 in AH. In DISCUSSION
NDVH group, 84% of the patients had menorrhagia, 12%
had cervicitis, 4% had adenomyosis, 4% had endometrial In this study In NDVH group, 60% of the patients fall in
hyperplasia, 4% had fibroid, 2% had cervical polyp. In the age range between 41-50 years, 34% in the range of
AH group, 80% of the patients had menorrhagia, 2% had 30-40 years and 6% in the range of 51-60 years. And in
adenomyosis, 4% had fibroid. Postoperative stay was the AH group 40% patients were between 41-50 years,
prolonged in cases with AH as compared to NDVH. In 50% between 30-40 years and 10% in the range between
NDVH group, 80% cases had hospital stay <= 4 days and 51-60 years. From these results it showed that majority of
20% had stay >4 days. the patients in both groups were between 41-50 years. In
relation to age, similar studies comparing NDVH and AH
Table 5: Indications. have following results: Michel S, Hoffman et al NDVH-
41.9 years; AH -42.7 years.3 Dewan Rupali et al NDVH –
NDVH AH 44 years; AH -42.5 years.4 Robert Kovac S NDVH -43.1
Indications
(N = 50) (N = 50) years; AH -47.2 years.5 Thus age results in present study
No. % No. % were comparable to the standard one. It is between the
Fibroid 02 04 02 04 ages of 40-50 years that most women suffer from
Menorrhagia 42 84 40 80 abnormal uterine bleeding.
Cervicitis 06 12 0 0
Adenomyosis 02 04 01 02 In this study, Table 2 result showed that 98% of the
Endometrial hyperplasia 02 04 0 0 patients in NDVH group were multipara with 2%
Cervical Polyp 01 02 0 0 primipara patients and 96% of the patients in AH group
were multipara with 2 % primipara and 2 % nullipara.
In AH group, all cases had stayed >= 4 days with 70 % Other studies in relation to parity suggest majority of
have been stayed between 4-8 days and 30% had stay > 8 women were multipara. Average parity in other study
days (Table 6). Regarding the pain scoring on result showed that in Michel S, Hoffman et al NDVH-
postoperative day-3, above table no 7-result showed that 2.8; AH-2.73, Dewan Rupali et al NDVH -3.5; AH -2.54
mean pain score in NDVH group was 1.96 cm whereas and Robert Kovac S NDVH- 2.25; AH- 0.835. Thus
mean pain score in TAH group was 6.16 cm. parity in present study is comparable to the standard
studies. In present study In NDVH group, there were 3

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cases of Previous Caesarean section, 11 cases of LapTL, 3 cases of wound gap in AH group, 2 belonged to
13 cases of Abdo TL, 1 case of appendicectomy and In overweight category concluding that obesity is
the AH group, there were 6 cases of Previous Caesarean contributing factor in wound complications. Statistically
section, 9 cases of LapTL, 15 cases of Abdo TL, 2 cases significant difference in the incidence of wound infection
of appendicectomy, 1 case of Lap. Cholecystectomy. This was found by Pradeep Kumar Garg and co-workers6.
study was comparable with other study including, the Similar conclusion was derived by Shailesh Kore and
study by Pradeep Kumar Garg and co-workers296, there coworkers, S. Taylor and co-workers, Liu Sui-Ling and
was one case of previous C. Sin the NDVH group. No co-workers and Dewan Rupali and coworkers.4,8-10 There
patient in the TAH group had any previous surgical were 26% cases of fever in AH group and 10% cases in
history and the study by Singh Abha et all, there were 14 NDVH group. Thus, it suggests that post-operative
cases of CS and one case of tubectomy both in VH group complications were more in AH group.
and in TAH group.
CONCLUSION
In this study In NDVH group, 88% cases had time less
than or equal to 60 minutes and 12% of cases had time There was significant difference in the duration of
between 61 to 120 minutes and In AH group, 54% cases surgery, less time with NDVH. NDVH was associated
had time less than or equal to 60 minutes and 46% of with decreased postoperative morbidity when compared
cases had time between 61 to 120 minutes.Using to TAH. Length of hospital stay was significantly less for
Fischer's test for statistical analysis, P value < 0.0001, NDVH when compared to TAH.
suggesting that there is significant difference in time
taken by 2 groups. Other study by Christian oftosen et all Thus, it can be concluded that NDVH was feasible, safe
2000 shows that duration of surgery is shorter for NDVH and provide more patient comfort without increasing the
compared with TAH. The difference in the time between duration of surgery and other post-operative
the two groups when compared is statistically complications.
significant.7
Funding: No funding sources
In this study Menorrhagia was the major indication for Conflict of interest: None declared
hysterectomy with 84% cases in NDVH group and 80% Ethical approval: The study was approved by the
cases in AH group. there was not much of a difference in Institutional Ethics Committee
the number of patients regarding the indications for
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