OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal hysterectomy. STUDY DESIGN: A prospective study of vaginal hysterectomy was carried out in women with benign uterine tumors. The only exclusion criteria were a suspected adnexal mass, a very narrow vagina and an immobile uterus. The women were stratified into 3 groups according to uterine weight. The groups were compared as regards indications, operative time, complication rates, analgesia requirements and postoperative recovery. RESULTS: A total of 214 women underwent vaginal hysterectomy: group 1, n = 114, uteri < 180 g; group 2, n = 73, uteri 180-500 g; group 3, n = 27, uteri > 500 g (maximum 1,350 g). The groups differed with respect to mean age (P = .003) and menopausal status (P = .002) but not gravidity, parity, previous pelvic surgery or preoperative hemoglobin levels. Concerning the indications for hysterectomy, only the incidence of pelvic compression differed between the groups (P = .04). There was no difference in the frequency of concomitant surgical procedures (e.g., adnexectomy) between the groups. Morcellation rate was 30% in group 1, 73% in group 2 and 100% in group 3. The overall complication rate was not significantly different between the groups: 20.1%, 15.0% and 22.2%, respectively. The only major complication was an injury to the in-fundibulopelvic ligament in a group 1 patient. Operative time increased significantly with uterine weight (82 +/- 35.4, 91.8 +/- 35.4 and 94.8 +/- 36.5 minutes, respectively; P = .01). There were no significant differences between the groups as regards perioperative hemoglobin loss, analgesia requirements, time to flatus and stool return or length of hospital stay. CONCLUSION: Vaginal hysterectomy can be performed successfully even in the case of greatly enlarged uteri; nulliparity and a history of pelvic surgery are not absolute contraindications.
OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal hysterectomy. STUDY DESIGN: A prospective study of vaginal hysterectomy was carried out in women with benign uterine tumors. The only exclusion criteria were a suspected adnexal mass, a very narrow vagina and an immobile uterus. The women were stratified into 3 groups according to uterine weight. The groups were compared as regards indications, operative time, complication rates, analgesia requirements and postoperative recovery. RESULTS: A total of 214 women underwent vaginal hysterectomy: group 1, n = 114, uteri < 180 g; group 2, n = 73, uteri 180-500 g; group 3, n = 27, uteri > 500 g (maximum 1,350 g). The groups differed with respect to mean age (P = .003) and menopausal status (P = .002) but not gravidity, parity, previous pelvic surgery or preoperative hemoglobin levels. Concerning the indications for hysterectomy, only the incidence of pelvic compression differed between the groups (P = .04). There was no difference in the frequency of concomitant surgical procedures (e.g., adnexectomy) between the groups. Morcellation rate was 30% in group 1, 73% in group 2 and 100% in group 3. The overall complication rate was not significantly different between the groups: 20.1%, 15.0% and 22.2%, respectively. The only major complication was an injury to the in-fundibulopelvic ligament in a group 1 patient. Operative time increased significantly with uterine weight (82 +/- 35.4, 91.8 +/- 35.4 and 94.8 +/- 36.5 minutes, respectively; P = .01). There were no significant differences between the groups as regards perioperative hemoglobin loss, analgesia requirements, time to flatus and stool return or length of hospital stay. CONCLUSION: Vaginal hysterectomy can be performed successfully even in the case of greatly enlarged uteri; nulliparity and a history of pelvic surgery are not absolute contraindications.
Authors: K J Neis; W Zubke; T Römer; K Schwerdtfeger; T Schollmeyer; S Rimbach; B Holthaus; E Solomayer; B Bojahr; F Neis; C Reisenauer; B Gabriel; H Dieterich; I B Runnenbaum; W Kleine; A Strauss; M Menton; I Mylonas; M David; L-C Horn; D Schmidt; P Gaß; A T Teichmann; P Brandner; W Stummvoll; A Kuhn; M Müller; M Fehr; K Tamussino Journal: Geburtshilfe Frauenheilkd Date: 2016-04 Impact factor: 2.915