Outcome of Non-Descent Vaginal Hysterectomy at a Single Centre in Sri Lanka: an Observational Study

Abstract

INTRODUCTION: Hysterectomy is the commonest major gynaecological surgery performed worldwide. Though many routes of hysterectomy are described, open abdominal approach remains the commonest route to date for indications other than genital prolapse. There is evidence of advantages of non-descent vaginal hysterectomy (NDVH) over abdominal hysterectomy in such indications. However, the acceptance rate for vaginal approach by the gynaecologists remains low. We describe the outcome data of a series of non-descent vaginal hysterectomies performed in a single centre in Sri Lanka. OBJECTIVES: To describe the post-operative outcome and complications of NDVH for benign indications of uteri less than 14 weeks size. METHOD: An observational study was undertaken at the ward 14 of The De Soysa Maternity Hospital, Colombo over a period of one year from May 2007 to April 2008 among women who underwent NDVH for benign conditions. Those with co-existing genital prolapse requiring surgical correction, uteri larger than 14 weeks, a history of previous abdominal surgery and medical co-morbidities were excluded from the study. RESULTS: The study included 53 patients who underwent NDVH. The majority had a normal sized uterus 39 (73.6%). There was a statistically significant improvement in post-operative urinary index compared to pre-operative urinary index [Kruskal-Wallis test-6.155, degrees of freedom = 2, p < 0.05 (0.046)]. There was no difference in pre-operative and post-operative bowel function. The frequency of coitus and patient satisfaction appear to have improved post-surgery. Most patients [n=45 (85%)] had a faster than expected recovery. There were no visceral injuries and only one patient required blood transfusion following surgery. One patient developed a urinary tract infection. The mean post-operative hospital stay was 4.11 days (95% CI=3.48-4.74 days). CONCLUSIONS: The outcome and complication rates of non-descent vaginal hysterectomy this series were comparable with evidence from literature. Therefore, we conclude that NDVH is a feasible option for benign gynaecological conditions with a uterus less than 14 weeks in size in the current gynaecological practice of Sri Lanka.