الفهرس 
Indications and Contraindications for Non-DescentVaginal HysterectomyOnly 14 pages are availabe for public view
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Abstract
Introduction: Hysterectomy remains the commonest elective major operation in the world with nearly 600 000 procedures being performed annually in the USA, while more than 70 000 women have hysterectomies each year in England alone. In most countries at least 70%of hysterectomies are performed abdominally despite evidence that it is feasible to achieve vaginal hysterectomy rates of between 77% and 88%. There is considerable evidence from observational and uncontrolled studies showing that vaginal hysterectomy is associated with several advantages. Apart from the cosmetic benefit, the operating time is shorter, complications are less frequent, recovery is faster, and overall treatment costs are reduced. The advent of laparoscopic hysterectomy has not altered these conclusions, and a recent independent overview concluded that ‘Specific guidelines should be largely to replace abdominal hysterectomy not by laparoscopic hysterectomy but with vaginal hysterectomy’. Aim of work: Our study aimed to compare the duration of operation, blood loss, duration of hospital stay, need for analgesia, intraoperative and postoperative complications of vaginal hysterectomy for cases with relative contraindications to vaginal hysterectomy. Patients and methods: This study was performed in Obstetrics and Gynecology Department, Mansoura University Hospitals. All the patients requiring hysterectomy with one or more relative contraindication to vaginal hysterectomy were included in our study from period of April 2005 to October 2008. The patients were assigned randomly into 2 groups: study group (vaginal hysterectomy = 60 cases), and control group (abdominal hysterectomy = 60 cases). Inclusion criteria includes: Patients with non-prolapsed normal or enlarged uterus up to size 14 weeks. All cases with non-prolapsed uterus with benign adenexial swelling and previous cesarean section. Results: A preoperative assessment and examination under anesthesia is an integral part of decision making for route of hysterectomy. Size, descent and mobility of the uterus, vaginal and cervical accessibility are important factors in determining the success of the surgery but do not form absolute contraindications. Debulking is safe and helps in accomplishing hysterectomy by vaginal route, requiring no expensive equipment and training in comparison to laparoscopic surgery. Uterine dimensions along with fundal height should be considered in assessment. Position of the fibroid is as important at its size. Since failure of surgery does not add to morbidity, in today’s era of minimally invasive surgery all hysterectomies should be done by vaginal route unless contraindicated. Conclusions: Vaginal hysterectomy is associated with significantly shorter hospitalization, less discomfort and faster recovery than abdominal hysterectomy. Abdominal hysterectomy may be associated with a higher risk of postoperative fever, while bleeding may be more frequent with vaginal surgery. These findings support the view that vaginal hysterectomy should not be restricted to women with genital tract prolapse.