A report on 2,798 vaginal hysterectomies

Campbell, Zeph B.

doi:10.1016/0002-9378(46)90125-1

Cited by 28 publications

(5 citation statements)

References 19 publications

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“…However, we did find statistical significance for some ancillary outcomes, such as increased operative time, increased estimated operative loss, and increased preoperative and postoperative hospital stays. Similar results were reported in pre-laparoscopic era by Heaney [24] Campbell [25] and after introduction of laparoscopy by Agostini et al [5] who succeeded to perform NDVH in 96.2%(50/52) of nullipara compared to 99.7% (292/293) of the parous patients [P = 0.06,relative risk (RR) = 1.04 (0.98-1.09)]. Sheth [3] reported that of 7324 NDVH, 750 out of them were nulliparous of which 640 or 82% had a successful NDVH without laparoscopic aids.…”

Section: Discussionsupporting

confidence: 89%

“…Those in the nulliparous group had a gravidity of 2.3  1.2 (0-5) and a parity of zero, whereas those in the parous group had a gravidity of 6.2  2.5 (1-12)  (95% CI) =3.9 (3.55 to 4. 25…”

Section: Resultsmentioning

confidence: 99%

“…William Shakespeare on confidence and courage said, "Our doubts are traitors, and make us lose the good we often might win, by fearing to attempt". Founding fathers of gynecologic surgery (GS), Heany [24] and Campbell [25] as well as the prior FIGO president Shirish Sheth led the war of the unique defining procedure of GS, namely the NDVH against lay gynecologist who alleged a lot of contraindications to NDVH as nulliparity, larger uterine size, prior pelvic surgery, and obesity. Details of this war regarding the nulliparity as an alleged contraindication was reviewed excellently and extensively by the dexterous Sheth [3] in his book (The Nulliparous patient: Vaginal Hysterectomy).…”

Section: Discussionmentioning

confidence: 99%

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Comparative Analysis of Non-Descent Vaginal Hysterectomy in Nulliparous and Parous Women: Insights from a Retrospective Study

2023

The Egyptian Journal of Hospital Medicine

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Background: A lot of alleged contraindications to Non-Descent Vaginal Hysterectomy (NDVH) were cited by lay gynecologic surgeons: is this true? Objective: This study aimed to compare NDVH achievement rate and perioperative consequences in nulliparous and parous women. Methods: This retrospective cohort study involved 1008 patients who had NDVH between 2010 and 2023 at Benha University Hospital and private centers.Results: 203 (20.1%) were nulliparous (reference group), while 805 (79.9%) were parous, out of parous women 202 (20%) were primiparous, while 603 (59.9%) were multiparous (investigational group). Both groups were parallel regarding most preoperative features and no clinically significant alterations were perceived in perioperative consequences as transfusion, ureteral and bladder or bowel injuries, fever, systemic infections, fistula, conversion to total abdominal hysterectomy and total postoperative complications (P>0.05). NDVH was successfully executed in 97.04% (197/203) of the nulliparous and 98.01% (789/805) of the parous women [P = 0.39, relative risk (RR) = 1.48, 95% CI (0.58-3.79), number need treat (NNT), i.e. gynecologist need to operate upon 103 women to meet one case converted to abdominal hysterectomy]. No difference was noticed in overall intraoperative complications rate [16/203 (7.9%) vs 61/805(7.3%), P = 0.37, RR = 1.03 (0.61-1.76)], but the EBL was less in nulliparous compared to parous women (295  140 vs.405  160,  (95% CI) =110 (85.9 to 134.1), P=0.0001). Conclusions:The results regarding intraoperative switching to TAH, achievement rate of NDVH and perioperative consequences revealed that NDVH is secure and viable in nulliparous women and gynecologic surgeon shouldn't deem nulliparity as a contraindication for NDVH and the maluses of laparoscopy for hysterectomy should be revised.

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Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparative Analysis of Non-Descent Vaginal Hysterectomy in Nulliparous and Parous Women: Insights from a Retrospective Study

2023

The Egyptian Journal of Hospital Medicine

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“…Campbell wrote in 1946 37 that… the bulk of a uterus to be removed is not a contraindication to the vaginal route … Within limits, his words are as true today as they were then. Considerable enlargement of uterine size should not be looked upon as a contraindication to vaginal hysterectomy and should certainly not be used to justify the use of abdominal or laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Vaginal hysterectomy for the large uterus

Magos

Bournas

Sinha

et al. 1996

BJOG

143

101

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Objective To assess the feasibility and safety of performing vaginal hysterectomy on enlarged uteri the equivalent of 14 to 20 weeks of gestation in size. Design A prospective observational study. Setting The Royal Free Hospital, London. Participants Fourteen consecutive women undergoing vaginal hysterectomy for uterine fibroids up to 20 weeks in size. Interventions Vaginal hysterectomy with or without bilateral salpingo‐oophorectomy or oophorectomy. Main outcome measures Uterine size and weight, techniques used to reduce uterine size, surgical outcome, operative time, estimated operative blood loss, intra‐and post‐operative complications, duration of hospitalisation. Results The mean uterine size was 16.3 weeks (range 14 to 20 weeks). All hysterectomies were completed successfully by the vaginal route. The uteri weighed 380 to 1100 g, with a mean of 638.7 g. Bisection combined with myomectomy and morcellation were used in most cases to obtain reduction in uterine size, whereas coring was only utilised in two cases. The mean operating time was 84.3 min with a range of 30 to 150 min. The only complications were transient haematuria (n= 6) and superficial vaginal grazes (n= 5). One of the women required a blood transfusion. The mean post‐operative hospital stay was 3.7 days (range 2 to 9 days). Conclusion Enlargement of the uterus to a size equivalent to 20 weeks of gestation should no longer be considered a contraindication to vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic surgery.

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“…Rarely uterine prolapse can be manifested along with rectal prolapse. 2,7,8 Prolapse refers to "the falling down or slipping of a body part from its usual position or relations". It is derived from the Latin pro--"forward" + labi -"to slide".…”

Section: Discussionmentioning

confidence: 99%

Rare case of huge rectal and uterovaginal prolapse

Laddad

Kshirsagar

Nagre

2013

Int J Reprod Contracept Obstet Gynecol

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A case of combined genital prolapse and rectal prolapse in a 60-year-old multipara is reported. The treatment of mixed prolapse remains surgical and should be treated the genital prolapse by vaginal hysterectomy with pelvic floor repair and the rectal prolapse by means of the Delorme operation. The mortality and morbidity rates are zero if this operation is used and the relapse rate is only 8 to 11% for the rectal prolapse. It would appear that the two approaches are rarely associated by the authors and would seem to be interesting to reconsider this question by indicating mixed treatment of the two prolapses whenever possible. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000): 237-239

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A report on 2,798 vaginal hysterectomies

Cited by 28 publications

References 19 publications

Comparative Analysis of Non-Descent Vaginal Hysterectomy in Nulliparous and Parous Women: Insights from a Retrospective Study

Comparative Analysis of Non-Descent Vaginal Hysterectomy in Nulliparous and Parous Women: Insights from a Retrospective Study

Vaginal hysterectomy for the large uterus

Rare case of huge rectal and uterovaginal prolapse

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