Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications

Jeppson, Peter C.; Balgobin, Sunil; Rahn, David D.; Matteson, Kristen A.; Dieter, Alexis A.; Ellington, David R.; Aschkenazi, Sarit; Grimes, Cara L.; Mamik, Mamta M.; Balk, Ethan M; Murphy, Miles

doi:10.1097/aog.0000000000001995

Cited by 24 publications

(31 citation statements)

References 62 publications

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“…A recent systematic review that has identified 15 studies and involved a total of 1389 patients has noted that the use of tissue sealer devices is associated (moderate level of evidence) with decreased operative time and blood loss in VH compared with traditional suture ligation [20]. The incorporation of use of the vessel-sealing device with the round ligament technique has been previously described for vaginal salpingectomy [25].…”

Section: Discussionmentioning

confidence: 99%

“…Traditional RCs to VH are identified based on expert opinion and include obesity (≥class I), nulliparity, previous cesarean delivery, presence of adhesions from previous surgery, enlarged uterus, lack of prolapse, and presence of benign adnexal pathologic condition [20,21]. Studies that examined patient characteristics that were traditionally considered to be barriers to VH failed to show a difference in observed length of hospital stay or increased risk of complications.…”

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confidence: 99%

“…Studies that examined patient characteristics that were traditionally considered to be barriers to VH failed to show a difference in observed length of hospital stay or increased risk of complications. As such, a recent systematic review by the Society of Gynecologic Surgeons Systematic Review Group failed to find any absolute contraindications to VH after evaluating a number of factors including obesity, previous laparotomy or cesarean delivery, nulliparity, or large uterus [20]. The American College of Obstetricians and Gynecologists continues to recommend VH as the preferred route of hysterectomy for benign indications, given that it has consistently been shown to be the safest and most cost-effective route of hysterectomy [22,23].…”

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confidence: 99%

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Feasibility and Outcomes of Opportunistic Bilateral Salpingectomy in Patients with Traditional Relative Contraindications to Vaginal Hysterectomy

Chichura

Yao

Bretschneider

et al. 2020

Journal of Minimally Invasive Gynecology

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Feasibility and Outcomes of Opportunistic Bilateral Salpingectomy in Patients with Traditional Relative Contraindications to Vaginal Hysterectomy

Chichura

Yao

Bretschneider

et al. 2020

Journal of Minimally Invasive Gynecology

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“…In a systematic review examining perioperative risk factors for VH, concurrent bilateral salpingo-oophorectomy was reported as a risk factor for complications [14]. In another study evaluating salpingo-oophorectomy by the transvaginal route, 127 patients (109 patients with concurrent VH and 18 patients with previous VH) had transvaginal salpingo-oophorectomy, and it was found that complications developed in 9 of the 109 patients (fever, bleeding, ureteral injury, return to operating theatre) [15].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have argued that a history of previous pelvic surgery is not an obstacle for VH and does not increase complication rates [19,21]. Conversely, the study of Akyol et al [10] and the review of Jeppson et al [14] reported that a history of previous pelvic surgery was associated with development of complications in VH. In this study, it was found that a history of previous pelvic surgery was statistically higher in the group with complications.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience

et al. 2019

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Objectives: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. Material and methods: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. Results: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤ 2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1-1.4)], low preoperative haemoglobin [OR: 0.96 (0.94-0.98)], uterine weight [OR: 2.69 (2.62-2.76)], and long operation time [OR: 1.04 (1.02-1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96-1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. Conclusions: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse.

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Opportunistic salpingectomy at the time of vaginal hysterectomy: A systematic review and meta‐analysis

Bonavina,

Busnelli,

Salmeri

et al. 2024

Intl J Gynecology & Obste

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BackgroundDespite the rising rates of opportunistic salpingectomy at the time of surgery for non‐malignant conditions, salpingectomy is not widely adopted during vaginal hysterectomy (VH) and has not been extensively investigated.ObjectivesThe aim of the primary study was to determine the feasibility of bilateral opportunistic salpingectomy at the time of VH. Secondary aims included surgical outcomes, factors associated with patient selection, and the prevalence of incidental tubal malignancies.Search StrategyIn this systematic review and meta‐analysis we searched Pubmed, Embase and ClinicalTrials.gov databases from inception to September 1, 2023, using relevant keywords.Selection CriteriaOriginal articles with no language restriction reporting outcomes of women undergoing planned VH with opportunistic salpingectomy, were considered eligible. Studies including patients undergoing VH with and without opportunistic salpingectomy were also included.Data Collection and AnalysisThe Newcastle‐Ottawa scale was used to assess quality of observational studies. DerSimonian–Laird random effects meta‐analysis was performed and pooled effect estimates and proportions with corresponding 95% confidence intervals were computed. Heterogeneity was assessed using the I2 statistic.ResultsSeven observational cohort studies including 4808 women undergoing opportunistic salpingectomy at the time of VH and 10 295 patients undergoing VH alone were selected. The pooled proportion of success was 81.83 per 100 observations (95% CI: 75.35–87.54). Opportunistic salpingectomy at the time of VH, when feasible, was associated with a significant reduction in intraoperative complications (OR 0.06, 95% CI: 0.01, −0.37, P = 0.03) and total operative time (95% CI: −17.80, −1.07, P = 0.03) compared to those where it failed. Successful salpingectomy was significantly hindered by nulliparity (OR 0.12, 95% CI: −17.69, −1.21, P < 0.001) and favored by pelvic organ prolapse (OR 3.20, 95% CI: 1.35, 7.55, P = 0.008). Immunohistochemical tubal abnormalities were found in 13/579 (2.1%) patients. The overall quality of the evidence, according to the GRADE assessment, was low.ConclusionOpportunistic salpingectomy is safe, effective, and feasible at the time of VH. Nulliparity and pelvic organ prolapse are factors potentially influencing surgical outcomes.

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Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications

Abstract: Minimal data exist to guide surgeons with respect to planning and performing a vaginal hysterectomy. This study identifies available information and future areas for investigation.

Cited by 24 publications

References 62 publications

Feasibility and Outcomes of Opportunistic Bilateral Salpingectomy in Patients with Traditional Relative Contraindications to Vaginal Hysterectomy

Feasibility and Outcomes of Opportunistic Bilateral Salpingectomy in Patients with Traditional Relative Contraindications to Vaginal Hysterectomy

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience

Opportunistic salpingectomy at the time of vaginal hysterectomy: A systematic review and meta‐analysis

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