Is vaginal hysterectomy is equally safe for the enlarged and normally sized non-prolapse uterus? A cohort study assessing outcomes

Newbold, Peter; Vithayathil, Mathew; Fatania, Kavi; Yoong, Wai

doi:10.1016/j.ejogrb.2014.11.031

Cited by 9 publications

(11 citation statements)

References 25 publications

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“…This observation was similar to previous studies. 24,27 However, mean hemoglobin drop and need of blood transfusion in post-operative period for index group patients was not significantly different than control group.…”

Section: Resultsmentioning

confidence: 81%

“…Similar results were observed in previous studies. 27 More operative time was because of surgical debulking using various methods like bisection (Figure 1, 2 and 3), coring, myomectomy (Figure 4), ( Figure 5) morcellation ( Figure 6) or a combination of these methods. 23,24,27 Mean blood loss in present study was significantly more in index group compared to control group and can be explained by more surface area of pathological mucosa and more need of surgical manipulation in this group of patients.…”

Section: Resultsmentioning

confidence: 99%

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Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

Manda

Nagar

Rajoria

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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Background: Vaginal hysterectomy is less commonly performed for benign pathologies if the uterine size exceeds 12 weeks in the belief that complications could be higher in this group. The aim of this prospective study was to compare surgical outcomes and safety of vaginal hysterectomy in women with non-prolapsed uteri of >12 weeks size to those with uteri of<12 weeks removed vaginally for similar indications.Methods: In this prospective cohort study, 92 patients were included who underwent NDVH for benign uterine conditions between May 2016 to December 2018. The index group comprised 32 women who underwent vaginal hysterectomy for non-prolapse uterus with uterine enlargement (>12 weeks), while the control group consisted of 60 women with uteri <12 weeks. Demographic data, duration of surgery, blood loss, intraoperative and postoperative complications were compared.Results: Women in the two groups had statistically similar mean age, Body Mass Index and parity (44 vs 42.77 years, 20.8 vs 21.56 kg m3 and 3.26 vs 3.83, respectively; p > 0.05). The mean operative time was significantly longer in the index group (62.47min; vs 48.17 min; p <0.0001). Women with enlarged uteri had greater mean estimated blood loss (123.2 ml vs 75.9 ml; p < 0.0001) but the mean length of hospital stay was similar (5.531 days vs 5.177 days; p > 0.05). Intra- and post-operative complications such as blood transfusion and pelvic sepsis, post-operative febrile illness and systemic infections were comparable in both groups.Conclusions: Vaginal hysterectomy in larger non-prolapsed uteri takes longer to perform and is associated with more blood loss compared to uteri <12 weeks but is not associated with a significant increase in complication rates.

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Section: Resultsmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

Manda

Nagar

Rajoria

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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“…In a retrospective study of 452 cases evaluated by a single surgeon wherein a uterine weight of 250 g or more was defined as a large uterus, uterine weight and previous vaginal delivery were reported to be a disadvantage for VH [17]. In another study that evaluated vaginal hysterectomies in women whose uterine weight of 280 g or more was defined as a large uterus, it was found that large uterine size increased the duration of operation and the amount of bleeding, but there were no differences concerning complications [18]. Another study also reported that VH could be safely performed with favourable outcomes, even in women with a uterus heavier than 280 g [19].…”

Section: Discussionmentioning

confidence: 98%

“…It is postulated that large uterine size is known to be a cause of technical difficulty in VH. There is no consensus in the literature on the definition of a large uterus regarding weight threshold [17,18]. In a retrospective study of 452 cases evaluated by a single surgeon wherein a uterine weight of 250 g or more was defined as a large uterus, uterine weight and previous vaginal delivery were reported to be a disadvantage for VH [17].…”

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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“…The size of the uterus can affect the ease of removal, and it is unclear whether an enlarged uterus is a contraindication for NDVH (1,4) . The large sized uterus more than 12 week was considered a traditional contraindication by most acting gynecologists who were surveyed for their opinion regrades routs for hysterectomy for benign gynecological diseases as stated in SGS's systematic review attributable to uncertainties about increased technical difficulty and risk of complications (31,33,34) , despite that a lot of pioneered gynecologists worldwide including American (2,3,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) , Canadian (45) , English (46)(47)(48)(49) , Indian (23,50,51) , Chinese (52) , Malaysian (53) ,south Africans (8,9,45,54) , French (4,(55)(56)(57) , polish (1,58) , Italian (59)(60)(61) , Greece (62) , Turkan (63)(64)(65) had been challenged the alleged uterine size as a contraindication for NDVH and they had succeeded in that task with great safety. Therefore, the goal of this retrospective research is to determine...…”

Section: Introductionmentioning

confidence: 99%

Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

Ahmed,

Elmantwe,

Helal

et al. 2024

Benha Medical Journal

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Background: An enlarged fibroid uterus greater than 12 weeks considered a contraindication for Non-Descent Vaginal Hysterectomy (NDVH) by most gynecologic surgeons, is this contraindication real or alleged? Aim: to evaluate impact of uterine size on peri-operative consequences in women underwent NDVH for benign conditions. Patients and Methods: This study includes 340 women underwent NDVH; 232 women had uterine size up to 12 weeks (control group) and 108 women had uterine size more than 12 and up to 24 weeks (index group). Results: Both groups were similar regards menopausal, nulliparity status, number of prior vaginal birth, preoperative medical status, and American Society of Anesthesiologists grades (P>0.05), but different in percentage of women with fibroids, cervical pathology, prior Cesarean section, and virgin lower abdomen(P<0.05). No important differences were detected in perioperative outcomes as transfusion, thrombosis, ureteral, bladder, or bowel injuries, fever, systemic infections, fistula, conversion to total abdominal hysterectomy, total postoperative (PO) complications and length of PO hospital stay (P>0.05). However, the effect of uterine size larger than 12 weeks in comparison to uterine size up to 12 weeks was significant on the subsequent outcomes total operative time (55 minutes) operative blood loss (160 ml), needs for general anesthesia, needs for debulking, needs for analgesics, decline in PO HB, and return to usual activity(P<0.05).Conclusion: Non-Descent Vaginal Hysterectomy (NDVH) cloud be executed for women had fibroids with uterine size greater than 12 weeks without increase in perioperative morbid outcomes when compared to women with uterine size up to 12 weeks.

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Is vaginal hysterectomy is equally safe for the enlarged and normally sized non-prolapse uterus? A cohort study assessing outcomes

Cited by 9 publications

References 25 publications

Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

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

Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

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