Short Term Outcome of Vaginal Hysterectomy- Ward Mayo Procedure

Abstract

BACKGROUND Vaginal hysterectomy is often performed to correct uterovaginal prolapse. The effect of surgery is seldom addressed. Long term results and QOL data are sparse. The objectives of the study were to determine the short-term complications and to assess the post-operative wellbeing of the patients following Ward Mayo surgery at Department of Obstetrics and Gynaecology, Calicut Medical College. To determine the incidence of vault-prolapse one year after surgery. MATERIALS AND METHODS Hospital based prospective cohort study. All post-menopausal patients in the age group 50-70 years with third degree uterovaginal prolapse POP Q stage III and IV, who underwent Ward Mayo procedure from IMCH Calicut are followed up for a period of 1 year. Patients were reviewed 6 weeks after surgery and at the end of 1 year. RESULTS Regarding short term complications, 12% had anaemia requiring blood transfusion, 3% had urinary bladder injury, 8% had post-operative fever, 3% had vaginal infection. Presence of COPD and a BMI of more than 25 are significant risk factors for the short-term complications. In long term, 26% developed de-novo urinary symptoms. 90% patients had satisfactory relief from pre-surgery symptoms. Emotional stress of hysterectomy was experienced by 7%. Incidence of vault prolapse was nil. The proportion of Ward Mayo surgeries at IMCH in 2016 is 11.4%. CONCLUSION Vaginal hysterectomy is an efficient treatment for uterovaginal prolapse. However, 15% of the operated patients developed de novo urinary stress incontinence. Therefore, efforts to identify latent stress incontinence should be undertaken preoperatively and it should be properly corrected during the surgery.