June 20th, 2018

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Morbidity of Vaginal Hysterectomy for Benign Tumors as a Function of Uterine Weight
Authors:  Bruno Deval, M.D., Arash Rafii, M.D., David Soriano, M.D., Emmanuel Samain, M.D., Ph.D., Michel Levardon, M.D., and Emile Daraļ, M.D., Ph.D.
  OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal hysterectomy.

STUDY DESIGN: A prospective study of vaginal hysterectomy was carried out in women with benign uterine tumors. The only exclusion criteria were a suspected adnexal mass, a very narrow vagina and an immobile uterus. The women were stratified into 3 groups according to uterine weight. The groups were compared as regards indications, operative time, complication rates, analgesia requirements and postoperative recovery.

RESULTS: A total of 214 women underwent vaginal hysterectomy: group 1, n=114, uteri <180 g; group 2, n=73, uteri 180-500 g; group 3, n=27, uteri >500 g (maximum 1,350 g). The groups differed with respect to mean age (P=.003) and menopausal status (P=.002) but not gravidity, parity, previous pelvic surgery or preoperative hemoglobin levels. Concerning the indications for hysterectomy, only the incidence of pelvic compression differed between the groups (P=.04). There was no difference in the frequency of concomitant surgical procedures (e.g., adnexectomy) between the groups. Morcellation rate was 30% in group 1, 73% in group 2 and 100% in group 3. The overall complication rate was not significantly different between the groups: 20.1%, 15.0% and 22.2%, respectively. The only major complication was an injury to the infundibulopelvic ligament in a group 1 patient. Operative time increased significantly with uterine weight (82±35.4, 91.8±35.4 and 94.8±36.5 minutes, respectively; P=.01). There were no significant differences between the groups as regards perioperative hemoglobin loss, analgesia requirements, time to flatus and stool return or length of hospital stay.

CONCLUSION: Vaginal hysterectomy can be performed successfully even in the case of greatly enlarged uteri; nulliparity and a history of pelvic surgery are not absolute contraindications. (J Reprod Med 2003;48: 435-440)
Keywords:  hysterectomy, vaginal; uterus; uterine diseases
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