Safia Tabassam, Arif Tajammul, Waseema Arif.
Vaginal Hysterectomy.
Pak J Obstet Gynaecol Jan ;10(1,2):1-5.

Vaginal hysterectomy is a specialized surgical procedure practiced by gynecologists world wide. A study conducted at Services Hospital Lahore showed that the vaginal route was chosen for hysterectomy in 42 of 225 hysterectomies making a figure of 18.66%. The mean age of the patients was 49.05 ± 8.93 years (range 3070 years) and the mean parity was 6.1 ± 2.38. Thirty six women were still married at the time of surgery and thirty (83.33%) of these were sexuallv active. Twenty four (57.14%) were premenopausal and had a mean cycle of 28.2 ± 2.84 days. The commonest indication was prolapse (64.28%) followed by irregular bleeding (30.95%). In all of the patients the uterus was smaller than size of eight weeks gestation and was freely mobile. Vaginal hysterectomy (VH) alone was the commonest procedure (35.71%) followed by VH along with anterior colporraphy and posterior colpoperineorraphy (28.57%). Only two patients (4.76%) underwent unilateral oophorectomy. None of the patients had bilateral oophorectomy. General anaesthesia was used in 80.95% while epidural was employed in 19.04%. The mean operating time was 71 ± 19.2 minutes and the mean estimated blood loss was 214.3 ± 97.08 m1s. The per-operative complication rate was 14.3% while the post-operative rate was 33.33%. There was no mortality in this series. The mean hospital stay was 6.38 ± 2.19 days. The choice of only small uteri for a vaginal procedure shows hesitation by surgeons to take on bigger sizes. Their small ratio compared to abdominal hysterectomy denotes preference of the abdominal route. There is need for redefining indications of vaginal hysterectomy and we recommend its wider use than present. Oophorectomy with vaginal hysterectomy must be considered as with abdominal hysterectomy where deemed necessary.

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