Comparative study of different routes of hysterectomy
Abstract
Background: To compare the various routes of hysterectomy and find the most commonly performed hysterectomy type and the various complications associated with each.
Methods: This prospective study was carried out in the department of Obstetrics and Gynaecology, N.S.C.B. medical College, Jabalpur during June 2007 to August 2008. A total of 174 cases included in the study. The women were divided into three groups depending on the surgical approach: the abdominal group consisted of women who underwent hysterectomy via a suprapubic or median incision; the laparoscopically assisted vaginal hysterectomy (LAVH) group consisted of women who underwent vaginal hysterectomy assisted by laparoscopic procedure (excluding uterine artery ligation) and vaginal hysterectomy.
Results: The indications of hysterectomy differed among groups. Four main indications in the cases coming to medical college: Fibroid, DUB, Genital prolapse and PID. Prolapse was a more frequent indication for vaginal hysterectomies; however, abdominal hysterectomies or Laparoscopically assisted vaginal hysterectomies were used in 16 out of the 76 cases that involved only prolapse. Fibroids were more frequently an indication for abdominal or laparoscopic assisted vaginal hysterectomy.
Conclusion: The vaginal route has significant advantages over LAVH and abdominal hysterectomy and should be the route of first choice. Hence there is a tremendous scope for improvement by careful preoperative assessment, meticulous surgical techniques and proper postoperative care in order to reduce the complication rate.
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