Hysterectomy for Benign Uterine Pathology Among Women Without Previous Vaginal Delivery

Tohic, Arnaud Le MD1; Dhainaut, Caroline MD1; Yazbeck, Chadi MD1; Hallais, Corinne MD2; Levin, Ishai MD1; Madelenat, Patrick MD1

doi: 10.1097/AOG.0b013e3181656a25
Original Research

OBJECTIVE: To evaluate the feasibility and the complication rate of vaginal hysterectomy in benign uterine pathology (except for uterine prolapse) among patients without previous vaginal delivery.

METHODS: A review of the medical records in patients without previous vaginal delivery who underwent hysterectomies between January 1995 and June 2004 was carried out. Patients were divided into two different groups: group 1 included patients with first-intention abdominal hysterectomy; group 2 included patients with vaginal approach further stratified into 2a without and 2b with laparoscopic assistance.

RESULTS: Three hundred patients without previous vaginal delivery underwent hysterectomy during this period. Vaginal hysterectomy was planned in 75.7% of cases. Success rate for planned vaginal hysterectomies was 92.1%. The mean weight of uteri extracted by vaginal and abdominal approaches were 326 g and 1,047 g, respectively (P<.001). The mean operative time was significantly longer in the laparoscopic-assisted approach (160 minutes) than in the abdominal approach (120 minutes), and significantly shorter in exclusively vaginal (75 minutes) than in other procedures (P<.001). The use of the laparoscopic assistance in hysterectomy decreased significantly over the period of the study (P<.001). The mean duration of hospital stay was significantly shorter in group 2 than in group 1 (3.8 days compared with 6.2 days, P<.001), but no differences were noted between subgroups 2a and 2b.

CONCLUSION: Vaginal hysterectomy should not be contraindicated in patients lacking previous vaginal delivery. In these particular patients, most of the procedures can be performed by vaginal approach, with the benefit of limiting the costs and the duration of hospital stay.

LEVEL OF EVIDENCE: II

Vaginal hysterectomy should not be contraindicated in patients without previous vaginal delivery.

From the 1Obstetrics and Gynaecology Department, Bichat-Claude Bernard University Hospital, APHP, Paris, France; 2Epidemiology and Public Health Department, CHU Hôpitaux de Rouen, Hôpital Charles Nicolle, Rouen, France.

See related editorial on page 812.

Presented at the 2nd Congress of the Société Française de Chirurgie Gynécologique et Pelvienne, Dunkerque, France, February 24–26, 2005.

Corresponding author: Dr. Arnaud Le Tohic, Obstetrics and Gynaecology Department, CHU Bichat–Claude Bernard, 170, Boulevard Ney, 75018 Paris, France; e-mail: arnaud.le-tohic@bch.ap-hop-paris.fr.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 by The American College of Obstetricians and Gynecologists.