TMSS Medical College Journal

Background: Hysterectomy is the commonest gynaecologic operation performed worldwide not only for malignant | disease but also for many benign conditions such as uterine fibroid, endometrial hyperplasia, adenomyosis, uterine | prolapse, dysfunctional uterine bleeding and cervical intraepithelial neoplasia. Various approaches have been adopted by gynaecologist such as abdominal, vaginal and laparoscopic assisted hysterectomy. Objective: To compare the hysterectomies performed via the vaginal and abdominal routes in terms of indications and associated complications. Materials & Methods: This prospective comparative study was conducted in the department of Obstetrics and Gynaecology of TMSS Medical College & Rafatullah Community hospital, Bogra from Jaunary 2015 to December 2016. | Results: A total of 100 patients were enrolled in this study with justified gynaecologic symptoms and sings and dividing them into two groups A and B (50 in each group). Group A underwent vaginal hysterectomy and group B abdominal hysterectomy. Operation time, intra-operative blood loss, time to out of bed activity, duration of hospital stay, wound | infection and blood transfusion were minimum in the vaginal hysterectomy group (VH) compared with abdominal hysterectomy group (AH). In majority of cases, the age group of vaginal hysterectomy patients (Group A) were between 61 to 70 years and abdominal hysterectomy group (Group B) were 51 to 60 years. Parity was 3 to 4 in both groups. Indications for vaginal hysterectomy were dysfunctional uterine bleeding (DUB) and uterine prolapse with size of uterus less than 10 weeks while in abdominal hysterectomy were dysfunctional uterine bleeding (DUB) and uterine fibroid with | size of uterus 12 weeks or above. The operation time in case of vaginal hysterectomy group was between 40-60 minutes | (Mean 50 minutes) whereas in abdominal hysretrctomy group was 60-80 minutes (Mean 70 minutes). Duration of hospital stay in vaginal hysterectomy group was 5- 7 days (Mean 6 days) but in abdominal hysterectomy group was 6 -10 | days (Mean 8 days). Convalescent periods were 1-5 (mean 3) nights in abdominal hysterectomy group while 1-3 (mean | 2) nights in vaginal hystrectomy group. Post operative complications such as urinary tract infection (UTI) 6 (12%) and wound infection 2 (4%) occured in vaginal hysterectomy group while urinary tract infection (UTI) 22 (44%) and wound inflection 12 (24) occured in abdominal hysterectomy group.. Post-operative followup was given to all patients for evaluating the complication. Conclusion: Vaginal hysterectomy has advantage over abdominal hystrectomy in the treatment of benign gynaecologic diseases, providing greater efficacy, safety, quick or early post-operative recovery, | shorter hospital stay with minimal invasiveness. |

The term hysterectomy originates from two Greek Words “hystero” means uterus and “ectomy” means resection from human body. This surgical procedure is indicated in several gynaecologic problems. In United states, hysterectomy is second to caesarean section delivery performed in women of reproductive age and one in three women has undergone a hysterectomy by age about 60 years. Approximately 600000 hysterectomies were performed annually in the United states'. Routes for hysterectomy include abdominal, vaginal and laparoscopic (LH) approaches. Abdominal hysterectomy is used for uterine fibroid, malignancies or when there are adhesions and removal of uterus is not possible through vaginal route. Vaginal hysterectomy was initially only used for prolapse or inversion but its indications are now increasing. Vaginal hysterectomy is least invasive than abdominal hysterectomy and results in better quality of life. Vaginal hystrectomy in true sense is a scar less hysterectomy. Iftikhar R et al reported better post operative quality of life that is functional capacity, physical aspect and higher satisfaction rate in the vaginal hysterectomy compared to abdominal hystrectomy?. Miskry A et al found that vaginal hystrectomy was associated with significant benefits interms of reduced hospital stay and improved patient recovery’. In this study minimum intra-operative complications occurred in patients of vaginal hysterectomy group and no vaginal approach was converted to abdominal approach. To ensure the efficacy and safety of operation, the most minimally invasive surgery should be chosen and vaginal hysterectomy appears to have advantages over abdominal hystetrectomy in the treatment of benign gynaecological diseases.