Vaginal hysterectomy and oophorectomy in women with 12-20 weeks' size uterus.Acta Obstet Gynecol Scand. 2007; 86(11):1359-69.AO
To compare the surgical outcomes of vaginal hysterectomy and prophylactic oophorectomy in women with a uterine size<12 weeks' gestation and 12-20 weeks' gestation, without decensus.
In this prospective comparative study, 241 consecutive vaginal hysterectomies were planned for women with benign disease of the uterus. All hysterectomies were performed by the same surgeon (author), and divided into 2 groups: a uterine weight >280 g (n=83, 280-1150 g) and a uterine weight <280 g (n=158). The 2 groups were compared for success rates of hysterectomy and bilateral oophorectomy vaginally, operative time, change in haemoglobin, haemorrhage, length of hospital stay, operative complications, and febrile morbidity.
All 241 hysterectomies were completed successfully vaginally, and no patients required laparotomy or additional procedures in both groups. No significant intra- and post-operative complications requiring admission to the hospital were encountered in either group. Mean operating time was significantly longer in the uteri >/=280-g group than in the <280-g group (69.4+/-24.4 versus 108.2+/-41.2 min, p<0.0001). The rate of intraoperative haemorrhage (8.43 versus 1.2%) and the change in haemoglobin were significantly higher in the >/=280-g group compared with the <280-g group (p<0.01). Significant positive linear correlation between uterine weight and operative time was seen in all 241 hysterectomies (p<0.001). The rate of bilateral oophorectomy was similar between the uteri >/=280-g group (89.8%) and the <280-g group (92.9%). The main intraoperative complication of the 241 vaginal hysterectomies was bladder injury that occurred in 1 case (0.4%) in the <280-g group. There were no statistically significant differences in intra- and post-operative complications, febrile morbidity, and postoperative hospital stay between the groups.
Our findings demonstrate that despite the prolonged operating time and increased intraoperative blood loss, vaginal hysterectomy can be safely performed on a large uterus. Routine bilateral prophylactic oophorectomy can be performed in all patients who have sufficiently long infundibulopelvic ligaments to permit removal of the entire ovary.