Razia Iftikhar.
Vaginal hysterectomy is superior than abdominal hysterectomy.
J Surg Pak Jan ;13(2):55-8.

Objective: To determine the outcome of vaginal hysterectomy versus abdominal hysterectomy in terms of intra operative and post operative complications in women with benign uterine conditions. Study design: A comparative study. Place and duration of study: Baqai Medical University Karachi from November 2006 to February 2008. Patients and Methods: The study included 50 women who under went vaginal hysterectomy (VH) and 50 women who had abdominal hysterectomy (AH) for benign uterine diseases. Inclusion criteria for vaginal hysterectomy was utero vaginal prolapse (UV prolapse), uterine fibroid less than 12 weeks size and DUB and for abdominal hysterectomy was menorrhagia and pelvic pain, fibroid uterus, adenomyosis of uterus and dysfunctional uterine bleeding. Patients over 60 years of age, cancer of cervix and uterine malignancy were excluded from the study. Detailed history was taken and examination done. Routine investigations including ultrasound were carried out and hysterectomy was performed by clamp-cut and ligate method. Results: The mean age of patients was 52 years and parity between 4-10. The commonest indication for surgery in VH was UV prolapse 30(60%), DUB 15(30%), fibroid less than 12 weeks size 5(10%) while the commonest indication for surgery in AH was fibroid 20(40%), DUB 15(30%), menorrhagia and pelvic pain, 10(20%) and adenomyosis of uterus 5(10%). Among the intra operative complications there was one case of bladder injury in patient who underwent AH which was repaired. It was a case of previous C section. There were 2(4%) case of excessive haemorrhage (>500ml) one in each TAH and VH respectively. Early post operative complications like febrile morbidity was noted in each group, 10(20%) in AH and 5(10%) in vaginal hysterectomy, urinary tract infection in 4(8%) cases of VH and AH each. Wound infection in 6(12%) of AH and nil in VH. Paralytic Ileus in 4(8%) cases of AH and nil in VH. Vaginal vault haematoma in 2(4%) cases of VH while wound haematoma in 1(2%) case of AH. Late complications like vaginal discharge was noted in 3(6%) of VH while 2(4%) cases of AH. There was 1(2%) case of vault granulation in each AH & VH. Conclusions: Vaginal hysterectomy is easy to perform and is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and post operative morbidity, while abdominal hysterectomy is associated with longer duration of surgery, longer hospital stay, greater blood loss, more intra operative and post operative morbidity.

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