Non Descent Vaginal Hysterectomy- safe, cost effective, scarless procedure in bulky uterus

Abstract

Introduction:Removal of the uterus through the vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” (NDVH). If hysterectomy is indicated for benign disease then indications are for NDVH unless contraindicated. With advent of morcellation and debulking techniques, the ease and success of performing NDVH has increased.Aims and objectives-1.To study age distribution, parity, menstrual status and marital status of patients undergoing NDVH.2.To study chief complaints and indications of NDVH.3.To study size of uteri in patients selected and the different techniques of debulking used during NDVH.4.To assess the safety of NDVH in patients with previous pelvic surgery.Material and methods:Total 50 patients were included in the study. Detailed history was taken including obstetric history, menstrual history and clinical examination was performed. Then basic blood tests, ultrasonography, Pap smear, Dilatation and curettage was done for all the patients. After taking consent and doing proper preoperative preparation, patient was posted for NDVH. Post operative complications were noted. Patients were told to come for follow up after 15 days.Results: Out of 50 patients, 52% belonged to 41-50years age group and 40% were from 31-40 years of age group. 98% were married, 88% were menstruating and 12% were menopausal. Multiparity was favoured factor for NDVH. Menorrhagia, dysmenorrhoea, chronic abdominal pain were found in 72%, 18% and 16% respectively. 78% had previously performed tubectomy. In ultrasonography, normal sized uterus was found in 34%, anterior wall fibroid was next common finding found in 32%. Uterine fibroid was commonest indication for surgery.Conclusion: NDVH was found to be safe, scarless procedure which was also cost effective. NDVH is possible in bigger size uteri with use of different methods of debulking which is safe and it accomplishes the surgery by vaginal route in most of the cases.