Vaginal approach opposite (vs) to the abdominal in the surgical treatment of uterine myoma

Abstract

Background. Hysterectomy is the second most common surgery performed on women of childbearing age. There are several ways to remove the uterus: abdominally, vaginally, through an incision at the back of the vagina, or laparoscopically. The goal of our study is to compare the complications in total hysterectomy depending on used surgical approach. Materials and methods. The retrospective study that constitutes the object of the present research was conducted on 1147 patients with uterine myoma and genital prolapse, admitted in the Clinic Municipal Hospital ‘’Saint Arhanghel Mihail’’of Chisinau over a period of 5 years (2010 – 2014). 142 of these patients (13% of cases) underwent total hysterectomy. Vaginal hysterectomy was performed at 82 patients and abdominal one at 60 patients. Results and discussion. In the result of this study the advantages of vaginal hysterectomy were recorded: reduced postoperative recovery time, fewer days of hospitalization, reduced hospital costs, reduced surgery time. Among the intraoperative observation, the mean duration of surgery of abdominal hysterectomy was 98.8 min and that of vaginal was 87 min (p=0.0192). Wound infection was the main cause for febrile morbidity in abdominal hysterectomy group where as urinary tract infection was the main cause for febrile morbidity in vaginal hysterectomy. There was one case of bladder injury and 1 case of ureteric injury in abdominal hysterectomy group while none in vaginal hysterectomy group. There was 6% of thromboembolic complications in abdominal hysterectomy and 1,5% in vaginal hysterectomy. There were 2 (4.0%) cases of postoperative hemorrhage in abdominal hysterectomy group and none in vaginal hysterectomy group.Conclusions. This study showed that vaginal hysterectomy was Associated with less intraoperative complications and postoperative morbidities and complications as compared to abdominal hysterectomy. Only a physician can determine the best approach to hysterectomy in an individual woman.