Laparoscopic Hysterectomy for Benign Conditions a Hospital Based Cross Sectional Study
- 1. Assistant Professor, Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar
- 2. Associate Professor, Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar
Description
Background: Hysterectomy is one of the most common surgical procedures performed in women. It is a ‘signature’ procedure for all gynaecologist. As a frequently done surgery the best route is imperative in the interest of the patients. Aim: The aim of this study is to evaluate, analyze the indications of surgery and compare hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH) and Non-descent Vaginal Hysterectomy (NDVH) in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, total Hundred women requiring hysterectomy for benign non-prolapsed uterus were selected for the study, 50 cases for each group were admitted due to benign gynaecological conditions in Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from September 2019 to February 2020. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: Most of women underwent hysterectomy in either group were of age group 41-50 years. Age range was 30-55 years and women who underwent hysterectomy in study were of lower and middle socio-economic groups. Parity was 3 or more than 3 in most of the women who underwent hysterectomy in both groups. Nulliparity was 2% in NDVH and 4% in TAH. Majority of cases who underwent NDVH and TAH were of thin, and average built. In either group bleeding disorder was the most common chief complaints. All-women who underwent hysterectomy had Hb% more than 9gm%. Pap smear showed inflammatory or normal smear in most of the cases. On cervical biopsy pre-malignant lesion was present in 12% NDVH cases and 8% in TAH cases. On endometrial sampling, majority of cases who underwent NDVH had endometrial hyperplasia and those underwent TAH had normal endometrium. Majority of cases had history of previous surgery i.e. BLTL. Most common indications were DUB and fibroid comprising of 66% and 64% in NDVH and TAH group respectively. Majority of cases who underwent NDVH had normal to just bulky uterus (90%) in TAH utrine size was 6-12 weeks (in 64%). BSO was the most common associated procedure in TAH. ACR and PNR were the most common associated procedure in NDVH group. There was 1 case of failed surgery and 1 case of bleeding pedicle in NDVH. There was1 case of bladder injury in TAH group. Mean blood loss in NDVH was 254 gm where as in TAH was 136.6gm. Mean haemoglobin change in NDVH was 0.671 gm% where as in TAH was 0.79 gm%. Post-op minor complications were 98% in TAH group and 38% in NDVH group. Majority of patients in NDVH were ambulant within 24h. and in TAH group after 24h. to 36h. Blood transfusion was given in 4% cases of NDVH and 12% cases of TAH. Majority of NDVH cases were discharged on 4-5th day and TAH cases were discharged on 7-8th day. Fibroid was most common histological finding followed by endometrial hyperplasia in both groups. In NDVH groups cost was less as compared to TAH group. Vault granuloma was the most common finding on follow up of patients in both groups. One case of incisional hernia and 2 cases of hypertrophic scar were seen in TAH group. Mean convalescence period in NDVH group was 16-24 and In TAH group 42-36 days. Conclusion: The utility and safety of vaginal hysterectomy for the moderately enlarged uterus upto 12 weeks with good mobility and proper anatomic condition. Thought vaginal hysterectomy is possible for the uterus of more than 12 weeks size, it needs good experience. With experience operative time, blood loss and complications can be reduced.
Abstract (English)
Background: Hysterectomy is one of the most common surgical procedures performed in women. It is a ‘signature’ procedure for all gynaecologist. As a frequently done surgery the best route is imperative in the interest of the patients. Aim: The aim of this study is to evaluate, analyze the indications of surgery and compare hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH) and Non-descent Vaginal Hysterectomy (NDVH) in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, total Hundred women requiring hysterectomy for benign non-prolapsed uterus were selected for the study, 50 cases for each group were admitted due to benign gynaecological conditions in Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from September 2019 to February 2020. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: Most of women underwent hysterectomy in either group were of age group 41-50 years. Age range was 30-55 years and women who underwent hysterectomy in study were of lower and middle socio-economic groups. Parity was 3 or more than 3 in most of the women who underwent hysterectomy in both groups. Nulliparity was 2% in NDVH and 4% in TAH. Majority of cases who underwent NDVH and TAH were of thin, and average built. In either group bleeding disorder was the most common chief complaints. All-women who underwent hysterectomy had Hb% more than 9gm%. Pap smear showed inflammatory or normal smear in most of the cases. On cervical biopsy pre-malignant lesion was present in 12% NDVH cases and 8% in TAH cases. On endometrial sampling, majority of cases who underwent NDVH had endometrial hyperplasia and those underwent TAH had normal endometrium. Majority of cases had history of previous surgery i.e. BLTL. Most common indications were DUB and fibroid comprising of 66% and 64% in NDVH and TAH group respectively. Majority of cases who underwent NDVH had normal to just bulky uterus (90%) in TAH utrine size was 6-12 weeks (in 64%). BSO was the most common associated procedure in TAH. ACR and PNR were the most common associated procedure in NDVH group. There was 1 case of failed surgery and 1 case of bleeding pedicle in NDVH. There was1 case of bladder injury in TAH group. Mean blood loss in NDVH was 254 gm where as in TAH was 136.6gm. Mean haemoglobin change in NDVH was 0.671 gm% where as in TAH was 0.79 gm%. Post-op minor complications were 98% in TAH group and 38% in NDVH group. Majority of patients in NDVH were ambulant within 24h. and in TAH group after 24h. to 36h. Blood transfusion was given in 4% cases of NDVH and 12% cases of TAH. Majority of NDVH cases were discharged on 4-5th day and TAH cases were discharged on 7-8th day. Fibroid was most common histological finding followed by endometrial hyperplasia in both groups. In NDVH groups cost was less as compared to TAH group. Vault granuloma was the most common finding on follow up of patients in both groups. One case of incisional hernia and 2 cases of hypertrophic scar were seen in TAH group. Mean convalescence period in NDVH group was 16-24 and In TAH group 42-36 days. Conclusion: The utility and safety of vaginal hysterectomy for the moderately enlarged uterus upto 12 weeks with good mobility and proper anatomic condition. Thought vaginal hysterectomy is possible for the uterus of more than 12 weeks size, it needs good experience. With experience operative time, blood loss and complications can be reduced.
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IJPCR,Vol14,Issue7,Article45.pdf
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Additional details
Dates
- Accepted
-
2022-07-07
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue7,Article45.pdf
- Development Status
- Active
References
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