Vaginal hysterectomy and oophorectomy in women with 12-20 weeks' size uterus.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.