الفهرس 
The History of vaginal hysterectomy
Early HistoryOnly 14 pages are availabe for public view
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Abstract
Vaginal hysterectomy has gained great popularity over
abdominal hysterectomy over the past decades. This is
attributed to the fact that it’s associated with less operative
time, less estimated intraoperative blood loss, less incidence
of intraoperative complications and shorter period of hospital
stay.
Large uterine size, previous uterine surgery and lack of
uterine descent have been considered obstacles to the vaginal
route but the biggest obstacle is the inexperience and the lack
of training. A lot of techniques have been adopted to
overcome the problem of the large size such as coring,
bisection and vaginal myomectomy.
Laparoscopic hysterectomy and laparoscopic assisted
vaginal hysterectomy are considered to be the beginning of a
new era in the history of hysterectomy, LAVH is now
accepted as an attractive alternative to abdominal
hysterectomy in nearly all benign pathologies. It’s associated
with less operative complications, less intraoperative blood
loss, shorter hospital stay. However, it may be associated
with more operative time and higher incidence of urinary
complications.The aim of the current study is to compare between VH
and LAVH in cases of uteri weighing more than 280gm as
regards the operative and the postoperative outcomes.
The current trial was conducted at Ain Shams
University Maternity Hospital during the period from 2014 to
2016. A total of 50 cases with uteri larger than 280gm were
recruited from the outpatient clinic and included in the study.
Then, they were randomized into two groups, group 1 had
VH while group 2 had LAVH.
The operative time was assessed and the time of any
concomitant procedure was excluded, estimated
intraoperative blood loss was measured. Moreover, any
intraoperative complication was recorded. Postoperatively,
any morbidity was recorded as well as the pain score and the
length of hospital stay. The total hospital costs was
calculated before discharge.
Both groups were matched in the demographic data
and the history of previous cesarean sections in order to
eliminate any factor which can affect the operative time and
blood loss.
When the two groups was compared, there was no
significant difference between the two groups regarding the
operative time ,estimated intraoperative blood loss and rate of intraoperative complications. Postoperatively, there was
no significant difference between the two groups regarding
the rate of postoperative morbidity and postoperative hospital
stay while there was significant difference between the 2
groups favoring the LAVH group in the postoperative pain
score after 24hrs. Total hospital costs were significantly
higher in case of the LAVH group.
The estimated ultrasound weight was significantly
correlated with actual uterine weight measured
postoperatively.
When analyzing the operative complications, there was
one case of bladder injury in each group, both cases were
diagnosed intraoperatively and repaired vaginally with no
further complications. Also, one case was converted to
laparotomy in each group; the one in the VH case was due to
difficulty in opening the Douglas pouch while the one in the
LAVH group was due to severe adhesions. Postoperatively, 2
cases need blood transfusion in the VH group and 4 cases
need blood transfusion in the LAVH group. One case of
incisional hernia was reported in the LAVH group 4 weeks
after the operation.