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Results for “Hysterectomy, Vaginal”

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At least 19 recordsLinked to original sources
PubMed2003

[Uterine myomatosis--abdominal hysterectomy, vaginal hysterectomy or laparoscopic-assisted vaginal hysterectomy?].

OBJECTIVE: To evaluate the way of the surgical treatment of uterine fibroids in two 5 year long periods. In the first period (1987-1991) the operative procedures--hysterectomies--were performed usually by the classical abdominal approach. In the second period (1997-2001) the modern trend of minimal invasive surgery was applied. Through analysis of three surgical procedures used (AHY, VHY, LAVHY) the conclusions concerning the advantages, disadvantages and correct indications for the selection of hysterectomy in cases of uterine fibroids are presented. STUDY DESIGN: Retrospective study. STUDY SETTING: Department of Obstetrics and Gynecology, Medical Faculty and University Hospital, Palacký University, Olomouc. METHODS: The total of 1172 patients (604 in the first period and 568 in the second period) were operated by abdominal hysterectomy (AHY), vaginal hysterectomy (VHY) or laparoscopically assisted vaginal hysterectomy (LAVHY). The factors influencing the mode of hysterectomy (body mass, weight of uterus, parity, adnexal finding, previous surgery) were analyzed. The type of anesthesia and per and postoperation complications (blood loss, conversion of vaginal to abdominal approach, inflammatory complications and administration of antibiotics) were also evaluated. RESULTS: Each of the chosen surgical procedures has advantages and disadvantages. Abdominal hysterectomy as the most invasive procedure is indicated only in extremely unfavourable findings. The least invasive procedure is VHY, which therefore is the optimal solution for the patient. LAVHY represents the operation which combines advantages of both AHY and VHY and fulfills also the criteria for minimal invasive surgery. CONCLUSION: The choice of the optimal surgical procedure in patients with uterine fibroids depends on the complex assessment of the preoperative finding, the technical possibilities of the setting and the experience of the surgeon. The goal is to chose the safest but at the same time least invasive surgical procedure.

Female↗
PubMed1996

A cost analysis of endometrial ablation, abdominal hysterectomy, vaginal hysterectomy, and laparoscopic-assisted vaginal hysterectomy in the treatment of primary menorrhagia.

STUDY OBJECTIVE: To assess the cost of four procedures performed to treat primary menorrhagia. DESIGN: Retrospective analysis. Setting. A 394-bed womens' teaching hospital. PATIENTS: Eighty healthy women undergoing one of the four procedures. Interventions. The study patients were equally divided among vaginal hysterectomy (VH), total abdominal hysterectomy (TAH), laparoscopic-assisted vaginal hysterectomy (LAVH), and endometrial ablation (EA). MEASUREMENTS AND MAIN RESULTS: Endometrial ablation was associated with significantly reduced hospital costs and a shorter recovery period than the other modalities. Hospital costs were less for VH and return to work was quicker after LAVH and VH. This study did not evaluate long-term failures or complications unless they occurred within the first 2 months after the procedure. CONCLUSION: Among women who could be treated by any of these techniques, VH was significantly more cost effective for the permanent management of primary menorrhagia than LAVH and TAH. The cost efficiency of EA was clearly implied, but further studies must be completed to evaluate the long-term costs associated with treatment failures. Although physicians should not choose a procedure based exclusively on cost, the expense of a less efficient or more costly procedure may affect a hospital's competitiveness in this era of managed care.

Cost-Benefit Analysis↗
PubMed1984

[A rare complication of vaginal hysterectomy: vaginal evisceration. Apropos of a case of recurrent evisceration].

A patient developed repeated vaginal eviscerations after vaginal hysterectomy. This is a rare complication, only 21 cases having been reported in the literature. The present case was a 61 year old woman with post-vaginal hysterectomy eviscerations 8 and 21 months after the operation. Reduction of the herniated loop and suturing of the ununited vaginal stump is generally a simple procedure, but the perineal reconstruction necessary to prevent recurrence raises problems that are discussed in detail.

Abdomen↗
PubMed2000

Adrenalin versus terlipressin: blood loss and cardiovascular side-effects in the vaginal part of laparoscopically-assisted vaginal hysterectomy or vaginal hysterectomy.

The purpose of the study was to compare blood loss and cardiovascular side-effects in the course of the vaginal part of laparoscopically-assisted vaginal hysterectomy (LAVH) or single vaginal hysterectomy (VH) [1]. Blood loss was evaluated in relation to local application of two haemostatic agents, e.g. adrenalin as a gold standard versus terlipressin. The investigation was designed as a prospective randomised study. A prospective group of 40 patients selected for LAVH or VH was randomised into two groups, e.g. 20 patients in each group. In both of these groups, the blindly selected haemostatic agent was applied locally immediately before circular colpotomy, the surgeon not being aware which agent was being used. Because of the claimed delayed effect of terlipressin a third group of another 20 patients was randomly selected. For comparison in this group terlipressin was locally already applied before the laparoscopic part of LAVH, e.g. 20-25 minutes before performing circular colpotomy. Thus, this particular group could not be made blind to the surgeon. The study confirmed a significantly superior haemostatic effect of adrenalin. On the other hand after the adrenalin application a higher frequency of hypertensive reactions and mild arrythmias were observed but without any clinical seguelae.

Adult↗
PubMed1994

Patient Selection for Laparoscopically Assisted Vaginal Hysterectomy vs Vaginal Hysterectomy in a Private Hospital Setting

The purpose of this study is to analyze the patient selection patterns of physicians in private practice performing laparoscopically assisted vaginal hysterectomy (LAVH). Forty-nine laparoscopic hysterectomies were compared to 30 vaginal hysterectomies (VH) performed during the same time period. There was no statistical difference with respect to patient age, gravity, and parity. There were no major complications in either group and no difference in minor complications. Significantly larger percentages of LAVH patients were operated on for fibroids, endometriosis, and pelvic pain. Fifty-one percent of LAVH patients but only 23% of VH patients underwent bilateral salpingo-oophorectomy. Blood loss was greater in the LAVH group. The mean operating time was 95±36 minutes for VH vs. 164±48 minutes for LAVH. The mean uterine weights were not statistically different, 149±66 g for VH and 161±92 g for LAVH. We conclude that patients undergoing LAVH in a private hospital setting are a different population than those undergoing VH and that those differences are reflected both in the indications for surgery and in the performance of oophorectomy.

Journal Article↗
PubMed1991

Trends in thirty years of vaginal hysterectomy.

Vaginal hysterectomy, as currently performed at the University of Vienna, was first described by Halban in 1932. From 1955 to 1985, a total of 9,967 hysterectomies were performed. The vaginal route was used for 6,078 (60.9 per cent) of these procedures. Sixty-four per cent of the women operated upon were multiparous, 27 per cent were uniparous and 8 per cent were nulliparous. A comparison of the periods 1955 to 1975 and 1976 to 1985 revealed the following trends: the incidence of uterine myomas (30.6 to 27.1 per cent), in situ carcinoma of the cervix (6.5 to 7.9 per cent) and endometrial carcinoma (1.4 to 0.6 per cent) remained largely constant. In the past decade, indications for positional abnormalities (uterine descent and prolapse) were encountered more often (27.6 to 41.6 per cent) than in the first observation period, while the incidence of recurrent metrorrhagia was found to decline (33.9 to 22.8 per cent). The most common complications included hemorrhage during the operation, lesions of the bladder, hemorrhage until 48 hours after surgical treatment and hemorrhage from days 2 to 14 postoperatively (around 0.5 per cent, respectively). During the second observation period, no postoperative fistulas developed. Two instances of tubal prolapse were seen. Laparotomy was done in four of 6,078 instances. Two patients died of septic complications. Whenever possible, we prefer vaginal hysterectomy because of its low complication rate, low mortality rate and low postoperative morbidity.

Age Factors↗
PubMed1992

Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting.

OBJECTIVE: To compare outpatient laparoscopy-assisted vaginal hysterectomy with standard outpatient vaginal hysterectomy. METHODS: Fifty-six women scheduled for vaginal hysterectomy were randomly assigned to undergo either a laparoscopy-assisted vaginal hysterectomy with endoscopic staples (N = 29) or a standard vaginal hysterectomy (N = 27). There were no differences between the study groups with regard to age, gravidity, parity, preoperative indications, and previous operations. RESULTS: Twenty-eight of 29 laparoscopy-assisted vaginal hysterectomies and all 27 vaginal hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were completed. The mean operating time was significantly longer for laparoscopy-assisted vaginal hysterectomy (120.1 versus 64.7 minutes). Fifty-three of the 55 patients completing surgery were discharged home by 12 hours from the time of admission. Complications with laparoscopic hysterectomy were related to the technical aspects of laparoscopy. The incidence of febrile morbidity was similar in the groups. Although patients having laparoscopy-assisted hysterectomy required statistically significantly more pain medication and had lower postoperative hematocrit measurements, this did not make a clinical difference in the postoperative courses. The mean hospital charge for laparoscopy-assisted vaginal hysterectomy was $7905 and for vaginal hysterectomy $4891. CONCLUSION: Other than cost, laparoscopy-assisted vaginal hysterectomy and standard vaginal hysterectomy appear comparable in patients who could otherwise undergo a vaginal hysterectomy.

Adult↗
PubMed1987

Elective cesarean hysterectomy versus vaginal hysterectomy for the treatment of cervical intraepithelial neoplasia.

We retrospectively compared elective cesarean hysterectomy and vaginal hysterectomy for cervical intraepithelial neoplasia. Sixteen patients had cesarean hysterectomy and 53 had vaginal hysterectomy. There were no deaths in either group and no neonatal complications in the cesarean hysterectomy group. Major and minor complications were comparable in the two groups except that urinary tract infection was statistically more common in the cesarean hysterectomy group. The mean hospital stay for the two groups was comparable. The estimated blood loss and transfusion rate were higher in the cesarean hysterectomy group. The transfusion rate was probably artificially increased because of overzealous intraoperative transfusion. Elective cesarean hysterectomy does not cause unacceptably high morbidity, and it is an acceptable alternative to interval vaginal hysterectomy for cervical intraepithelial neoplasia in poorly compliant patients.

Adult↗
PubMed2001

Vaginal hysterectomy.

Vaginal hysterectomy represents the ultimate minimal access hysterectomy. The indications for the procedure extend well beyond those of prolapse. Good training and advances in surgical technique allow the removal of enlarged fibroid uteri as well as vaginal oophorectomy. This article also considers the complications which may follow.

Female↗
PubMed1994

A critical analysis of laparoscopic assisted vaginal hysterectomies compared with vaginal hysterectomies unassisted by laparoscopy and transabdominal hysterectomies.

The first 115 laparoscopically assisted vaginal hysterectomies (LAVH) done by our faculty surgeons were compared with 220 vaginal hysterectomies (VH) and 194 abdominal hysterectomies (AH) done in our affiliated hospitals over the same period of time. Logistic regression analysis indicates that LAVHs were done for cases that would significantly be more likely selected for AH than for VH (p less than 0.0001). Matched case control studies with 28 LAVH/VH and 34 LAVH/AH pairs and bivariate analyses demonstrated that LAVH can be accomplished with low morbidity, short lengths of stay, and little, if any, increase in operating times compared with VH and AH. The LAVH procedure can be expected to replace many AHs in the future.

Adolescent↗
PubMed2026

Vaginal Hysterectomy Versus Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery Hysterectomy; Results of a Randomised Controlled Trial.

OBJECTIVE: To compare Vaginal Hysterectomy (VH) with Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) hysterectomy (VANH) as a day-care procedure. DESIGN: Single-blind, multicentre randomised controlled trial. SETTING: Two Dutch non-academic teaching hospitals. POPULATION: Women aged &#x2265;&#x2009;18&#x2009;years undergoing hysterectomy for benign indications. METHODS: Women were randomised 1:2 (VH or VANH). Primary outcome was SDD. Secondary outcomes included operative time, rate of elective salpingectomies, intraoperative blood loss, complications (Clavien-Dindo), pain scores (NRS) and analgesic use, post-operative recovery (RI-10), and quality of life (EQ-5D-5L). Analyses were performed on an intention-to-treat basis. RESULTS: A total of 113 patients were included in the analyses (n&#x2009;=&#x2009;42 VH, and n&#x2009;=&#x2009;71 VANH). SDD occurred significantly more frequently in the VANH group (87.3%) than VH group (71.4%; OR 2.76, 95% CI 1.04-7.25; p&#x2009;=&#x2009;0.04). VANH was associated with a significantly shorter operative time (median 55&#x2009;min versus 65&#x2009;min; p&#x2009;=&#x2009;0.005), less blood loss (median 50&#x2009;mL vs. 150&#x2009;mL; p&#x2009;<&#x2009;0.001) and more often elective opportunistic salpingectomy compared to VH (100% vs. 77.4%; p&#x2009;=&#x2009;0.008). NRS were significantly lower in the VANH group the first hour post-operative (3 vs. 1, p&#x2009;<&#x2009;0.001). Post-operative complications (VH 9.5% vs. VANH 15.5%; p&#x2009;=&#x2009;0.34), readmission (VH 4.8% vs. VANH 8.5%; p&#x2009;=&#x2009;0.47), analgesic use, recovery, and quality of life were not statistically significant. CONCLUSIONS: VANH is a safe and effective alternative to VH, offering a higher likelihood of SDD, shorter operative time, reduced blood loss, and more often an elective salpingectomy, without increased complications or differences in pain, recovery, or quality of life.

Humans↗
PubMed2005

Postoperative analgesic requirements - total laparoscopic hysterectomy versus vaginal hysterectomy.

BACKGROUND: There is limited information available on the requirement for postoperative analgesic drugs in patients submitted to total laparoscopic hysterectomy (TLH) compared with patients undergoing vaginal hysterectomy (VH). AIM: To compare the postoperative analgesic requirements in patients who underwent a TLH with patients who had a VH. METHODS: Chart review of 53 patients who had TLH and 47 who had VH and were seen postoperatively by an acute pain management service in order to assess postoperative analgesic requirements. Patient controlled analgesia (PCA) was part of the standard protocol for postoperative pain management. Analgesic requirement was recorded as the mean doses of morphine and number of days that patients used non-steroidal anti-inflammatory drugs (NSAIDs), oxycodone and tramadol. RESULTS: The requirement for total morphine was approximately half the dose in patients who had a TLH (10.8 +/- 12.6 mg) compared with patients who had a VH (19.4 +/- 21.9 mg) (P 0.017). The length of use of NSAIDs was significantly reduced in patients who had undergone a TLH (2.0 +/- 0.95 days) as compared with patients who had a VH (2.85 +/- 1.1 days) (P < 0.0001). CONCLUSIONS: Patients submitted to TLH require less postoperative analgesic drugs when compared with patients who had VH. Prospective randomised trials are warranted to compare analgesic requirements between patients submitted to TLH and VH.

Adult↗
PubMed2005

Laparoscopic uterosacral ligament uterine suspension compared with vaginal hysterectomy with vaginal vault suspension for uterovaginal prolapse.

This study compares the outcomes of laparoscopic uterosacral ligament uterine suspension (LUSUS) to those of vaginal vault suspension with total vaginal hysterectomy (TVH) for the treatment of symptomatic uterovaginal prolapse. We compared the outcomes of 25 LUSUS to those of 25 TVH with vaginal vault suspension among age-matched controls. No significant complications occurred in either group. EBL and hospitalization duration were significantly less in LUSUS patients (72 cc vs. 227 cc, P < .0001 and 1.05 vs. 1.65 days, P = .002). Vault support, as measured by postoperative pelvic organ prolapse quantitation system point D in the LUSUS group and point C in the TVH group, was better for the LUSUS group (D = -9 vs. C = -7.6, P = .002). No LUSUS group patient underwent reoperation for recurrent apical prolapse as compared to three TVH patients. LUSUS is an effective treatment for appropriately selected women with uterovaginal prolapse who desire uterine preservation.

Adult↗