Nasira Sabiha Dawood, Rabia Mahmood, Naila Haseeb


Background: Abdominal and vaginal hysterectomies are the two predominant operative
modalities for various uterine conditions; however the indications for selecting a particular
procedure in any setting may not be optimally defined. This study was undertaken to evaluate the
appropriate route of hysterectomy (abdominal or vaginal) in a hospital population for women with
benign disease by comparing peri-operative and post-operative complications. Methodology: This
quasi-experimental study was undertaken at the Department of Obstetrics and Gynaecology, Fauji
Foundation Hospital/Foundation University Medical College, Rawalpindi from January to
December 2007. Eighty subjects were equally divided into vaginal and abdominal hysterectomy
groups by convenience (non-probability) sampling. The primary outcome measures were operative
time, primary haemorrhage, wound infection, post-operative analgesia, febrile morbidity, hospital
stay and secondary haemorrhage; secondary outcome measure were estimated cost, re-admission
and reopening. Results: There were no differences in the patients’ mean age, parity, body mass
index, and preoperative haemoglobin levels between groups. Vaginal hysterectomy was associated
with less febrile morbidity, wound infection operative time, economic cost, bleeding requiring
transfusion and re-admission than abdominal hysterectomy. Main indication for women having
abdominal operation was leiomyomas, whereas more women having uterovaginal prolapse had
vaginal hysterectomy. Conclusion: Patients requiring a hysterectomy for benign lesions having a
moderate-sized uterus can be offered vaginal route for surgery.
Keywords: Hysterectomy, Abdominal hysterectomy, vaginal hysterectomy, indications, postoperative outcome, post-operative complications

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DeFrances CJ, Hall MJ. 2005 National Hospital Discharge

Survey. Adv Data. 2007;(385):1–19.

Edozien LC. Hysterectomy for benign conditions. BMJ


Kovac SR. Transvaginal hysterectomy: rationale and surgical

approach. Obstet Gynecol 2004;103:1321–5.

Spilsbury K, Hammond I, Bulsara M, Semmens JB.

Morbidity outcomes of 78,577 hysterectomies for benign

reasons over 23 years. BJOG 2008;115:1473–83.

Silva-Filho AL, Werneck RA, de Magalhães RS, Belo AV,

Triginelli SA. Abdominal vs vaginal hysterectomy: a

comparative study of the postoperative quality of life and

satisfaction. Arch Gynecol Obstet. 2006;274:21–4.

Shahida A. Short and long term complications of Abdominal

and Vaginal Hysterectomy for benign disease. Pak Armed

Forces Med J 2004;54(1):71–5.

Merrill RM. Hysterectomy surveillance in the United States,

through 2005. Med Sci Monit 2008;14(1):CR24-CR31.

Saha R, Sharma M, Padhye S, Karki U, Pandey S, Thapa J.

Hysterectomy: an analysis of perioperative and post operative

complication. Kathmandu Univ Med J 2003;1:124–7.

Milovanović Z, Stanojević D. [Myomectomy via the vagina].

Srp Arh Celok Lek 2004;132(1–2):18–21.

Carminati R, Ragusa A, Giannice R, Pantano F. Anterior and

posterior vaginal myomectomy: a new surgical technique.

Med Gen Med 2006;8(1):42.

Mistrangelo E, Febo G, Ferrero B, Ferrero S, Deltetto F,

Camanni M. Safety and efficacy of vaginal hysterectomy in

the large uterus with the LigaSure bipolar diathermy system.

Am J Obstet Gynecol 2008;199:475.e1–5.

Farrell E. Dysfunctional uterine bleeding. Aust Fam

Physician 2004;33:906–8.

Leung KY. Changing pattern of hysterectomies for benign

conditions. Hong Kong Med J 2007;13(3):176–7.

Harris WJ Early complications of abdominal and vaginal

hysterectomy. Obstet Gynecol Surv 1995;50:795–805.

Dutton S, Hirst A, McPherson K, Nicholson T, Maresh MA.

UK multicentre retrospective cohort study comparing

hysterectomy and uterine artery embolisation for the

treatment of symptomatic uterine fibroids (HOPEFUL

Study): main results on medium-term safety and efficacy.

BJOG 2007;114(11):1340–51.

McCracken G, Hunter D, Morgan D, Price JH. Comparison

of laparoscopic-assisted vaginal hysterectomy, total

abdominal hysterectomy and vaginal hysterectomy. Ulster

Med J 2006;75(1):54–8.

Wu HH, Yang PY, Yeh GP, Chou PH, Hsu JC, Lin KC. The

detection of ureteral injuries after hysterectomy. J Minim

Invasive Gynecol 2006;13:403–8.

Cosson M, Lambaudie E, Boukerrou M, Querleu D, Crépin

G. Vaginal, laparoscopic, or abdominal hysterectomies for

benign disorders: immediate and early postoperative

complications. Eur J Obstet Gynecol Reprod Biol


Ibeanu OA, Chesson RR, Echols KT, Nieves M, Busangu F,

Nolan TE. Urinary tract injury during hysterectomy based on

universal cystoscopy. Obstet Gynecol 2009;113(1):6–10.

McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard

A, Hargreaves J, Bridgman S, Clarke A. Severe

complications of hysterectomy: the VALUE study. BJOG


McPherson K, Herbert A, Judge A, Clarke A, Bridgman S,

Maresh M, Overton C. Psychosexual health 5 years after

hysterectomy: population-based comparison with

endometrial ablation for dysfunctional uterine bleeding.

Health Expect 2005;8:234–43.

Ikram M, Saeed Z, Saeed R, Saeed M. Abdominal versus

vaginal hysterectomy. Professional Med J 2008;15:486-91.

Iftikhar R. Vaginal hysterectomy is superior than abdominal

hysterectomy. J Surg Pak 2008;13:55–8.

Akingba DH, Deniseiko-Sanses TV, Melick CF, Ellerkmann

RM, Matsuo K. Outcomes of hysterectomies performed by

supervised residents vs those performed by attendings alone.

Am J Obstet Gynecol 2008;199:673.e1-6.

Oláh KS, Khalil M. Changing the route of hysterectomy: the

results of a policy of attempting the vaginal approach in all

cases of dysfunctional uterine bleeding. Eur J Obstet Gynecol

Reprod Biol 2006;125:243–7.

Kovac SR. Guidelines to determine the route of

hysterectomy. Obstet Gynecol 1995;85(1):18–23.

Schindlbeck C, Klauser K, Dian D, Janni W, Friese K.

Comparison of total laparoscopic, vaginal and abdominal

hysterectomy. Arch Gynecol Obstet 2008;277:331–7.

J Ayub Med Coll Abbottabad 2009;21(4)

Sesti F, Calonzi F, Ruggeri V, Pietropolli A, Piccione E. A

comparison of vaginal, laparoscopic-assisted vaginal, and

minilaparotomy hysterectomies for enlarged myomatous

uteri. Int J Gynaecol Obstet 2008;103:227–31.

Khan I, Shazia, Farooq M. Vaginal Hysterectomy: study of

cases. Ann King Edward Med Coll 2005;11:356–7.

Khan A. Why Not Vaginal Route for Hysterectomy. Pak J

Obstet Gynaecol 1997;10(3):11–7.

Henry D, Muriel FR, Hirway P. Sustaining improvement in

surgical infection prevention measures forhysterectomy. J

Healthc Qual 2007;29(5):50–6.

Tabassam S, Tajammul A, Arif W. Vaginal Hysterectomy.

Pak J Obstet Gynaecol 1997;10(1,2):1–5.

Ashraf M. Vaginal Hysterectomy for Conditions Other Than

Prolapse. Ann King Edward Med Coll 1998;4(3):16–7.

Bashir R, Parveen Z, Sultana R, Khan B. A two years audit

of complications of hysterectomy at Ayub Teaching Hospital

Abbottabad. J Ayub Med Coll Abottabad 2005;17(2):47–9.

Charoenkwan K, Phillipson G, Vutyavanich T. Early versus

delayed (traditional) oral fluids and food for reducing

complications after major abdominal gynaecologic surgery.

Cochrane Database Syst Rev 2007;17(4):CD004508.


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