[Hysterectomy for a benign lesion: can the vaginal route be used in all cases?].
OBJECTIVE
To determine which factors indicate the vaginal route cannot be used for hysterectomy and study the morbidity of this technique in comparison with the abdominal route.


METHODS
A retrospective study was conducted in 682 patients who underwent hysterectomy for benign lesions between 1992 and 1996. Genital prolapses and/or urinary incontinence accounted for 31% of the indications. Mean patient age was 50 years. There were 75 nulliparous patients and 27% of all patients had a pelvic history (including cesarean section) which might compromise vaginal hysterectomy.


RESULTS
Hysterectomy was performed via the abdominal route in 39.7% of the cases and via the vaginal route in 60.3% including 5.7% with laparoscopic assistance. Factors which dictated the abdominal route were: large size of the uterus (47%), pelvic background (30%), tubo-ovarian pathology (6%), multiple elements (6%), unknown (11%). Operation time depended on the surgical route, parity, pelvic background and associated techniques (prolapse, oophorosalpingectomy, uterine segmentation). Morbidity was very low and the same for both routes: 1.8% operative accidents (mainly bladder wounds), 1% reoperation, only one case of thromboembolism and less than 0.5% postoperative fever.


CONCLUSIONS
There is no absolute contraindication to vaginal hysterectomy. It would appear unreasonable to an unexperienced surgeon to use the vaginal route for a fixed uterus with an estimated weight over 400 g in nulliparous patients with a pelvic background. In a department with vaginal training, 84% of all hysterectomies could be performed by vaginal route, because half of the indications for the abdominal route are excessive or a matter for laparoscopic assistance.
Fédération Femme-Mère-Nouveau-né, Hôpital Edouard Herriot, Lyon.
X
X
Martin
A
A
Gjata
F
F
Golfier
D
D
Raudrant
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002585:Cesarean Section; D000075202:Contraindications; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data*; D008875:Middle Aged; D010298:Parity; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
Hystérectomie pour lésion bénigne: peut-on tout faire par voie vaginale?