Narrow pubic arch and increased risk of failure for vaginal hysterectomy.
OBJECTIVE
The purpose of this study was to evaluate the risk factors involved in failed vaginal hysterectomies.


METHODS
Data on all vaginal hysterectomies performed by a single gynecologic surgeon were collected prospectively. Patients requiring pelvic floor repair were excluded. Any procedure converted to the abdominal approach was classified as a failed vaginal hysterectomy and comprised the study group. For every woman who had a failed vaginal hysterectomy, the next 2 women who had successful vaginal hysterectomies immediately after the failed vaginal hysterectomy were taken as controls. Risk factors such as age, parity, body weight, surgical indication, uterine size, presence of leiomyomata in the anterior lower uterine segment, previous pelvic surgeries, abdominopelvic adhesions, location and length of cervix, narrow pubic arch, intraoperative complications such as bleeding requiring transfusion, visceral injury, nulliparity, and adnexal removal were compared between groups.


RESULTS
We compared 25 failed vaginal hysterectomies with 50 controls whose procedures were completed successfully through the vagina. Among all the factors gynecologists can assess preoperatively, only the presence of a narrow pubic arch increased the risk of failure for vaginal hysterectomy (odds ratio [OR] 4.1; 95% confidence interval 1.32-12.69). Intraoperative bleeding with transfusion was also found as an independent cause for conversion to laparotomy (OR 7.37; 95% confidence interval 1.75-31.06).


CONCLUSIONS
Women with a narrow pubic arch are not good candidates for vaginal hysterectomy. The most common unpredictable cause for conversion to laparotomy from the vaginal approach is intraoperative bleeding requiring transfusion.


METHODS
II-2
Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA. ozgur.harmanli@temple.edu
Ozgur H
OH
Harmanli
Rubina
R
Khilnani
Vani
V
Dandolu
Ashwin J
AJ
Chatwani
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D007813:Laparotomy; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications; D011446:Prospective Studies; D011630:Pubic Bone / Q000503:physiopathology*; D012307:Risk Factors; D017211:Treatment Failure