[Hysterectomies in patients with no history of vaginal delivery. A study of 243 cases].
OBJECTIVE
The object of this study was to audit the policy of hysterectomy in nulliparous women in a university hospital.


METHODS
A retrospective medical records analysis of all hysterectomies performed during an 8-year period. Patients with no history of vaginal delivery were stratified into three groups: group 1, patients who underwent abdominal hysterectomies; group 2, patients undergoing vaginal hysterectomy (2a) or laparoscopy-assisted vaginal hysterectomy (2b). The groups were compared as to demographic data, surgical complications and outcomes.


RESULTS
During the study period, there were 243 hysterectomies in patients with no history of vaginal delivery. Among these, vaginal hysterectomies (group 2) were undertaken in 75% (182 patients) and successfully performed in all but 13 patients (7.1%). Mean uterine weight was 943 grams in group 1 and 370 grams in group 2. Abdominal route (group 1) was associated with longer operative time (average: 105 min) than vaginal route (group 2a; 81 min) but shorter operative time that laparoscopy-assisted vaginal route (group 2b; 173 min). There was no significant difference in mean estimated blood loss and complications rates between groups 1 and 2. Hospital stay was shorter in group 2. Laparoscopic assistance was not associated with bigger uteri, neither with fewer complications.


CONCLUSIONS
Nulliparity should no longer be considered a contraindication to vaginal hysterectomy. In such patients, many more hysterectomies should be carried out vaginally and laparoscopic assistance does not offer obvious advantages over the standard vaginal approach.
Dhainaut
C
C
Service de gynécologie-obstétrique, CHU Bichat-Claude-Bernard, 170, boulevard Ney, 75018 Paris, France.
Salomon
L-J
LJ
Junger
M
M
Marcollet
A
A
Madelenat
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data*; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009929:Organ Size; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014599:Uterus / Q000033:anatomy & histology