title: Vaginal hysterectomies in patients without uterine prolapse: ten-year experience.
abstract: OBJECTIVE
  To review the results of vaginal hysterectomies in patients without uterine prolapse.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  University affiliated hospital, Hong Kong.
  
  
  METHODS
  All patients who had vaginal hysterectomies in the absence of uterine prolapse from 1999 to 2005 inclusive (first period) and 2006 to 2009 inclusive (second period).
  
  
  METHODS
  The number of such hysterectomies, indications, operative procedures, complications, use of preoperative gonadotropin-releasing hormone agonist, and concomitant vaginal salpingo-oophorectomies performed.
  
  
  RESULTS
  In all, 94 and 98 patients fulfilling the necessary inclusion criteria within the two respective periods underwent vaginal hysterectomy. The indications for hysterectomy in the respective groups were similar, and 89 (95%) and 90 (92%) of the patients were Chinese. The respective proportions having additional procedures were 11% versus 23% (P=0.018) and the respective vaginal bilateral salpingo-oophorectomy rates were 1% versus 15% (P<0.001). The vault haematoma rate decreased significantly in the second period (from 12% to 1%; P=0.002). There were no significant differences between the periods with respect to mean operative blood losses, uterine weights, and operating times. The use of gonadotropin-releasing hormone agonist resulted in reduced mean uterine sizes (12 weeks vs 10 weeks; P=0.041). A decreasing trend in mean operating times and blood losses was also observed after such use. Vaginal hysterectomy and bilateral salpingo-oophorectomies were successfully performed in 12 (80%) patients without laparoscopic assistance. For this procedure, a learning curve was also evident.
  
  
  CONCLUSIONS
  Surgeons' experience can influence the complication rate and the chance of successful vaginal salpingo-oophorectomy. More liberal use of gonadotropin-releasing hormone agonist may further reduce the complication rate and allow more vaginal hysterectomies.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong. kelvincheung82@hotmail.com
authors.forename: K W
authors.initials: KW
authors.lastname: Cheung
authors.forename: T C
authors.initials: TC
authors.lastname: Pun
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006406:Hematoma / Q000453:epidemiology; D006723:Hong Kong / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D061646:Operative Time; D010052:Ovariectomy / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D058994:Salpingectomy / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D007987:Gonadotropin-Releasing Hormone
keywords: Gonadotropin-releasing hormone; Hematoma; Hysterectomy, vaginal; Ovariectomy