Veginal Hysterectomy
Hysterectomy is a surgery to remove women’s uterus and the most common major gynecological
surgical procedure.
The uterus is one of the organs of the female reproductive system, inside it’s
cavity the growth of fetus
occurs during pregnancy.
One can no
longer have children after she gets her
uterus removed and she will no longer have
periods (menstruate).If her ovaries are not
removed during hysterectomy she will continue to make
female hormones. Removal of ovaries is
frequently done together with hysterectomy to decrease the
risk of
ovarian cancer. However recent studies have shown that prophylactic oophorectomy without
an
urgent medical indication decreases women’s long term survival rates substantially and has other
serious adverse
effects, particularly in terms of inducing early-onset-osteoporosis through
removal of the major sources
of female hormonal production. This effect is
not limited to pre-menopausal women,even the women
who
have already entered menopause were
shown to have experienced a decrease in long term
survivability
post oophorectomy. Studies revels ovaries should not be removed till
the
age of 65.
Basically 90%
of hysterectomies are done in non carcinomatous Condition .This is preferred in
indications like
DUB ,leiomyoma ,adenomyosis,PID,CIN,cervical polyp ,endometrial
polyp ,post
menopausal bleeding and various carcinomatous conditions of the uterus.
. Hysterectomy
can be total /subtotal/
radical.Radical
hysterectomy is required in cancer patients. Hysterectomy can be done by
abdominal,
vaginal or laparoscopic
method.
(A)
Trans abdominal hysterectomy
·
It
is the years old standard procedure
to do hysterectomy.
·
Uterus
is removed through incision in the
anterior abdominal wall.
·
Less
cost, easily available surgeons.
By this
method you can do.
Total/subtotal hysterectomy or radical
hysterectomy.
Disadvantage
·
Scar
on abdomen.
·
More
painful.
·
Wound
infection.
·
Incisional
hernia formation.
·
Larger
duration of recovery about
2-3 months.
(B)
Laparoscopic method (LAVH) (TLH)
It is done with
laparoscopic instruments &
camera through three small
Incision in the
anterior abdominal wall.
(We provide services )
(We provide services )
Disadvantage
1.
Highly skilled paramedical staff
required during operation.
2.
Higher cost & higher operative time.
3.
Scars on abdomen.
4.
Port site hernia can occurs.
5.
Recovery period 15-30 days.
6.
This type of surgery cannot be done
in high risk patients.
(C)
Vaginal
hysterectomy
Earlier
vaginal hysterectomy was done in patients having uterine prolapse per vagina.
But now vaginal hysterectomy is being done even
in patients without prolapse called non
descent
vaginal hysterectomy (NDVH).Always
total hysterectomy is done.
1.
Less
cost than laparoscopic method
2.
Less
hospital stay.
3.
Less
duration of operation.
4.
No
scar on body (cosmetic),
hysterectomy done natural
orifice.
5.
Can
be done in high risk patients.
6.
Reduced
morbidity.
7.
Less
recovery time.
8.
Early
back to work.
9.
Can
be done in large size uterus by
bisection myomectomy,
bisection
debulking &clamp less approach.
10. NDVH can also be done in previously
operated patients if uterus is mobile.
In 80% of patients ovaries can be removed by NDVH
Disadvantage
1)
Cannot be done in very big uterine fibroid.
2)
Cannot be done in cancerous conditions or
when uterus is not mobile.
So NDVH, on account of cost &
operation time
reasonably better
alternative to laparoscopic
hysterectomy and in view of recovery time & c
abdominal wall damage .
NDVH is better than Trans
abdominal hysterectomy.
In worldwide most of
the hysterectomies are being done vaginally.
In rural areas of Punjab some people have anxiety that some part
In rural areas of Punjab some people have anxiety that some part
of uterus remains inside by NDVH method, this is wrong perception,
always total uterus is removed by this method.
Senior Surgeon
Rajiv Singla Multi Specialty Hospital
Aggarsain Market ,Near Bus Stand
Sunam(Punjab)INDIA
E-mail- singla2347@gmail.com
Contact - 9814431212
