Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

Abstract

: Background: An enlarged fibroid uterus greater than 12 weeks considered a contraindication for Non-Descent Vaginal Hysterectomy (NDVH) by most gynecologic surgeons, is this contraindication real or alleged? Aim: to evaluate impact of uterine size on peri-operative consequences in women underwent NDVH for benign conditions. Patients and Methods: This study includes 340 women underwent NDVH; 232 women had uterine size up to 12 weeks (control group) and 108 women had uterine size more than 12 and up to 24 weeks (index group). Results: Both groups were similar regards menopausal, nulliparity status, number of prior vaginal birth, preoperative medical status, and American Society of Anesthesiologists grades (P>0.05), but different in percentage of women with fibroids, cervical pathology, prior Cesarean section, and virgin lower abdomen(P<0.05). No important differences were detected in perioperative outcomes as transfusion, thrombosis, ureteral, bladder, or bowel injuries, fever, systemic infections, fistula, conversion to total abdominal hysterectomy, total postoperative (PO) complications and length of PO hospital stay (P>0.05). However, the effect of uterine size larger than 12 weeks in comparison to uterine size up to 12 weeks was significant on the subsequent outcomes total operative time (55 minutes) operative blood loss (160 ml), needs for general anesthesia, needs for debulking, needs for analgesics, decline in PO HB, and return to usual activity(P<0.05). Conclusion: Non-Descent Vaginal Hysterectomy (NDVH) cloud be executed for women had fibroids with uterine size greater than 12 weeks without increase in perioperative morbid outcomes when compared to women with uterine size up to 12 weeks.