Vol. 4, Issue 12, Part C (2018)

Background: The origins of hysterectomy are unclear but removal of a prolapsed gangrenous uterus is mentioned by Soranus in a manuscript dated almost two thousand years ago. Berengario from Bologna is given credit for the first authentic description of the removal of the uterus through the vagina, a procedure which is dated 1517. The first abdominal hysterectomy was a subtotal hysterectomy performed by Charles Clay in Manchester 1843. The procedure was indicated by an adnexal mass that in fact was a large fibroid and the corpus of the uterus was removed. Despite the successful operation the patient died on the 15th postoperative day. Since the time of its discovery the sole indication of vaginal hysterectomy, prolapsed uterus is even now the prime indication for vaginal hysterectomy. With the fine tuning of procedure, undeniable intra-operative and post-operative advantages of vaginal route has made it now common choice of route for hysterectomy by enthusiastic and skilled gynecologists.

AIM: Comparison of outcome between total laparoscopic hysterectomy and vaginal hysterectomy in a non-descent uterus in a rural hospital.

Materials and Methods: A Cross sectional study was conducted for a period of 1year from March 2016 to April 2017 in Rural Development Trust Hospital, Bathalapalli, Ananthapur Dist and AIMSR, Chittoor. 100 patients who have under gone TLH and NDVH were compared for time taken for surgery, intra-operative blood loss, intra operative injuries, postoperative infections and duration of hospital stay.

Results: The average duration of surgery for NDVH group is 98+44.85 (mean+ 2SD) mins and TLH group is 124+ 40. 82(mean+2SD) mins, requirement for blood transfusion is 12% in NDVH group and 14% in TLH group, there was one case of ureteric injury and one case of bladder injury in both NDVH and TLH group, one case of bowel injury in NDVH group whereas in TLH none of them got bowel injury. In NDVH group there is 4% post-operative febrile morbidity and in TLH group it is 10%. The mean duration of stay in hospital NDVH group is 4.46+0.973 and in TLH group it is 4.48+0.677 days.

Conclusion: NDVH is associated with less operative time and decreased intra operative complications when compared to TLH. No significant difference in the length of hospital stay, pain scale and post-operative complications or blood transfusions noted between the two groups.