Background: A lot of alleged contraindications to Non-Descent Vaginal Hysterectomy (NDVH) were cited by lay gynecologic surgeons: is this true?
Objective: This study aimed to compare NDVH achievement rate and perioperative consequences in nulliparous and parous women.
Methods: This retrospective cohort study involved 1008 patients who had NDVH between 2010 and 2023 at Benha University Hospital and private centers.
Results: 203 (20.1%) were nulliparous (reference group), while 805 (79.9%) were parous, out of parous women 202 (20%) were primiparous, while 603 (59.9%) were multiparous (investigational group). Both groups were parallel regarding most preoperative features and no clinically significant alterations were perceived in perioperative consequences as transfusion, ureteral and bladder or bowel injuries, fever, systemic infections, fistula, conversion to total abdominal hysterectomy and total postoperative complications (P>0.05). NDVH was successfully executed in 97.04% (197/203) of the nulliparous and 98.01% (789/805) of the parous women [P = 0.39, relative risk (RR) = 1.48, 95% CI (0.58–3.79), number need treat (NNT), i.e. gynecologist need to operate upon 103 women to meet one case converted to abdominal hysterectomy]. No difference was noticed in overall intraoperative complications rate [16/203 (7.9%) vs 61/805(7.3%), P = 0.37, RR = 1.03 (0.61–1.76)], but the EBL was less in nulliparous compared to parous women (295 140 vs.405 160, (95% CI) =110 (85.9 to 134.1), P=0.0001).
Conclusions: The results regarding intraoperative switching to TAH, achievement rate of NDVH and perioperative consequences revealed that NDVH is secure and viable in nulliparous women and gynecologic surgeon shouldn’t deem nulliparity as a contraindication for NDVH and the maluses of laparoscopy for hysterectomy should be revised
|
