Challenging generally accepted contraindications to vaginal hysterectomy

OBJECTIVE: A number of preexisting clinical conditions are generally accept ed as contraindications to vaginal hysterectomy. The purpose of this study was to evaluate the validity of this concept. STUDY DESIGN: The study vaginal hysterectomy group consisted of 250 consecu tive patients undergoing vaginal hysterectomy. These patients (1) had a lar ge uterus (> 180 g), (2) either were nulliparous or had no previous vaginal delivery, or (3) had a previous cesarean delivery or pelvic laparotomy. Th ree control groups used for comparison underwent (1) laparoscopically assis ted vaginal hysterectomy, (2) vaginal hysterectomy, or (3) abdominal hyster ectomy. The records for all patients were analyzed for age, weight, parity, primary diagnosis, uterine size, operative time, blood loss, analgesia, ho spital stay, resumption of diet, incidence of morcellation, and surgical co mplications. Sample size calculations were based on previous studies of com plications associated with vaginal hysterectomy (alpha = .05, beta = .20). RESULTS: Hysterectomy was successfully completed by the intended vaginal ro ute in all study patients. Major and minor complications (3.2%) were signif icantly less (P < .001) than in the other groups as follows: vaginal hyster ectomy, 10.4%; laparoscopically assisted vaginal hysterectomy, 11.6%; and a bdominal hysterectomy, 13.6%. The decrease in hematocrit was 5.7% in the st udy vaginal hysterectomy group compared with 6.2% for vaginal hysterectomy, 6.5% for abdominal hysterectomy (P = .009), and 6.6% for laparoscopically assisted vaginal hysterectomy (P = .002). Hospital stay was shorter for the study group (2.1 days) than for vaginal hysterectomy (2.3 days; P < .001) and abdominal hysterectomy (2.7 days; P < .001). Operative time was shorter in the study vaginal hysterectomy group (49 minutes) than with laparoscopi cally assisted vaginal hysterectomy (76 minutes; P < .001) or abdominal hys terectomy (61 minutes; P < .001), although morcellation was carried out mor e frequently in the study group (34%) than with vaginal hysterectomy (4%) o r laparoscopically assisted vaginal hysterectomy (11%). CONCLUSION: Our data indicate that a large uterus, nulliparity, previous ce sarean delivery, and pelvic laparotomy rarely constitute contraindications to vaginal hysterectomy.