Is vaginal hysterectomy is equally safe for the enlarged and normally sized non-prolapse uterus? A cohort study assessing outcomes

ObjectiveGynecologists are reluctant to perform vaginal hysterectomy if the uterine size exceeds 12 weeks in the belief that complications could be higher in this group. The aim of this cohort control study was to compare demographics, surgical outcomes and safety of vaginal hysterectomy in women with non-prolapsed uteri weighing >280 g (>12 weeks size) to those with uteri weighing <280 g removed vaginally for similar indications.Study designIn this study, classified as Canadian Task Force II (cohort-control), the index group comprised 41 women who underwent vaginal hysterectomy for non-prolapse indications with uterine enlargement >280 g (12 weeks), while the control group consisted of 66 women with uteri <280 g. Demographic data as well as duration of surgery, blood loss, intraoperative complications and readmission rates were compared.ResultsWomen in the two groups had statistically similar mean age, body mass index and parity (47.7 vs 44.9 yrs, 30.3 vs 32.4 kg m−3 and 2.8 vs 2.4, respectively; p > 0.05). The mean operative time was significantly longer in the index group (123.3 ± 43.2 vs 85 ± 32.1 min; p = 1.47 × 10−6). Women with enlarged uteri had greater mean estimated blood loss (402.8 ± 402.2 vs 160.8 ± 123.2 ml; p < 0.0001) but the mean length of stay was similar (45.4 ± 28.7 vs 37.6 ± 26.2 h; p > 0.05). Two uteri weighing >1000 g were removed vaginally. Intra- and post-operative complications such as bladder injury, blood transfusion and pelvic sepsis were similar in both groups.ConclusionsVaginal hysterectomy in larger non-prolapsed uteri takes longer (mean 38 min longer) and is associated with more blood loss (mean increase 242 ml) compared to normal-sized uteri but is not associated with a significant increase in complication rates.