RESURGENCE OF NONDESCENT VAGINAL HYSTERECTOMY(NDVH)-THE NEED OF THE HOUR?

Background: Hysterectomy is the second most common operation performed by gynaecologist. The motive to try to suit the surgical procedure to modern medicine, which aims at maximum reduction of surgical damage, has led to the rediscovery of vaginal route. Against this background, we are trying to find out if Nondescent Vaginal Hysterectomy(NDVH) has an edge over Total Abdominal Hysterectomy(TAH) for benign conditions of the uterus(size <14weeks). Method: Prospective cohort study carried out in the Department of Obstetrics and Gynaecology, Amala Institute Of Medical Sciences, Thrissur during 2016-2017. 80 patients requiring hysterectomy for benign gynaecological disorders, uterine size less than 14 weeks was included in the study, the two groups consisting of 40 cases each of NDVH and TAH respectively. The patient, after discussing the pros and cons of both the surgeries with the consultant, herself decided the route of surgery. Results: Mean operative time was comparable in both NDVH and TAH arms (98.8 ? 30.32mins vs 99.5 ? 26.69mins). Intraoperative blood loss and postoperative complications like febrile morbidity and wound infection was significantly lesser in NDVH. Pain during postoperative days 1, 2 and 3(using Visual Analog Scale) was also significantly less in NDVH with mean pain score 3.1, 2.9, 2.9 as compared to 5.00, 5.20, 4.80 in TAH group(p<0.05). Mean hospital stay was also significantly less with NDVH. Conclusion: As minimally advancing technology continues to be developed and refined, surgeons must choose the safest and best cost-effective surgical approach for the patient; and this necessitates the need for resurgence of NDVH.