VAGINAL HYSTERECTOMY: EXTRAPERITONEAL VERSUS INTRAPERITONEAL APPROACH

Abstract

he vaginal hysterectomy is associated with significant benefits in terms of reduced hospital stay, better post-operative quality of life, a shorter period of convalescence, higher satisfaction rate and can be considered a minimally invasive procedure. Vaginal hysterectomy can be more complex and gynecologists need to be familiar with surgical techniques. Many surgeons might not feel comfortable with the vaginal route particularly where relative contraindications exist (e.g. large uterus, nulliparity, inadequate access, previous cesarean delivery pelvic laparotomy and if oophorectomy is required Entery into the peritoneal cavity through the anterior or the posterior cul de sac during vaginal hysterectomy can sometimes be challenging. In many experiences, the anterior or the posterior peritoneal fold can be high or distorted by fibroids in many women, in other cases there may be a minimal uterine descend, long cervix, or adhesions. However, there is no need for the surgeon to abandon the vaginal approach. T Summary 174 The extraperitoneal approach to vaginal hystectomy is a technique that offers a good solution in these special situations. This technique involves the extraperitoneal dissection of the uterosacral and the cardinal ligaments to gain uterine descent and if necessary extraperitoneal ligation of the uterine vessels, "extraperitoneal bites". This would allow easy entery into both the anterior and the posterior cul de sac after achievement of adequate uterine descent. Objective: The aim of the current study is to study the extraperitoneal technique as regard its safety and efficacy, comparing it with the traditional intraperitoneal technique. And to search wether this technique can be used as a primary method for vaginal hysterectomy. Methods: Fifty four women candidates for vaginal hysterectomy were recruited in this study, all shared the same elligibility criteria, and were randomized into two groups, to undergo the intraperitoneal or the extraperitoneal techniques of vaginal hysterectomy. The two groups are then compared as regard