COMPARISON BETWEEN BISECTION AND MYOMETRIAL CORING AS AN EFFECTIVE TECHNIQUE IN UTERINE DEBULKING DURING VAGINAL HYSTERECTOMY

Abstract

Vaginal hysterectomy has gained ground over abdominal hysterectomy over the last decades. Vaginal hysterectomy is featured over abdominal hysterectomy by shorter operative time, less blood loss, shorter hospital stay, avoidance of laparotomy and less overall complication rates. The traditional main obstacles against performing hysterectomy through the vaginal route in all women that are candidates for hysterectomy are previous uterine surgery, non-descent of the uterus, and large uterine size. The later obstacle, in particular, large uterine size, is no longer a major obstacle against vaginal hysterectomy. Several surgical procedures have been proposed in order to overcome such an obstacle. The main two techniques in reducing the size of large uteri during vaginal hysterectomy are bisection and myometrial coring. Aim of the study The aim of the current trial was to compare the efficacy and safety of bisection and myometrial coring in reducing large uterine size in women planned for vaginal hysterectomy in Ain Shams University Maternity hospital. Patients and methods The current trial was conducted at Ain Shams University Maternity Hospital during the period between August 2011 and November 2013. A total of 76 women were recruited in the current trial and were randomized into two groups; Group I: Including 38 women who underwent bisection of the uterus during vaginal hysterectomy. Group II: Including 38 women who underwent myometrial coring during vaginal hysterectomy. Procedure time was assessed in the form of total operative time and uterine artery pedicle securing time (time from securing the first vascular pedicle till removal of the uterus). Blood loss was estimated intraoperatively and postoperatively by measuring hemoglobin level 24-48 hours later. Delay discharge form hospital and occurrence of intra and postoperative complications were also reported. Results Both groups were matched in the demographic data of the study population in order to alleviate any confounding factors which may affect some aspects as operative time and blood loss. In our study, a great interest was given to the operative time (total and uterine artery pedicle securing time), blood loss and postoperative hemoglobin drop as they are the main outcomes of the study and their relation to uterine weight. Upon comparing both groups, we found no significant differences, when analyzed globally, as regard uterine weight, operative time (total and uterine artery pedicle securing time), blood loss, postoperative hemoglobin drop and hospital stay. However, after subgroup analysis, we found that there were significant differences between both groups as regard total operative time, uterine artery pedicle securing time and blood loss in women with uterine size equivalent to more than 12 weeks gestation.