Surgery

Complications following Vaginal Hysterectomy



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Hysterectomy is the process in which the uterus is removed through a surgical procedure. It can be performed through two different methods and these are the abdominal hysterectomy and vaginal hysterectomy.

In many centers performing hysterectomies, the preferred surgical approach would be the vaginal route whereas certain factors will determine the necessity to undertake abdominal hysterectomy. Thus, in instances of suspected cancers and when the size of the uterus is larger than 12 weeks, many would prefer to undertake abdominal approach for doing hysterectomy.

What are the advantages of doing vaginal hysterectomy?

Being a procedure which does not require an abdominal incision, a patient undergoing vaginal hysterectomy will be able to recover faster than their counterparts undergoing abdominal hysterectomy. At the same time, it may require lesser number of days in the hospital and these patients will also be able to undertake activities of daily living rather early when compared to other surgical patients. Apart from these, there may be other advantages such as less bleeding, less risk of anesthetic complications…etc as well.

What are the complications associated with this procedure?

When looking at research pertaining to assessing possible complications following vaginal hysterectomy, one of the commonest complications was the appearance of vaginal vault infections. During the surgery, the vagina will be closed distally as a blindly ending canal. Therefore, it is the site in which the main surgical scar gets exposed to the outside environment and therefore is a susceptible location for infections. At the same time, possible presence of pathogenic organisms or else the ease in which such organisms can ascend to the vaginal vault from the perineum will make the risk of vaginal vault infections rather high.

Another possible complication which has been recognized through research is the possibility of bladder injuries although it is relatively rare than vaginal vault infections. Furthermore, it can also be associated with fistulae formation and vesico-vaginal or uretero-vaginal fistulae are possibilities during a vaginal hysterectomy.

A hemorrhage is another complication that can be associated with any surgical procedure although both vaginal and abdominal hysterectomies will have a severe hemorrhage risk to a certain extent. When considering hemorrhages, it should be remembered that, both primary and secondary hemorrhage could take place and therefore should be vigilant during the immediate as well as late post operative stages.

In even rarer instances, deep vein thrombosis and pulmonary embolism can take place following vaginal hysterectomies although they are not characteristic to this procedure only. In the long run, vault prolapse can also be considered as a possible complication in patients undergoing vaginal hysterectomy although it would not be as serious as some of the other complications mentioned above.

Reference:

http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1978;volume=24;issue=4;spage=221;epage=225;aulast=Bhattacharya

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