Skip to main content

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

The Journal of Obstetrics and Gynecology of India volume 66, pages 499–504 (2016)Cite this article

Abstract

Objective

NDVH is a minimally invasive, safe, effective, and economical surgery. Still AH is preferred for benign gynaecological indications. Our study aims to promote NDVH in all technically possible cases by adequate counselling of the patient.

Methods

This prospective observational study enrolled 100 women seeking hysterectomy for benign gynaecological conditions (excluding prolapse) in a teaching hospital. Women were counselled on the basis of ‘PREPARED’ questionnaire to assess their awareness about NDVH and were offered NDVH as the proposed surgery and result is analysed.

Results

We observed that there was a little awareness about NDVH and its outcome among the subjects. Ten out of 100 patients refused to perform NDVH after counselling and underwent TAH. Rest of the 90 patients opted for NDVH. Forty out of 90 patients were aware about NDVH, but they were sceptical about the outcome, and 50 were totally unaware. After applying ‘PREPARED’ questionnaire and counselling, we could motivate them to accept NDVH. It was successful in all cases except one where laparotomy was done for ovarian artery retraction. With no significant post-operative complications, early return to routine activity and low cost of surgery, all patients were satisfied with surgical outcome and improved quality of life.

Conclusion

We conclude that patients accept the surgery with open mind after proper counselling and detailing of the procedure. Most of the abdominal hysterectomy can be converted successfully to NDVH in technically feasible cases by experienced hands so adequate training to gynaecology residents is the need of the time. NDVH is economical to the patient as well as for the healthcare system.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Kovac SR, Barhan S, Lister M, et al. Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Am J Obstet Gynecol. 2002;187:1521–7.

    Article  PubMed  Google Scholar 

  2. Kovac SR. Hysterectomy outcomes in patients with similar indications. Obstet Gynecol. 2000;95:787–93.

    CAS  PubMed  Google Scholar 

  3. Maresh MJ, Metcalf MA, McPherson K, et al. The VALUE national hysterectomy study: description of the patient and their surgery. Br J Obstet Gynaecol. 2002;109:302–12.

    CAS  Article  Google Scholar 

  4. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156–8.

    Article  Google Scholar 

  5. Sheth SS. Vaginal or abdominal hysterectomy? In: Sheth SS, editor. Vaginal hysterectomy. 2nd ed. Jaypee Brothers Medical Publishers (P) Ltd: New Delhi, India; 2014. p. 273–93.

    Google Scholar 

  6. Moen MD, Richter HE. Vaginal hysterectomy: past, present, and future. Int Urogynecol J. 2014;25(9):1161–5.

    Article  PubMed  Google Scholar 

  7. Garry R. Health economics of hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2005;19:451–65.

    Article  PubMed  Google Scholar 

  8. Barton-Smith P. Clinical practice: Modernizing hysterectomy surgery—is robotics the answer? RCOG Membersh Matters. 2011;1(1):14–5.

    Google Scholar 

  9. Dicker RC, Greenspan JR, Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Am J Obstet Gynecol. 1982;144:841–8.

    CAS  Article  PubMed  Google Scholar 

  10. Ray A, Pant L, Magon N. Deciding the route for hysterectomy: Indian triage system. JOGI. 2015;65(1):39–44.

    Google Scholar 

  11. Ransom SB, McNeeley SG, Malone JM Jr. A cost-effectiveness evaluation of preoperative type-and-screen testing for vaginal hysterectomy. Am J Obstet Gynecol. 1996;175(5):1201–3.

    CAS  Article  PubMed  Google Scholar 

  12. Sharma C, Sharma M, Raina R, et al. Gynecological diseases in rural India: a critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery. J Midlife Health. 2014;5(2):55–61.

    PubMed  PubMed Central  Google Scholar 

  13. Singh A (2007) Profile of hysterectomy cases in rural North India. Internet J Gynecol Obstet 7(1).

  14. Callen M, Lettenmaier C, Green CP. Counselling makes a difference. In: Population Reports, Series J. Baltimore, Johns Hopkins School of public health, Publication Information Programme 2001 No. 1.

  15. Dayaratna S, Goldberg J, Harrington C, et al. Hospital costs of total vaginal hysterectomy compared with other minimally invasive hysterectomy. Am J Obstet Gynecol. 2014;210:120.e1–6.

    Article  Google Scholar 

  16. Dorsey JH, Holtz PM, Griffiths RI. Cost and changes associated with three alternative techniques of hysterectomy. N Engl J Med. 1996;335:476–82.

    CAS  Article  PubMed  Google Scholar 

  17. Rogo-Gupta LJ, Lewin SN, Kim JH, et al. The effect of surgeon volume on outcomes and resource use for vaginal hysterectomy. Obstet Gynecol. 2010;116:1341–7.

    Article  PubMed  Google Scholar 

  18. Tohic AL, Dhainaut C, Yazbeck C, et al. Hysterectomy for benign uterine pathology among women without previous vaginal delivery. Obstet Gynecol. 2008;111(4):829–37.

    Article  PubMed  Google Scholar 

  19. Agostine A, Bretelle F, Cravello L, et al. Vaginal hysterectomy in nulliparous women without prolapse: a prospective comparative study. Int J Obstet Gynecol. 2003;110:515–8.

    Google Scholar 

  20. Sheth SS, Malpani AN. Vaginal hysterectomy following previous caesarean section. Int J Gynecol Obstet. 1995;50:165–9.

    CAS  Article  Google Scholar 

  21. Khung TTG. An approach to Vesico uterine peritoneum through a new surgical space for vaginal hysterectomy in a patient with history of caesarean section. Malays J Obstet Gynaecol. 1995;4:39–42.

    Google Scholar 

  22. Sheth SS. The scope of vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2004;115:224–30.

    Article  PubMed  Google Scholar 

  23. Garg PK, Deka D, Malhotra N. Non descent vaginal hysterectomy for benign condition. A better proposition than abdominal hysterectomy. Obs and Gynae Today. 2002;6:345–6.

    Google Scholar 

  24. Penketh R, Griffiths A, Chawath S. A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24-hour day case surgery setting. BJOG. 2007;114(4):430–6.

    CAS  Article  PubMed  Google Scholar 

  25. Silva Filho AL, Andrade R, de Magalhaes RS, et al. Abdominal vs vaginal hysterectomy: a comparative study of the postoperative quality of life and satisfaction. Arch Gynecol Obstet. 2006;274(1):21–4.

    Article  PubMed  Google Scholar 

  26. Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;8(3):CD003677.

    Google Scholar 

  27. Zakaria MA, Levy BS. Outpatient vaginal hysterectomy: optimizing perioperative management for same-day discharge. Obstet Gynecol. 2012;120:1355–61.

    Article  PubMed  Google Scholar 

  28. Ocheke AN, Ekwempu CC, Musa J. Underutilization of vaginal hysterectomy and its impact on residency training. West Afr J Med. 2009;28(5):323–6.

    PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of OBG, L.N. Medical College and J.K. Hospital, Kolar Road, Bhopal, 462042, M.P, India

    Sapna B. Jain & Kshma D. Chandrakar

Authors
  1. Sapna B. Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kshma D. Chandrakar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sapna B. Jain.

Ethics declarations

Conflict of interest

The authors of the article Sapna B. Jain and Kshma D. Chandrakar declare that they have no conflict of interest.

Human Rights and Ethical Statements

All procedures followed were in compliance with the ethical requirements of this journal.

Informed Consent

Written informed consent was taken from the subjects.

Additional information

Sapna B. Jain, M.D. (OBG) is an Assistant Professor in Department of OBG at L.N. Medical College and J.K. Hospital; Kshma D. Chandrakar, D.N.B. (OBG), Senior Resident in Department of OBG at L.N. Medical College and J.K. Hospital.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jain, S.B., Chandrakar, K.D. Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance. J Obstet Gynecol India 66, 499–504 (2016). https://doi.org/10.1007/s13224-016-0858-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-016-0858-2

Keywords

  • NDVH
  • Rural
  • Economic
  • Counselling
  • PREPARED