Vaginal Hysterectomy, Salpingectomy, and Adnexectomy
Vaginal hysterectomy (VH) is the preferred route of hysterectomy for benign gynecological indications. The most recent Cochrane review (2015)  involving 47 studies and 5102 women concluded superiority of the vaginal route over abdominal, laparoscopic, and robotic-assisted hysterectomy. The vaginal approach provided faster return to normal activities, greater patient satisfaction and quality of life, fewer intraoperative visceral injuries, and less major long-term complications (such as fistula, pain, urinary and bowel, pelvic floor, and sexual dysfunction). Review of evidence revealed that VH should be performed in preference to abdominal hysterectomy (AH). When VH is not feasible, it is preferable to perform laparoscopic hysterectomy (LH) over AH. Considering changing demographics with a rising obese patient population, the American College of Obstetricians and Gynecologists (ACOG) in 2015  recommended that vaginal hysterectomy be performed over other approaches for the obese patient in particular. The vaginal route with its single and concealed incision is associated with less serious adverse events such as wound infection and thromboembolism . In the face of available evidence and recommendations, it is important that the surgeon conducts a thorough discussion with the patient to allow full participation in the decision-making.
Keywordsvaginal hysterectomy benign gynecology
- 1.Aarts JW, et al. Surgical approach to hysterectomy for benign gynecological disease. Cochrane Database Syst Rev. 2015;(8):CD003677.Google Scholar
- 2.ACOG Committee Opinion No.619: gynecologic surgery in the obese women. Obstet Gynecol. 2015;125(1):274–8.Google Scholar
- 9.SGO. Clinical practice statement: salpingectomy for ovarian cancer prevention. Nov 2013. https://www.sgo.org/clinical-practice/guidelines/sgoclinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention/.
- 13.ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156–8.Google Scholar