Vaginal Hysterectomy, Salpingectomy, and Adnexectomy

Chapter

Abstract

Vaginal hysterectomy (VH) is the preferred route of hysterectomy for benign gynecological indications. The most recent Cochrane review (2015) [1] 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 [2] 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 [3]. 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.

Keywords

vaginal hysterectomy benign gynecology 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyMedical University of SilesiaBytomPoland
  2. 2.Department of Obstetrics and GynecologyWomen’s Health Institute, Cleveland ClinicClevelandUSA

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