Skip to main content
SpringerLink
Log in

Vaginal Hysterectomy: Indications, Avoiding Complications

  • Reference work entry
  • First Online:
Handbook of Gynecology

  • 430 Accesses

Abstract

Vaginal hysterectomy is believed to have been first successfully performed in 1813. Most women requiring a hysterectomy are candidates for the vaginal approach, and it should always be considered as first-line approach to hysterectomy. Both the American Congress of Obstetrics and Gynecology and the American Academy of Gynecologic Laparoscopists recommended vaginal hysterectomy whenever possible. Previous cesarean delivery and obesity are not contraindications to the vaginal approach; in fact the vaginal approach may be preferred in these patients. Paracervical vasopressin has been shown to decrease blood loss during vaginal hysterectomy, although the difference may not be clinically significant. Preemptive oral gabapentin and preemptive local anesthesia reduce post-op pain. Vaginal salpingoo-phorectomy and salpingectomy can be accomplished in the majority of patients. Unless vaginal apical suspension is planned, a modified McCall-type culdoplasty should be performed to prevent enterocele formation and to reattach the uterosacral ligaments to the vaginal cuff. In randomized trials, women returned to normal activities sooner after vaginal compared to abdominal hysterectomy and have less wound infections, urinary tract infections, and febrile episodes after a vaginal versus abdominal hysterectomy. Compared to laparoscopic-assisted vaginal hysterectomy or total laparoscopic hysterectomy, vaginal hysterectomy has shorter operating time, hospital stay, and cost. Complications occur in about 5% of cases, with the most common complications being cuff infection/abscess and dissection cystotomy. Cuff infection/abscess complicates about 1.2% of case, while dissection cystotomy occurs in roughly 0.5% of cases. Ureteral injury is relatively rare, but pelvic organ prolapse increases the risk of this complication.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 999.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 999.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011;18:1–3.

    Article  Google Scholar 

  • Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;8:CD003677.

    Google Scholar 

  • American College of Obstetricians and Gynecologists. Choosing the route of hysterectomy for benign disease. ACOG Committee Opinion No. 444. Obstet Gynecol. 2009;114:1156–8.

    Article  Google Scholar 

  • Antosh DD, Gutman RE, Iglesia CB, Sokol AI, Park AJ. Resident opinions on vaginal hysterectomy training. Female Pelvic Med Reconstr Surg. 2011;17(6):314–7.

    Article  PubMed  Google Scholar 

  • Ascher-Walsh CJ, Capes T, Smith J, Michels A. Cervical vasopressin compared with no premedication and blood loss during vaginal hysterectomy: a randomized controlled trial. Obstet Gynecol. 2009;113(2 Pt 1):313–8.

    Article  CAS  PubMed  Google Scholar 

  • Burkett D, Horwitz J, Kennedy V, Murphy D, Graziano S, Kenton K. Assessing current trends in resident hysterectomy training. Female Pelvic Med Reconstr Surg. 2011;17(5):210–4.

    Article  PubMed  Google Scholar 

  • Cavkaytar S, Kokanali MK, Topcu HO, Aksakal OS, Doganay M. Effects of horizontal vs. vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy: a prospective randomized study. J Minim Invasive Gynecol. 2014;21(5):884–7.

    Article  PubMed  Google Scholar 

  • Cho HY, Park ST, Kim HB, Kang SW, Park SH. Surgical outcome and cost comparison between total vaginal hysterectomy and laparoscopic hysterectomy for uteri weighing >500 g. J Minim Invasive Gynecol. 2014;21(1):115–9.

    Article  PubMed  Google Scholar 

  • Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013;121(3):654–73.

    Article  PubMed  Google Scholar 

  • Cruikshank SH, Kovac SR. Randomized comparison of three surgical methods used at the time of vaginal hysterectomy to prevent posterior enterocele. Am J Obstet Gynecol. 1999;180(4):859–65.

    Article  CAS  PubMed  Google Scholar 

  • Cruikshank SH, Pixley RL. Methods of vaginal cuff closure and preservation of vaginal depth during transvaginal hysterectomy. Obstet Gynecol. 1987;70(1):61–3.

    CAS  PubMed  Google Scholar 

  • Culligan PJ, Kubik K, Murphy M, Blackwell L, Snyder J. A randomized trial that compared povidone iodine and chlorhexidine as antiseptics for vaginal hysterectomy. Am J Obstet Gynecol. 2005;192(2):422–5.

    Article  CAS  PubMed  Google Scholar 

  • Dain L, Abramov Y. Factors affecting the feasibility of bilateral salpingo-oophorectomy during vaginal hysterectomy for uterine prolapse. Aust N Z J Obstet Gynaecol. 2011;51(4):307–9.

    Article  PubMed  Google Scholar 

  • Daraï E, Soriano D, Kimata P, Laplace C, Lecuru F. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study. Obstet Gynecol. 2001;97(5 Pt 1):712–6.

    PubMed  Google Scholar 

  • Dayaratna S, Goldberg J, Harrington C, Leiby BE, McNeil JM. Hospital costs of total vaginal hysterectomy compared with other minimally invasive hysterectomy. Am J Obstet Gynecol. 2014;210(120):e1–6.

    Google Scholar 

  • Desai VB. An update on inpatient hysterectomy routes in the United States. AJOG. 2015;213(5):742–3.

    Article  Google Scholar 

  • Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG. 2012;119(3):348–53.

    Article  CAS  PubMed  Google Scholar 

  • Duong TH, Patterson TM. Lower urinary tract injuries during hysterectomy in women with a history of two or more cesarean deliveries: a secondary analysis. Int Urogynecol J. 2014;25(8):1037–40.

    Article  PubMed  Google Scholar 

  • Engh ME, Hauso W. Vaginal hysterectomy, an outpatient procedure. Acta Obstet Gynecol Scand. 2012;91:1293–9.

    Article  PubMed  Google Scholar 

  • Fatania K, Vithayathil M, Newbold P, Yoong W. Vaginal versus abdominal hysterectomy for the enlarged non-prolapsed uterus: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014;174:111–4.

    Article  PubMed  Google Scholar 

  • Fitz-Gerald AL, Tan J, Chan KW, Polyakov A, Edwards GN, Najjar H, Tsaltas J, Vollenhoven B. Comparison of ultrasonic shears and traditional suture ligature for vaginal hysterectomy: randomized controlled trial. J Minim Invasive Gynecol. 2013;20(6):853–7.

    Article  PubMed  Google Scholar 

  • Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, Clayton R, Phillips G, Whittaker M, Lilford R, Bridgman S, Brown J. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004;328(7432):129.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ghezzi F, Uccella S, Cromi A, Siesto G, Serati M, Bogani G, Bolis P. Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial. Am J Obstet Gynecol. 2010;203(2):118.e1–8.

    Article  PubMed  Google Scholar 

  • Goldstein SR, Horii SC, Snyder JR, Raghavendra BN, Subramanyam B. Estimation of nongravid uterine volume based on a nomogram of gravid uterine volume: its value in gynecologic uterine abnormalities. Obstet Gynecol. 1988;72(1):86–90.

    CAS  PubMed  Google Scholar 

  • Guntupalli SR, Doo DW, Guy M, Sheeder J, Omurtag K, Kondapalli L, Valea F, Harper L, Muffly TM. Preparedness of obstetrics and gynecology residents for fellowship training. Obstet Gynecol. 2015;126(3):559–68.

    Article  PubMed  Google Scholar 

  • Harmanli OH, Dandolu V, Isik EF, Panganamamula UR, Lidicker J. Does obesity affect the vaginal hysterectomy outcomes? Arch Gynecol Obstet. 2011;283(4):795–8.

    Article  PubMed  Google Scholar 

  • Hilton P, Cromwell DA. The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service – a retrospective cohort study examining patterns of care between 2000 and 2008. BJOG. 2012;119(12):1447–54.

    Article  CAS  PubMed  Google Scholar 

  • Hristovska AM, Kristensen BB, Rasmussen MA, Rasmussen YH, Elving LB, Nielsen CV, Kehlet H. Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy: a randomized, placebo-controlled trial. Acta Obstet Gynecol Scand. 2014;93(3):233–8.

    Article  CAS  PubMed  Google Scholar 

  • Hur HC, Donnellan N, Mansuria S, Barber RE, Guido R, Lee T. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol. 2011;118(4):794–801.

    Article  PubMed  Google Scholar 

  • Ibeanu OA, Chesson RR, Echols KT, Nieves M, Busangu F, Nolan TE. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol. 2009;113:6–10.

    Article  PubMed  Google Scholar 

  • Jeppson PC, Rahimi S, Gattoc L, Westermann LB, Cichowski S, Raker C, Lebrun EW, Sung VW. Fellows’ pelvic research network of Society of Gynecologic Surgeons. Impact of robotic technology on hysterectomy route and associated implications for resident education. Am J Obstet Gynecol. 2015;212(2):196.e1–6.

    Article  PubMed  Google Scholar 

  • Kammerer-Doak DN, Rogers RG, Johnson Maybach J, Traynor MM. Vasopressin as an etiologic factor for infection in gynecologic surgery: a randomized double-blind placebo-controlled trial. Am J Obstet Gynecol. 2001;185(6):1344–7. discussion 1347–1348

    Article  CAS  PubMed  Google Scholar 

  • Karp DR, Mukati M, Smith AL, Suciu G, Aguilar VC, Davila GW. Predictors of successful salpingo-oophorectomy at the time of vaginal hysterectomy. J Minim Invasive Gynecol. 2012;19(1):58–62.

    Article  PubMed  Google Scholar 

  • Kjølhede P, Halili S, Löfgren M. Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for gynecological surgery. Acta Obstet Gynecol Scand. 2011;90(1):63–71.

    Article  PubMed  Google Scholar 

  • Kovac SR, Barhan S, Lister M, Tucker L, Bishop M, Das A. Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Am J Obstet Gynecol. 2002;187(6):1521–7.

    Article  PubMed  Google Scholar 

  • Kroft J, Selk A. Energy-based vessel sealing in vaginal hysterectomy: a systematic review and meta-analysis. Obstet Gynecol. 2011;118(5):1127–36.

    Article  PubMed  Google Scholar 

  • Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. Am J Obstet Gynecol. 2013;209(5):490.e1–9.

    Article  PubMed  Google Scholar 

  • Lakeman M, The S, Schellart R, Dietz V, ter Haar J, Thurkow A, Scholten P, Dijkgraaf M, Roovers J. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG. 2012;119:1473–82.

    Article  CAS  PubMed  Google Scholar 

  • Lipscomb GH, Ling FW, Stovall TG, Summitt RL Jr. Peritoneal closure at vaginal hysterectomy: a reassessment. Obstet Gynecol. 1996;87(1):40–3.

    Article  CAS  PubMed  Google Scholar 

  • Long JB, Eiland RJ, Hentz JG, Mergens PA, Magtibay PM, Kho RM, Magrina JF, Cornella JL. Randomized trial of preemptive local analgesia in vaginal surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(1):5–10.

    Article  PubMed  Google Scholar 

  • Mäkinen J, Brummer T, Jalkanen J, Heikkinen AM, Fraser J, Tomás E, Härkki P, Sjöberg J. Ten years of progress – improved hysterectomy outcomes in Finland 1996–2006: a longitudinal observation study. BMJ Open. 2013;3(10):e003169.

    Article  PubMed  PubMed Central  Google Scholar 

  • Muffly TM, Kow NS. Effect of obesity on patients undergoing vaginal hysterectomy. J Minim Invasive Gynecol. 2014;21(2):168–75.

    Article  PubMed  Google Scholar 

  • O’Neal MG, Beste T, Shackelford DP. Utillity of preemptive local anesthesia in vaginal hysterectomy. Am J Obstet Gynecol. 2003;189(6):1539–41. discussion 1541–1542

    Article  PubMed  Google Scholar 

  • Purohit RK, Sharma JG, Singh S, Giri DK. Vaginal hysterectomy by electrosurgery for benign indications associated with previous cesarean section. J Gynecol Surg. 2013;29(1):7–12.

    Article  PubMed  PubMed Central  Google Scholar 

  • Robert M, Cenaiko D, Sepandj J, Iwanicki S. Success and complications of salpingectomy at the time of vaginal hysterectomy. J Minim Invasive Gynecol. 2015;22(5):864–9.

    Article  PubMed  Google Scholar 

  • Rooney CM, Crawford AT, Vassallo BJ. Is previous cesarean section a risk for incidental cystotomy at the time of hysterectomy? A case-controlled study. Am J Obstet Gynecol. 2005;193:2041.

    Article  PubMed  Google Scholar 

  • Rorarius M, Mennander S, Suominen P, Rintala S, Puura A, Pirhonen R, Salmelin R, Haanpaa M, Kujansuu E, Yli-Hankala A. Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain. 2004;110:175–81.

    Article  CAS  PubMed  Google Scholar 

  • Roy S, Patkar A, Daskiran M, Levine R, Hinoul P, Nigam S. Clinical and economic burden of surgical site infection in hysterectomy. Surg Infect. 2014;15(3):266–73.

    Article  Google Scholar 

  • Sahin Y. Vaginal hysterectomy and oophorectomy in women with 12–20 weeks’ size uterus. Acta Obstet Gynecol Scand. 2007;86(11):1359–69.

    Article  PubMed  Google Scholar 

  • Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Di Francesco L, Piccione E. Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Arch Gynecol Obstet. 2014;290(3):485–91.

    Article  PubMed  Google Scholar 

  • Sheth SS. Vaginal hysterectomy as a primary route for morbidly obese women. Acta Obstet Gynecol Scand. 2010;89(7):971–4.

    Article  PubMed  Google Scholar 

  • Silva-Filho AL, Rodrigues AM, de Castro V, Monteiro M, da Rosa DG, Pereira e Silva YM, Werneck RA, Bavoso N, Triginelli SA. Randomized study of bipolar vessel sealing system versus conventional suture ligature for vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2009;146(2):200–3.

    Article  PubMed  Google Scholar 

  • Solomon ER, Muffly TM, Barber MD. Common postoperative pulmonary complications after hysterectomy for benign indications. Am J Obstet Gynecol. 2013;208(1):54.e1–5.

    Article  PubMed  Google Scholar 

  • Summitt RL Jr, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstet Gynecol. 1992;80(6):895–901.

    PubMed  Google Scholar 

  • Summitt RL Jr, Stovall TG, Bran DF. Prospective comparison of indwelling bladder catheter drainage versus no catheter after vaginal hysterectomy. Am J Obstet Gynecol. 1994;170(6):1815–8. discussion 1818–1821

    Article  PubMed  Google Scholar 

  • Sutton C. Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol. 1997;11:1–22.

    Article  CAS  PubMed  Google Scholar 

  • Sutton C. Past, present and future of hysterectomy. J Minim Invasive Gynecol. 2010;17(4):421–35.

    Article  PubMed  Google Scholar 

  • Swenson CW, Berger MB, Kamdar NS, Campbell DA Jr, Morgan DM. Risk factors for venous thromboembolism after hysterectomy. Obstet Gynecol. 2015;125(5):1139–44.

    Article  PubMed  PubMed Central  Google Scholar 

  • Teeluckdharry B, Gilmore D, Flowerdew G. Urinary tract injury at benign gynecologic surgery and the role of cystoscopy: a systematic review and meta-analysis. Obstet Gynecol. 2015;126:1161. E pub ahead of print

    Article  PubMed  Google Scholar 

  • Unger JB, Meeks GR. Vaginal hysterectomy in women with history of pervious cesarean delivery. AJOG. 1998;179:1473–8.

    Article  CAS  Google Scholar 

  • Vassallo BJ, Culpepper C, Segal JL, Moen MD, Noone MB. A randomized trial comparing methods of vaginal cuff closure at vaginal hysterectomy and the effect on vaginal length. Am J Obstet Gynecol. 2006;195(6):1805–8.

    Article  PubMed  Google Scholar 

  • Visco AG, Taber KH, Weidner AC, Barber MD, Myers ER. Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy. Obstet Gynecol. 2001;97(5 Pt 1):685–92.

    CAS  PubMed  Google Scholar 

  • Washburn EE, Cohen SL, Manoucheri E, Zurawin RK, Einarsson JI. Trends in reported resident surgical experience in hysterectomy. J Minim Invasive Gynecol. 2014;21(6):1067–70.

    Article  PubMed  Google Scholar 

  • Woelk JL, Borah BJ, Trabuco EC, Heien HC, Gebhart JB. Cost differences among robotic, vaginal, and abdominal hysterectomy. Obstet Gynecol. 2014;123(2 Pt 1):255–62.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wright KN, Jonsdottir GM, Jorgensen S, Shah N, Einarsson JI. Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies. JSLS. 2012;16:519–24.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, Neugut AI, Hershman DL. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013a;122(201):233–41.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI, Herzog TJ, Hershman DL. Robotically assisted vs. laparoscopic hysterectomy among women with benign gynecologic disease. JAMA. 2013b;309(7):689–98.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Begüm Özel

Authors
  1. Begüm Özel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Begüm Özel .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Donna Shoupe

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Özel, B. (2023). Vaginal Hysterectomy: Indications, Avoiding Complications. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-031-14881-1_69

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-14881-1_69

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14880-4

  • Online ISBN: 978-3-031-14881-1

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation