LAVH : LAVH means ‘Laparoscopic Assisted Vaginal Hysterectomy.

NDVH : NDVH means ‘Non-descent Vaginal Hysterectomy.

Indications of vaginal hysterectomy :

Genital prolapse : 

1. Third degree utero vaginal prolapse.
2. Second degree utero-vaginal prolapse.

Utero-vaginal prolapse associated with :

1. Fibroid uterus: Size< 12weeks.
2. Pelvic adhesions
3. Pelvic malignancy.
4. Post-menopausal women

Benign conditions of uterus without prolapse :

Where uterus is < 12 weeks.

Types of vaginal hysterectomy:

1. Total.
2. Radical or schauta’s hysterectomy.

Advantages of vaginal hysterectomy :

1. Can be effectively done in obese patient.
2. Postoperative complications are less.
3. Less morbidity & mortality.
4. Less postoperative pain & less need of analgesia.
5. Less hospital stay.
6. Early resumption of day- to-day activities.
7. No abdominal incision & scar.

Preoperative order for vaginal hysterectomy :

1. Written informed consent of the patient or guardian.
2. Proper sedation in the night before operation-by diazepam, bromazepam or alprazolam.
3. Nothing by mouth from the morning of the day of operation.
4. Lower bowel may be kept empty by soap water enema if constipated or glycerine suppository in the early morning of operation, if bowel habit is regular.
5. Shave and clean the operative area properly.
6. Morning medication-Anxiolytic eg diazepam before 2 hours of operation.
7. Opening of the intravenous channel by an appropriate cannula.
8. Prophylactic antibiotic

Post-operative care of vaginal hysterectomy :

1. After recovery from anaesthesia the patient should be shifted to the recovery room & kept under observation for 2 hours by trained medical & nursing staff for early detection of any complications.
2. Inj Pethidine 75 mg & Inj. Phenergan 25 mg IM should be given after recovery to relieve pain.
3. The patient should be placed on her side to prevent inhalation of vomitus & fall back of the tongue
4. During the first 24 hours of operation the patient should be given sedation & analgesic.
5. All the vital signs should be monitored ½ hourly such as pulse, BP, respiration & urine output for first 2 hours & 4 hourly.
6. The patient should be kept nothing by mouth till bowel sound returns.
7. Parental nutrition is maintained.
8. Parental antibiotics are given usually with : Inj. Ampicillin 500 mg, Inj Cloxacillin 500 mg IV 6 hourly till the patient is on fluid.
9. Fluid intake & urine output chart should be strictly maintained to avoid dehydration, hypovolemia or fluid overload.
10. The vaginal pack is to be removed after 24 hours.
11. When bowel sounds appear, she should be allowed to have liquid diet for 24 hours & subsequently semi-solid & then solid diet is allowed.
12. Parental antibiotics are to be replaced by oral ones.
13. The patient’s wound is to be cleaned daily & no dressing is required.
14. The catheter is removed after 5 days.
15. The perineal silk stitches are to be removed on the 7 post-operative day.
16. The patient can be discharged after 10-14 days.
17. Before discharge pelvic examination is done to make sure that the anterior & posterior vaginal walls are not adherent & the vault is healthy.
18. Early ambulation should be encouraged after 24 hours.
19. Deep breathing & leg movement are advised to prevent deep vein thrombosis

For more curiosity :

How many clamps are given in vaginal hysterectomy? : 3 clamps :

First clamp : Uterosacral ligament, Mackenrodt’s ligament & descending cervical artery.

Second clamp : Uterine artery on the base of the broad ligament.

Third clamp : Round ligament, fallopian tube, mesosalpinx & ligament of the ovary.

Complications of vaginal hysterectomy :

Per-operative : 

1. Primary haemorrhage
2. Trauma
3. Complications due to blood transfusion.
4. Complications due to anaesthesia.

Post operative complications :

1. Haemorrhage. (Secondary & reactionary).
2. Sepsis
3. Urinary: Retention of urine. & Infection leading to cystitis.
4. Vault cellulitis.
5. Pelvic abscess
6. Thrombophlebitis.
7. Pulmonary embolism.
8. Vault prolapse
9. Dyspareunia.
10. Recurrent of prolapse.
11. VVF following bladder injury.
12. RVF following rectal injury.

Management of secondary haemorrhage following vaginal hysterectomy :

• Secondary haemorrhage usually occurs between 5 – 10th day but may occur even in the 3rd week.
• It is due to sepsis of the wound.
• If the haemorrhage is brisk, along with resuscitative procedures, the patient is to be brought to the operation theatre & under general anaesthesia, the vagina is explored. The clots are removed to find any bleeding point.
• If only generalized oozing is found, tight intravaginal pack using dry roller gauze is enough.
• If bleeding point is visible, haemostatic sutures should be given followed by vaginal packing. The plug should be removed after 24 hours.
• Antibiotics are to be started again.

Disadvantages of vaginal hysterectomy :

1. More skill & experience are needed on the part of the surgeon.
2. Exploration of abdominal & pelvic organs cannot be done.
3. Tubo- ovarian pathology when needed is difficult to tackle.
4. Limitations in cases with.

• Uterus > 12 weeks of size.
• Presence of pelvic adhesions.

• Previous history of laparotomy with adhesions.