90 - Vaginal hysterectomy

Summary

Nearly 600 000 women undergo hysterectomy each year in the USA, and more than one-fourth of US women will have a hysterectomy – the second most frequent surgical procedure among reproductive-aged women – by the time they are 60 years old. The average annual rate of hysterectomy per 1000 women aged 15 years and older declined from 7.1 in 1980 to 6.6 in 1987, then holding at 5.5 from 1988 to 1993; the decline from 1987 to 1988 resulted from changes in the data collection used to define the survey. Conditions most often associated with hysterectomy are uterine leiomyomata, endometriosis, and pelvic organ prolapse.

The comprehensive study on hysterectomy published by Wingo and associates from the Centers for Disease Control and Prevention reported that there were 46 deaths among 119 972 women undergoing vaginal hysterectomy. The vaginal approach to hysterectomy was associated with a much lower mortality rate than the abdominal approach. Excluding pregnancy and cancer-related cases, the mortality rate for abdominal hysterectomy was 8.6 per 10 000 women while that for vaginal hysterectomy was 2.7 per 10 000 women. Therefore, hysterectomy should be considered a low-risk operation that can be performed to treat non-pregnant patients and those with benign gynecologic symptoms or disease. Vaginal hysterectomy can be used for many indications, including pelvic relaxation, cervical intraepithelial neoplasias, small leiomyoma, and recurrent dysfunctional uterine bleeding.

The success of a vaginal hysterectomy is directly related to the particular surgeon's experience.