caa a22 4500 445364319 CHVBK 20180317142924.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1007/s10397-010-0623-y doi (NATIONALLICENCE)springer-10.1007/s10397-010-0623-y Primary intent vaginal hysterectomy: outcomes for common contraindications to vaginal approach hysterectomy [Elektronische Daten] [Malcolm Mackenzie, Jeffrey Johnson] The objective of this study is, within a broadly inclusive selection strategy for benign vaginal hysterectomy, to determine whether the most commonly invoked "contraindications” to vaginal hysterectomy—fibroid enlargement >14weeks, prior cesarean, need for oophorectomy—result in increased risk of complications. This study is of retrospective design within a rural community hospital. All vaginal hysterectomies performed by a single practitioner over an 11-year-period (1998-2009) were used as samples in this study. With few exclusions, all candidates for benign hysterectomy underwent vaginal hysterectomy. Comparison was made between vaginal cases without enlargement >14weeks, prior cesarean, or need for oopherectomy defined as "Standard” and those with contraindications defined as "Non-standard.” Intraoperative complications and morbidity, including conversion to abdominal route, and postoperative morbidity, including return to the OR, transfusions, and length of hospital stay, were the main outcome measures. Of 325 hysterectomies attempted vaginally during the study period, 165 were classified as "Standard” and 160 classified as "Non-standard.” Hysterectomy was completed vaginally in 311 (95.7%) patients, while 14 (4.3%) required abdominal conversion; more common for the non-standard group (8.1% vs. 0.6%, p < 0.05). Complications not requiring conversion were not different. Only operative time, EBL, and uterine weight were increased for the non-standard group (p < 0.05). No differences were seen in length of stay, early, or late postoperative complications. Uterine enlargement >14weeks, prior cesarean, or oophorectomy conventionally contraindicates vaginal hysterectomy; a primary intent vaginal hysterectomy strategy using broad inclusion criteria results in a high vaginal hysterectomy rate, and low complication rates no greater for vaginal hysterectomies performed with contraindications than for those performed without such contraindications. Springer-Verlag, 2010 Vaginal hysterectomy nationallicence Contraindications nationallicence Fibroid nationallicence Cesarean nationallicence Oophorectomy nationallicence Mackenzie Malcolm Department of Obstetrics and Gynecology, Cheshire Medical Center/Dartmouth Hitchcock, Keene, NH, USA aut Johnson Jeffrey Department of Obstetrics and Gynecology, Cheshire Medical Center/Dartmouth Hitchcock, Keene, NH, USA aut Gynecological Surgery Springer-Verlag 8/2(2011-05-01), 135-143 1613-2076 8:2<135 2011 8 10397 https://doi.org/10.1007/s10397-010-0623-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10397-010-0623-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mackenzie Malcolm Department of Obstetrics and Gynecology, Cheshire Medical Center/Dartmouth Hitchcock, Keene, NH, USA aut NATIONALLICENCE 700 1- Johnson Jeffrey Department of Obstetrics and Gynecology, Cheshire Medical Center/Dartmouth Hitchcock, Keene, NH, USA aut NATIONALLICENCE 773 0- Gynecological Surgery Springer-Verlag 8/2(2011-05-01), 135-143 1613-2076 8:2<135 2011 8 10397 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer