Changing the route of hysterectomy: the results of a policy of attempting the vaginal approach in all cases of dysfunctional uterine bleeding.

Objective: To assess the effectiveness of a policy of performing a vaginal hysterectomy for as many cases of dysfunctional uterine bleeding without uterine prolapse as possible between 1997 and 2003.

Study Design: The study was prospective, with retrospective analysis of data.

Setting: Warwick Hospital.

Population: Eighty-seven women in a district hospital serving a population of 270,000 in South Warwickshire.

Methods: During 1997 and 2003, an effort was made to perform as many hysterectomies vaginally as possible, with oophorectomy where necessary, in women with dysfunctional uterine bleeding in the absence of prolapse. The trends of the three different operations, total abdominal hysterectomy, sub-total abdominal hysterectomy and vaginal hysterectomy over the 7-year period were analysed.

Main Outcome Measures: The ability to undertake surgery successfully, complications rates, length of hospital stay and changes in surgical practice.

Results: Over this 7-year period, it has proved possible to change the emphasis from abdominal to vaginal hysterectomy for dysfunctional uterine bleeding. In 1997, the most common operation for dysfunctional uterine bleeding (72.7%) was subtotal hysterectomy+/-bilateral salpingo-oophorectomy, followed by (27.3%) total abdominal hysterectomy+/-bilateral salpingo-oophorectomy. No cases were undertaken vaginally. By 2003, however, the trend had completely reversed, with the only procedure undertaken being vaginal hysterectomy+/-bilateral salpingo-oophorectomy. There is no evidence that such an approach increases the complication rate, and the recovery rate from surgery is improved with a tendency towards earlier discharge in the vaginal surgery group.

Conclusion: The vaginal approach is possible for an average gynaecologist working in a district general hospital, with no additional complications and an improved recovery rate for patients.