Vaginal Hysterectomy Following Earlier Ruptured Uterus and Cesarean Sections

Abstract

ABSTRACT

The majority of hysterectomies are performed abdominally except in select centers in a few countries. A history of pelvic surgery, cesarean section, or myomectomy is enough to deter some gynecologic surgeons from proceeding with a vaginal hysterectomy. If previous pelvic surgery in a patient is a consideration, such as a ruptured uterus in addition to cesarean section scar tissue, the standard approach is to schedule her for an abdominal hysterectomy. In the course of 1 year, two almost identical cases, each with a history of three cesarean sections and uterine rupture during their second pregnancy, underwent successful vaginal hysterectomies for dysfunctional uterine bleeding. Clinical, sonographic, and additional findings from examination of the anesthesized patients ruled out contraindications to vaginal hysterectomy. Further laparoscopic evaluation confirmed the feasibility of vaginal hysterectomy. After such an evaluation, the surgeon is likely to proceed with the vaginal hysterectomy with confidence. Two successful case studies of vaginal hysterectomy performed without any complications are presented to emphasize that the absence of contraindications in addition to favorable findings upon clinical examination as well as examination under anaesthesia is sufficient to schedule a patient for vaginal hysterectomy who has previously undergone repair for uterine rupture. (J GYNECOL SURG 14:185, 1998)