Completion of vaginal hysterectomy by electro surgery using anteroposterior approach in benign cases faced with obliterated posterior cul-de-sac

Abstract

Ramkrishna Purohit, Jay Gopal Sharma, Devajani Meher, Sanjay Raosaheb Rakh, Surya Malik Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India Background: Obliterated posterior cul-de-sac has been a real surgical challenge during vaginal hysterectomy. The present study demonstrates an anteroposterior approach to accomplish the vaginal hysterectomy in cases faced with an obliterated posterior cul-de-sac. Methods: In a retrospective study in private setup, 51 consecutive cases with obliterated posterior cul-de-sac during vaginal hysterectomy due to severe benign pelvic adhesions were studied to know the feasibility of the anteroposterior approach. The upper limit of uterus size was that of 16 weeks of gestation. Results: Vaginal hysterectomy was completed in 49 (96.08%) cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions. Two (3.92%) cases needed laparoscopic assistance to complete vaginal hysterectomy. Mean operation time was 109.92±40.13 (45–217) minutes due to the need for careful separation of adhesions from the uterus and indicated additional procedures. Mean weight of specimen uterus was 162±106.51 (40–460) grams. There was no major intra- or postoperative morbidity. Conclusion: Completion of vaginal hysterectomy was feasible using the anteroposterior approach in most of the cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions. Keywords: vaginal hysterectomy, obliterated posterior cul-de-sac, anteroposterior approach, difficult vaginal hysterectomy, severe pelvic adhesions, extraperitoneal uterosacral separation, sub-serosal morcellation, frozen pelvis

Keywords

• Vaginal hysterectomy
• Obliterated posterior cul-de-sac
• Anteroposterior approach
• difficult vaginal hysterectomy
• Severe pelvic adhesions