Route of Hysterectomy: Vaginal or Abdominal, in Case of Non-descent Uterus in Low-resource Setup

Aims and background: Hysterectomy is a commonly performed elective major gynecological procedure worldwide nowadays, so it is imperative to evaluate the feasibility and outcomes of hysterectomy done by various routes (abdominal, vaginal, laparoscopic, and robotic) in cases of non-descent uterus, given the increasing focus on cost-effectiveness and patient-centered care, particularly in resource-limited settings.In the present study, we have analyzed and compared the patients' outcomes in case of total abdominal hysterectomy, and vaginal hysterectomy (VH) in cases of a non-descent uterus.Materials and methods: It is a retrospective study of data obtained from January 2023 to February 2024 at Dhiraj Hospital, Piparia, Waghodia, Vadodara, Gujarat, India.A total of 100 hysterectomy cases performed for benign conditions were selected, of which 50 were non-descent vaginal hysterectomies (NDVH), while 50 were abdominal hysterectomies for the same indications.Results: The mean operative duration was shorter for NDVH (62 minutes) compared to abdominal hysterectomy (AH) (70 minutes).Intraoperative complications were reported more often in the AH group (8%) than in the NDVH group (4%).Three cases of abdominal wound infection were reported, all of which required re-suturing.The mean postoperative hospital stay was shorter in NDVH (4.1 days) than in AH (5.1 days), as patients in the vaginal group started ambulating earlier than those in the abdominal group.An overall lower complication rate was found in the NDVH group. Conclusion:Vaginal hysterectomy is a safer, more cost-effective, and less invasive procedure with fewer complications compared to AH, and should be the preferred method whenever appropriate.Clinical significance: Hysterectomy is a common gynecological procedure, and selecting the optimal surgical route in cases of a non-descent uterus is crucial, especially in low-resource settings.