Complications of vaginal hysterectomy under "difficult" circumstances.

Vaginal hysterectomy is less invasive than hysterectomy performed via the abdominal approach. The vaginal approach may be made difficult by prior conisation, a need to remove the adnexae or marked uterine enlargement requiring morcellement. In this retrospective study we have investigated the impact of these factors on the incidence of complications in 1912 patients subject to vaginal hysterectomy. We have studied the incidence of intraoperative hemorrhage, bladder damage, hemorrhage up to 48 h after surgery, hemorrhage up to 14 days after surgery, vault abscesses or collections and pelvic peritonitis. In patients with prior morcellement, intraoperative hemorrhage was significantly more frequent. All other complications were not significantly increased by the intraoperative difficulties specified above. Thus even "difficult" vaginal hysterectomy would seem to carry low morbidity.