Trends in thirty years of vaginal hysterectomy.

Vaginal hysterectomy, as currently performed at the University of Vienna, was first described by Halban in 1932. From 1955 to 1985, a total of 9,967 hysterectomies were performed. The vaginal route was used for 6,078 (60.9 per cent) of these procedures. Sixty-four per cent of the women operated upon were multiparous, 27 per cent were uniparous and 8 per cent were nulliparous. A comparison of the periods 1955 to 1975 and 1976 to 1985 revealed the following trends: the incidence of uterine myomas (30.6 to 27.1 per cent), in situ carcinoma of the cervix (6.5 to 7.9 per cent) and endometrial carcinoma (1.4 to 0.6 per cent) remained largely constant. In the past decade, indications for positional abnormalities (uterine descent and prolapse) were encountered more often (27.6 to 41.6 per cent) than in the first observation period, while the incidence of recurrent metrorrhagia was found to decline (33.9 to 22.8 per cent). The most common complications included hemorrhage during the operation, lesions of the bladder, hemorrhage until 48 hours after surgical treatment and hemorrhage from days 2 to 14 postoperatively (around 0.5 per cent, respectively). During the second observation period, no postoperative fistulas developed. Two instances of tubal prolapse were seen. Laparotomy was done in four of 6,078 instances. Two patients died of septic complications. Whenever possible, we prefer vaginal hysterectomy because of its low complication rate, low mortality rate and low postoperative morbidity.