Histerectomía vaginal en útero no prolapsado: experiencia en el Hospital Universitario de Caracas

Evaluar la experiencia con la histerectomia vaginal en utero no prolapsado en el servicio de ginecologia del HospitalUniversitario de Caracas. Se incluyeron 62 pacientes con indicacion de histerectomia por patologia uterina benigna, lesiones preinvasorasde cuello uterino y adenocarcinoma de endometrio en estadios iniciales. Fueron excluidas pacientes con: prolapso apical deorganos pelvicos, tumores anexiales con sospecha de malignidad, uteros poco moviles y fondo de saco de Douglas obliteradopor sindrome adherencial severo. La edad promedio fue 47 anos, 49 % tenia cirugias previas. La indicacion quirurgica fue miomatosis uterina en87,1 %. El peso uterino promedio fue 345,9 g. En 64,5 % se realizo morcelamiento y hubo adherencias en 14 %; el promedio detiempo operatorio fue 65 minutos y de perdida hematica intraoperatoria fue 300,8 ml. La estancia hospitalaria postoperatoriafue 1 dia (77,4 %). La intensidad del dolor a las 24 horas de postoperatorio fue 0 a 1 en la escala visual analoga en 53,2 % yen ningun caso fue mayor a 6. Una paciente requirio conversion a laparotomia por sindrome adherencial severo y en una seprodujo una lesion incidental de vejiga. Las complicaciones postoperatorias mas frecuentes fueron infeccion urinaria (6,5 %)y hematoma de cupula (3,2 %). Una paciente presento prolapso de cupula vaginal al ano de seguimiento. La histerectomia vaginal en utero no prolapsado es una tecnica segura y altamente reproducible que deberia serla primera opcion de abordaje en casos de histerectomia realizadas por cirujanos ginecologos. to evaluate the experience with vaginal hysterectomy in non-prolapsed uterus in the department of Gynecology ofHospital Universitario de Caracas, Venezuela. A prospective, descriptive, longitudinal study was performed in 62 patients of the pelvic floor unit of the Departmentof Gynecology between 2010 and 2016. Inclusion criteria: benign uterine pathology, preinvasive lesions of cervix, andendometrial adenocarcinoma (initial stages). Exclusion criteria: apical prolapse of pelvic organs, ovarian tumors suggestiveof malignancy, uterus with low mobility on pelvic examination, pouch of Douglas obliteration due to severe pelvic adhesionsproduct of endometriosis, pelvic inflammatory disease, multiple surgical interventions, etc. Mean age was 47 years. Forty nine percent of the patients had a previous surgery. The most frequent surgical indicationwas uterine myomatosis (87.1%). Mean uterine weight was 345.9 gr (range 30 to 2000 gr). Morcellation was performed in64.5% of the patients. Adhesions were observed in 14% of the cases, mean surgical time was 65 minutes, mean blood lossduring surgery was 300.8 ml, and postoperative hospital stay was 1 day in 77.4% of the cases. Postoperative pain intensity(24 hours) was 0 to 1 in the visual analog scale in 53.2% of the cases, and none of the patients had a score higher than 6. Onepatient required laparotomy due to severe pelvic adhesions and 1 case had a bladder injury. The most frequent postoperativecomplication was urinary tract infection (6.5%), followed by hematoma of vaginal vault (3.2%). One patient had a vaginalvault prolapse at one year of follow up. vaginal hysterectomy in non-prolapsed uterus has multiple advantages: lower surgical time, hospital stay andblood loss, faster postoperative recovery, low level of pain, no visible scars and low percentage of complications. It is a safeand highly reproducible technique that should be the first option for hysterectomy for gynecological surgeons.