ABSTRACT
It is mandatory for every gynaecologist to attain such a degree of operating skill via the different routes that the reason for doing a hysterectomy vaginally is that it is likely to have the best outcome for the patient [1], who is the only one who should be considered. Many gynaecological textbooks cite vaginal hysterectomy as a major contraindication after previous abdominopelvic surgery, especially with a history of peritonitis and intestinal obstruction, or ileus or abscess formation as a major contraindication to vaginal hysterectomy [2, 3].Yet, all of us know that, in this sort of case, when we do an abdominal hysterectomy, we have to separate loops of bowel from the abdominal wall, from one another, from omentum, and finally from the uterus, and then it is a surprise how easily the uterus often delivers. Recently, the author [4] was fortunate to have such a case in which an abdominal hysterectomy had failed at the hands of an experienced gynaecologist in a woman with a uterus sized 12 weeks, as a result of fibroids giving rise to severe menorrhagia. Her pelvic examination was favourable vis-àvis parameters of size, mobility, and adnexae. Vaginal hysterectomy was successfully attempted, which provided relief to the patient and satisfaction to the surgeon.We do therefore recommend that this type of situation not be considered a contraindication to the vaginal approach, because it avoids all or almost all of the bowel handling. Not only are these cases relatively easier to do, but the difference in their postoperative recovery is dramatic.
