E-Posters-Cervical Elongation may be Present but is not Prohibitive to Successful Vaginal Hysterectomy

Cervical Elongation may be Present but is not Prohibitive to Successful Vaginal Hysterectomy - Aldene O Zeno, MD

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This study aimed to examine the relationship between cervical elongation and perioperative outcomes in patients undergoing vaginal hysterectomy (VH) for pelvic organ prolapse (POP) compared to those undergoing VH for other benign indications. A retrospective cohort study was conducted on patients identified through CPT codes during the years 2015-2017. Cervical elongation was defined using three previously-reported definitions: uterine cervix:corpus length ratio > 0.79, cervix length > 3.38 cm, and cervix length > 5 cm.<br /><br />The study found that patients undergoing VH for POP had longer uterine cervix:corpus ratios compared to those undergoing VH for other indications. However, there was no significant difference in cervical elongation rates between the two groups using the three defined cutoffs. The presence of cervical elongation was not associated with adverse perioperative outcomes, suggesting that cervical elongation may not be a significant barrier to successful VH.<br /><br />The chart review yielded 217 cases, with 140 cases included for review (55 VH for POP and 85 VH for other indications). The groups had similar absolute cervix lengths, but POP cases had larger average uterine cervix:corpus length ratios. There were no statistically significant differences in cervical elongation using the defined cutoffs. Perioperative outcomes, such as hospital length of stay, estimated blood loss, and operating time, differed between the two groups, with POP cases experiencing longer operating times.<br /><br />Regression analysis showed that patient variables did not contribute to the association with cervical elongation. Furthermore, the presence of cervical elongation did not predict increased visceral injury, operating time, conversion to laparotomy, or extraperitoneal hysterectomy.<br /><br />In conclusion, the study suggests that cervical elongation may not pose a significant barrier to successful VH. The results indicate that surgeons should not consider cervical elongation as a prohibitive factor for performing VH, even in patients with POP. Power calculations determined that 23 patients per study arm would be necessary to demonstrate statistically significant differences.

Keywords

cervical elongation

perioperative outcomes

vaginal hysterectomy

pelvic organ prolapse

benign indications

retrospective cohort study

CPT codes

uterine cervix:corpus length ratio

cervix length

chart review