Intrafascial vagino-abdominal hysterectomy

The paper presents own modification of intrafascial hysterectomy. The material covers 32 patients operated on before June 30th 2001.
The surgery consists of two stages. The vaginal stage starts with circular incision of the vaginal part of uterine cervix, involving the pericevical fascia above the margin of the affected area. The cervix is separated from the adjacent tissue with 3 cm-long incision by scissors. The vaginal part of the uterine cervix is left or excised. The angles of wound are sutured with single polysorb stitches, the pericervical tissue is sutured with catgut. The abdominal stage involves: 1 – excision of the uterus body from the parametrium, 2 – cervical facsiotomy over the sacrouterine ligaments and circular incision ca 2 mm deep (that part of the surgery as well as the separation of the cervix is performed according to Woytorfs modification), 3 – separation of the uterine cervix from the pericervical tissue going towards the top of the separated area from the vaginal side, 4 – suturing the injury angles including pericervical tissue and sacrouterine ligaments with polysorb stitches and afterwards suturing the fascia previously surrounding the cervix with single stitches.
In the course of the postoperative period the following were observed:
a) excellent healing of the pericervical tissue sutured from the vaginal approach,
b) the vaginal roof does not become shallower or narrower, the vaginal walls are left intact by the surgery,
c) the healing of abdominal wound following abdominal hysterectomy is similar to the course observed by other authors.
Presented modification enables intrafascial hysterectomy – in the case of non-neoplastic diseases of the uterine cervix – within the area of healthy tissue, done in the most sparing way, leaving the vaginal walls continuity intact.