Effect of Posterior Colpotomy First Technique on the Vaginal Length During Total Abdominal Hysterectomy

the same surgeon performed all of the procedures using the same method. A lower midline or Pfannestiel incision is the first step in the complete abdominal hysterectomy procedure. They clamp, cut, and ligate the top pedicles. The cardinal and uterosacral ligaments were dissected, the wide ligament's leaves were cut, the bladder was carefully lowered, and the uterine vessels were skeletonized, cut, and tied. Group A (traditional technique): the surgeon makes a circumferential incision after initially entering the front vaginal wall. The surgeon performs a circumferential colpotomy at the topmost section of the vagina using the Group B (posterior colpotomy first) approach, entering the vagina via the posterior wall at the uppermost part of the uterosacral ligaments, followed by the left lateral fornix.

Reconstruction of the pelvic floor to ensure hemostasis and good pelvic support. The operative time was assessed by calculating the time between vaginal cuff opening and suturing after uterine artery ligation, As point D on the POP-Q system is omitted after hysterectomy, point C level was reassessed 2 weeks postoperative.

Total vaginal shortening (TVS) and vaginal shortening ratio (VSR) were calculated according to the formulas given below.

TVS=Preoperative VL-Postoperative VL at 3 months. VSP=Preoperative VL-Postoperative VL at 3 months\\ Preoperative VL*100

Inclusion criteria

• Ages 40 - 65 years
• sexually active
• BMI of 25-40 kg/m2
• had a fresh abdomen
• had a benign reason for a hysterectomy (multiple fibroid uterus, adenomyosis, or endometrial hyperplasia).

Exclusion criteria

• Patients who had vaginal and uterine prolapse,
• subtotal hysterectomy,
• caesarean hysterectomy in patients with major obstetric hemorrhage (placenta previa, accreta-increta-percreta, uncontrolled postpartum hemorrhage)
• malignant indications of total abdominal hysterectomy (uterine and cervical carcinoma)