الفهرس 
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Abstract
Hysterectomy is one of the most common surgeries performed in gynecology. It can be performed by vaginal and abdominal route. A large scale survey of hysterectomy has shown that 70. 0% to 80. 0% of hysterectomy are performed by the abdominal route. Only 10. 0% of hysterectomy done by vaginal route (Ikram, 2008). Many studies have been done to compare between abdominal and vaginal hysterectomies regarding morbidity and complications. Dicker and his associates stated that since wide spread introduction of prophylactic antibiotics, vaginal hysterectomy is associated with less febrile morbidity, less bleeding necessitating transfusion, shorter hospitalization and faster convalescence than abdominal hysterectomy (Tatra G). The same result were found in the study done by Khan (Gray LA). Whereas Dorsey and his associates in their study found that postoperative morbidity and complications were similar between abdominal and vaginal hysterectomy but duration of the operation, hospital stay and recovery time is significantly greater in abdominal hysterectomy than vaginal hysterectomy
Gynecologists currently use both vertical (longitudinal) and horizontal (transverse) cuff closures at the time of vaginal hysterectomy. Surgical texts have historically suggested vertical closure could decrease the incidence of short post hysterectomy vagina (Nichols, 1996). These arguments, however, have been based entirely on expert opinion and not on any scientific method. Several studies have addressed various ways of managing the vaginal cuff at hysterectomy (Cruikshank, 1987 and Gray, 1975). There are only two publications by one author based on a single study population, which attempted to address the question of what is the optimal method for vaginal cuff closure at vaginal hysterectomy with regard to its effect on vaginal length (Cruikshank, 1978 & 1988). The conclusion of these prior studies was that either vertical or horizontal closure of the cuff was acceptable.
This study was a randomized control study, conducted to compare the effect of the horizontal versus vertical closure of the vaginal cuff during vaginal hysterectomy on post operative vaginal length. This study was carried out on 48 non pregnant women with the inclusion criteria for vaginal hysterectomy (24 patients for vertical closure & 24 patients for horizontal closure) who receive care at maternity hospital at Ain Shams University in the period from 2009 to 2011. The vaginal length was measured in a lithotomy position immediately after the anesthesia and after the end of the operation immediately from the hyminal ring to the posterior fornix.
The age was range from 42-66 years old with mean age of 53 years. Uterine fibroid was the main indication in the group of horizontal closure (75%) while the first degree uterine prolapse was the main indication in the group of vertical closure (45. 8%). Pre-operative TVL in the group of the horizontal closure was range from 7. 8-10 cm with mean of 8. 917, while post-operatively range from 7-8. 5 with mean of 7. 667. Pre-operative TVL in the group of vertical closure was range from 7-9 cm with mean of 7. 854, while post-operatively was range from 6. 5-8. 5 cm with mean of 7. 688. We found there was 14% change in the TVL in the group of horizontal closure, while there was no significant change in the group of vertical closure.