VAGINAL HYSTERECTOMY COMPARED TO ABDOMINAL AND LAPAROSCOPIC HYSTERECTOMIES IN PATIENTS WITHOUT UTERINE PROLAPSE
Introduction: Except for the uterine prolapse indication, vaginal hysterectomy has been less popular than abdominal hysterectomy because the latter is considered safer and easier and surgeons often lack sufficient experience on the former. This study aims at comparing a group of patients without prolapse who underwent vaginal hysterectomy to another group of patients who underwent abdominal and laparoscopic hysterectomies with respect to intraoperative and early postoperative complications. Materials and Methods: We retrospectively reviewed the files of patients who presented to the gynecology outpatient clinic of Ondokuz Mayıs University (OMU), Turkey, between January 2013 and February 2018 and for whom hysterectomy was decided due to benign indications other than uterine prolapse. A total of 105 patients, 35 from each of the groups who underwent abdominal, laparoscopic and vaginal hysterectomies, were included in the study. The vaginal hysterectomy group was compared to the abdominal and laparoscopic hysterectomy patient groups with respect to duration of operation, decrease in hematocrit, blood transfusion, duration of hospitalization, hospital expenses, postoperative pain, wound site infection, and complications of intestine, bladder and ureter. Results: No statistically significant differences were found between the demographic characteristics of the groups. Vaginal hysterectomy was shown to be superior to laparoscopic and abdominal hysterectomies with respect to mean duration of operation (p<0.005), decrease in hematocrit showing the amount of bleeding (p<0.005), duration of hospitalization (p<0.005), hospital expenses (p<0.005) and amount of postoperative analgesic need (p<0.005). Wound site infection was found more in abdominal hysterectomy than in vaginal and laparoscopic hysterectomies (p<0.005). No statistically significant difference was found between vaginal, abdominal and laparoscopic hysterectomies with respect to blood transfusion and complications of intestine, bladder and ureter (p>0.005). Conclusion: The most important factor in choosing a hysterectomy method is the experience of the surgeon. However, vaginal hysterectomy should be the primarily preferred method, if possible, for being more advantageous in many respects.
De Frances CJ, Lucas CA, Buie VC, Golosinskiy A. 2006 National Hospital Discharge Survey. Natl Health Stat Report. 2008;5:1–20.
Whiteman MK. Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol. 2008; 198(1):34 e1-7.
Lepine LA Hillis SD, Marcbanks PA, Koonin LM, Morrow B, Kieke BA et al. Hysterectomy surveillance-United States 1980-1993. MMWR CDC Surveill Summ. 1997; 46(4): 1-15.
Vessey MP. Villard Mackintosh L, McPherson K, Coulter A. Yeates D. The epidemiology of hysterectomy: findings in a large cohort study. Br J Obstet Gynaecol. 1992; 99(5): 402-7.
Van Keep PA. Wildemeersch D. Lehert P. Hysterectomy in six European countries. Maturitas. 1983; 5(2): 69-75.
.Hirsc, NA. Technologies for the Treatment of Menorrhagia and Uterine Myomas, Australian Institute of Health Welfare: HealthCare Technology Series No. 10,AGPS,Canberra,1993.
Luoto R, Kaprio J. Keskimaki I. Pohjanlahti JP. Rutanen EM. İncidence, causes and surgical methods for hysterectomy in Finland 1987-1989. Int J Epidemiol. 1994; 23(2): 348-58.
Gollop TR, Santos AG, Rossi AG, Bianchi RF. Vaginal hysterectomy in non-prolapsed uteri: a 6 year experience. Einstein (SãoPaulo). 2012; 10(4): 462-5.
ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009; 114(5): 1156–8.
Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009; (3): CD003677.
Balakrishnan D, Dibyajyoti GA. Comparison between non-descent vaginal hysterectomy and total abdominal hysterectomy. J Clın Dıag Res. 2016; 10(1): QC11-4.
Wolman I. Berek and Novak’s Gynecology 15th Edition: Lippincott Williams and Wilkins, 2012, 1560 pp, Hardcover, Rs. 2659 on www. flipkart. com
Salcedo FL. Vaginal hysterectomy in non-prolapsed uteruses: "no scar hysterectomy". Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20(9): 1009-12.
Committee on Gynecologic Practice..Committee Opinion No 701: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017; 129(6): e155-9.
Schindlbeck C, Klauser K, Dian D, Janni W, Friese K.. Comparison of total laparoscopic, vaginal hysterectomy. Arch Gynecol Obstet. 2008; 277(4): 331–7.
Wattiez A, Soriano D, Cohen SB, Nervo P, Canis M, Botchorishvili R et al. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc. 2002; 9(3): 339–45.
Richardson RE, Bournas N, Magos AL. Is laparoscopichysterectomy a waste of time? Lancet. 1995; 345(8941):36-41.
Garry R. The future of hysterectomy. BJOG. 2005; 112(2):133–9.
Dolanbay M, Kutuk MS, Ozgun MT, Uludag S, Sahin Y. Laparoscopically assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learningcurve. Ginekol Pol. 2016; 87(5): 333–7.
Jones HW, Rock JA. Te Linde's operative gynecology. Lippincott Williams & Wilkins, 2015.
Sushil K, Antony ZK. Vaginal hysterectomy for benign nonprolapsed uterus. Initial Experience. J Obstet Gynaecol Ind. 2004; 54(1): 60-3.
Doucette RC, Sharp HT, Alder SC. Challenging generally accepted contraindications to vaginal hysterectomy. Am J ObstetGynecol. 2001; 184(7): 1386–89.
Kovac SR, Cruikshank SH, Retto HF. Laparoscopy assisted vaginal hysterectomy. J GynecolSurg. 1990; 6(3): 185-93.
Ursuleanu A, Nicodin O, Gussi I, Niculescu N, Costachescu G. Results of extension of classic indications of vaginal hysterectomy for benign uterine conditions. Chirurgia (Bucur). 2012; 107(6): 761–6.
Tu FF, Beaumont JL, Senapati S, Gordon TE. Route of hysterectomy influence and teaching hospital status. Obstet Gynecol. 2009; 114(1): 73-8.
Varma R, Tahseen S, Lokugamage AU, Kunde D. Vaginal route as the norm when planning hysterectomy for benign conditions: change in practice. Obstet Gynecol. 2001; 97(4): 613–6.
Paparella R, Sizzi O, Rossetti A, De Benedittis F, Paparella R. Vaginal hysterectomy in generally considered contraindications to vaginal surgery. Arch Gynecol Obstet. 2004; 270(2): 104-9.
Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Syst Rev. 2015; (8):CD003677.
Doganay M, Yildiz Y, Tonguc E, Var T, Karayalcin R, Eryılmaz OG, et al. Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity. Arch Gynecol Obstet. 2011; 284(2): 385–9.
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