Abdominal Hysterectomy - Vaginal Hysterectomy - Laparoscopically Assisted Vaginal Hysterectomy

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J Reprod Med. 2006 Dec;51(12):945-54

Observational comparison of abdominal, vaginal and laparoscopic hysterectomy as performed at a university teaching hospital.

Abdelmonem A,Wilson H, Pasic R.

Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40292, USA.

Objectives:

To compare short-term outcomes of total abdominal hysterectomy (TAH) to total vaginal hysterectomy (TVH) and laparoscopic hysterectomy (LH) regarding operative time, estimated blood loss, postoperative pain, recovery milestones, complication rates, hospital stay, hospital costs and patient satisfaction.

Study Design:

A prospective, observational study examined the above criteria for 177 women with the following distribution of hysterectomy type: TAH (n = 50, 28%), TVH (n = 76, 43%) and LH (n = 51, 29%).

Results:

Operative time was shortest for TVH (103 minutes), followed by TAH (127 minutes), and longest for LH (157 minutes) (p = 0.000). Blood loss was significantly higher in the TAH groups as compared to the TVH and LH groups. Pain estimates and analgesia requirements were significantly lower for the LH and TVH groups as compared to the TAH group. Recovery milestones were met significantly earlier in the TVH and LH groups. Complication rates did not differ significantly between the groups. Hospital stay was significantly longer for the TAH group (3.7 days) than for the TVH (1.9 days) and LH (1.5 days) groups. Hospital costs were significantly lower for the TVH groups as compared to TAH and LH groups. No significant cost difference was seen between TAH and LH. Satisfaction rates did not differ significantly between the groups though a greater percentage of patients in the LH group reported high satisfaction as compared to the other groups.

Conclusion:

Vaginal hysterectomy remains the most cost-effective approach; laparoscopy's role may be best suited to allowing conversion of laparotomy cases to a vaginal approach with assistance of a laparoscope.

Please click on the required question.

• 1 Are heavy periods a common problem?
• 2 What is in my menstrual flow?
• 3 What range of menstrual cycle length is considered to be normal?
• 4 How can menstrual blood loss be measured?
• 5 How can I tell if my periods are abnormally heavy?
• 6 What could be the cause of my very heavy menstrual periods?
• 7 I have been sterilised. Could this be the cause of my heavy periods?
• 8 Should I have tests to find the reason for my heavy periods?
• 9 How will my heavy period problems be investigated?
• 10 What is meant by anaemia due to heavy periods?
• 11 What is intermenstrual bleeding?
• 12 What is a hysteroscopy and D and C?
• 13 What is cervical cautery?
• 14 What happens after the D and C?
• 15 What treatments are available for my heavy periods?
• 16 What are the medical treatments available for heavy periods?
• 17 How do the various medical treatments for heavy periods work?
• 18 What would be reasonable initial treatment for a teenager or young woman with heavy periods?
• 19 What is a hysterectomy?
• 20 What are the indications for hysterectomy?
• 21 What are the risks (complications) of hysterectomy?
• 22 What is vault granulation?
• 23 What are the different types of hysterectomy?
• 24 Is it essential to remove the neck of the womb at hysterectomy?
• 25 Should my ovaries be removed or conserved during hysterectomy?
• 26 How long will I be in hospital when I have my hysterectomy?
• 27 I have had a hysterectomy. Do I still need to have smear tests?
• 28 What are the other surgical alternatives to hysterectomy?
• 29 How do endometrial ablation and hysterectomy compare?
• 30 Are there any psychological effects following hysterectomy?
• 31 How do we decide the best treatment for my period problems?
• 32 Could I have some recommended hysterectomy support groups?
• 33 Are there any support groups?
• Intermenstrual Bleeding - Bleeding between periods.

 

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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