Abdominal Hysterectomy - Vaginal Hysterectomy - Laparoscopically Assisted Vaginal Hysterectomy

Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals.

David-Montefiore E,Rouzier R,Chapron C,Darai E.

Service de Gynecologie-Obstetrique, Hopital Tenon, Universite Pierre et Marie Curie-Paris VI and.

Background:

Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders.

Methods:

Of the 15 university hospitals belonging to Collegiale de Gynecologie-Obstetrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach.

Results:

In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients' mean age (+/-SD), BMI, parity and previous Caesarean sections were 51.4 +/- 10.3 years, 25 +/- 5.7 kg/m(2), 2 +/- 1.6 children and 0.2 +/- 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P< 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P< 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53-5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39-4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01-4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P< 0.0001).

Conclusions:

This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.

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• 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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