Study of route of hysterectomy
Keywords:Abdominal hysterectomy, LAVH, NDVH, TLH
Background: The objective is to study complication rate, advantages and outcome of different route of hysterectomy.
Methods: A prospective study of 175 women over a period of 1 year i.e. from 01/01/2011 to 31/12/2011 SSG hospital, Vadodara. Depending on the patient profile, experience of surgeon optimum route of hysterectomy was decided.
Results mean operating time in AH group was 68.4±14.4min, which was 80±10.3min, 115.8±40.6min and 148.8±25.5min in NDVH, LAVH and TLH group respectively. TLH was performed by consultants. Febrile morbidity was significantly high in AH (23%). Bladder and ureteral injuries were seen in 4% and 3% cases of NDVH and AH group. Wound complications were seen in AH (10%), whereas vault complications were higher in TLH. The hospital stay was shortest in TLH. Women with TLH had early ambulation, early resumption to normal diet, early return to routine work and better sexual function.
Conclusions: Women with excessively enlarged uteri, significant pelvic pathology, or cancer are obvious candidates for AH. On the other hand, VH is frequently chosen for the small uterus in a multiparous woman with a large pelvis and no prior pelvic inflammatory disease or surgery. Although TLH, LAVH have significantly lower complication rate than AH, but overall cost is higher owing to the high operating room charges. The final selection of hysterectomy route should be based on surgeon’s experience and indication for surgery.
Keshavarz H, Hillis SD, Kieke BA, Marchbanks PA. Hysterectomy surveillance-United States, 1994-1999. MMWr CDC Surveill Summ. 2002;51(SS05):1-8.
Singh AJ, Arora AK. Effect of uterine prolapse on the lives of rural north Indian women. Singapore J Obstet Gynecol. 2003;34(2):52-8.
Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. Eur J Obstet Gynecol Reprod Biol. 2010;148(2):172- 6.
Candiani M, Izzo S. Laparoscopic versus vaginal hysterectomy for benign pathology. Curr Opin Obstet Gynecol. 2010;22:304-8.
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 Systematic Reviews. 2015(8).
Reich H. Laparoscopic hysterectomy. Surg Laparosc Endosc. 1992;2(1):85-8.
Reich H, De Caprio J, Mc Glynn F. Laparoscopic hysterectomy. J Gyneocol Surg. 1989;5:213-6.
Fawole AO, Awonuga DO. Gynaecological emergencies in the tropics: recent advances in management. Ann Ibad Postgrad Med. 2007;5(1):12-20.
Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, et al. Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Amer J obstet Gynecol. 2002;187(6):1561-5.
Asnafi N, Hajian K, Abdollahi A. Comparison of complications in abdominal hysterectomy versus vaginal hysterectomy. J Reprod Infertil. 2004;5(4).
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.
Zhu L, Lang JH, Liu CY, Shi HH, Sun ZJ, Fan R. Clinical assessment for three routes of hysterectomy. Chines Med J. 2009;122(4):377-80.
Ng CC, Chern BS. Total laparoscopic hysterectomy: a 5-year experience. Arc Gynecol Obstet. 2007;276(6):613.
Kovac SR. Clinical opinion: guidelines for hysterectomy. Am J Obstet Gynecol. 2004;191:635-40.
Sutasanasuang S. Laparoscopic hysterectomy versus total abdominal hysterectomy: a retrospective comparative study. J Med Assoc Thai. 2011;94:8-16.
Bolke JM. Laparoscopic assisted vaginal hysterectomy in a university hospital: a report of 82 cases in comparison with abdominal and vaginal hysterectomy. Am J Obstet Gynecol. 1993;168:1690-701.