DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182334

Comparative study of peri-operative outcome following laparotomy versus laparoscopic technique of abdominal hysterectomy for benign gynaecological lesions

Satyajit P. Gavhane, Dhruval K. Bhavsar, Vidyadhar B. Bangal, Swati D. Gagare, Amey R. Kodlikeri

Abstract


Background: Laparoscopic technique of hysterectomy is becoming increasingly popular in developing and developed world. Laparoscopic hysterectomy is a minimal access procedure that allows patients to recover faster. The study was undertaken to assess the impact of two abdominal techniques (laparoscopic and conventional laparotomy) on various variables like operative time, hospital stay, complications and convalescence period.

Methods: An observational longitudinal study was carried out at tertiary care centre. Two hundred and ten women, as per inclusion and exclusion criteria, who had undergone abdominal hysterectomy for benign uterine pathology, either by laparotomy (Group A) or by laparoscopic technique (Group B) during study period were included. Data was analyzed and compared by using different variables between two methods of hysterectomy, using percentages and Chi square test for normal distribution. P value less than 0.05 was considered significant.

Results: The mean duration of surgery was 100 minutes in group A and 175 minutes in Group B. There were two cases (1.90%) of minor injury to urinary bladder in Group A and one case (0.95%) of thermal injury to urinary bladder in Group B. The mean blood loss was around 240 ml and 70 ml in Group A and B respectively. The need for postoperative analgesia was observed in 100% cases from Group A and 38.09% from group B. The average duration required for out of bed ambulation was 25 hours and 14 hours in Group A and B respectively. The mean hospital stay in group A and B was 7.5 days and 3.5 days respectively.

Conclusions: Following laparoscopic hysterectomy, women had less morbidity, less need for post-operative pain relief, had early ambulation, short hospital stay and early resumption of routine activities at home as compared to women who had undergone abdominal hysterectomy by conventional method.


Keywords


Abdominal hysterectomy, Complications of hysterectomy, Laparoscopic hysterectomy, Surgical site infections

Full Text:

PDF

References


Dicker RG, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, DeStefano F, Rubin GL, Ory HW. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The collaborative review of sterilization. Am J Obstet Gynecol. 1982;144:841-8.

Easterday CL, Grimes DA, Riggs JA. Hysterectomy in the United States. Obstet Gynecol. 1983;62:203-12.

Luoto R, Kaprio J, Keskimäki I, Pohjanlahti J-P, Rutanen E-M. Incidence, causes and surgical methods for hysterectomy in Finland, 1987-1989. Int J Epid. 1994;23:348-58.

Davies A, Vizza E, Bournas N, O'Connor H, Magos A. How to increase the proportion of hysterectomies performed vaginally. Am J Obstet Gynecol. 1998;179:1008-12.

Garry R. Towards evidence-based hysterectomy. Gynaecol Endosc. 1998;7:225-33.

Graves EJ. National hospital discharge survey: annual summary, 1990. Vital Health Stat. 1992;13:112.

Ellstrom M, Ferraz- Nunes J, Hahlin M, Olsson JH. A randomized trial with a cost consequence analysis after laparoscopic and abdominal hysterectomy. Obstet Gynecol. 1998;91:30-4.

Van Den Eeden SK, Glosser M, Mathias SD, Calwell HH, Pasta DJ. Kunz K. Quality of life, health care utilization, and cost among women undergoing hysterectomy in a managed care setting. Am J Obstet Gynecol. 1998;178:91-100.

Tammaso Falcone, Marie Fidele R. Paraiso, Edward Marscha Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy. Am J ObstetGynecol. 1999;180:955-62.

Reich h, De Capro J, Mc Glynn F. Laparoscopic hysterectomy. J GynecolSurg. 1989; 5:213-16.

Nezhat F, Nezhat C, Gordon S, Wilkins E. Laparoscopic versus abdominal hysterectomy. J Reprod Med. 2002b;37:247-50.

Summitt RL, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstet Gynecol. 2002;80:895-901.

Phipps JH, Nayak JS. Comparison of laparoscopically assisted vaginal hysterectomy and bilateral salpingo-ophorectomy with conventional abdominal hysterectomy and bilateral salpingo-ophorectomy. Br J Obstet Gynaecol. 2003;100:698-700.

Raju KS, Auld BJ. A randomized prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy. Br J Obstet Gynaecol. 2004;101:1068-71.

Richardson RE, Bournas N, Magos AL. Is laparoscopic hysterectomy a waste of time? Lancet. 2005;345:36-41.

Langebrekke A, Eraker R, Nesheim B-I, Urnes A, Busund B, Sponland G. Abdominal hysterectomy should not be considered as a primary method for uterine removal. A prospective randomised study of 100 patients referred to hysterectomy. Acta Obstet Gynecol Scand. 1996;75:404-7.

Olsson J-H, Ellström M, Hahlin M. A randomised trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103:345-50.

Summitt RL, Stovall TG, Steege JF, Lipscomb GH. A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates. Obstet Gynecol. 1998;92:321-6.

Yuen PM, Mak TWL, Yim SF, NganKee WD, Lam CWK, Rogers MS, Chang AMZ.Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy. Am J Obstet Gynecol. 1998;179:1-5.

Falcone T, Paraiso MFR. Mascha E. Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy. Am J Obstet Gynecol. 1999;180:955-62.

Marana R, Busacca M, Zupi E, Garcea N, Paparella P, Catalano GF. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: A prospective, randomized, multicenter study. Am J Obstet Gynecol. 2001;180:270-5.

Munro MG, Deprest J. Laparoscopic hysterectomy: Does it work?: A bicontinental review of the literature and clinical commentary. Clin Obstet Gynecol. 1995;2:401-25.

Meikle SF, Nugent EW, Orleans M. Complications and recovery from laparoscopy assisted vaginal hysterectomy with abdominal and vaginal hysterectomy. Obstet Gynecol. 2000;89:304-11.

Garry R, Phillips G. How safe is the laparoscopic approach to hysterectomy? Gynaecol Endosc. 2005;4:77-9.

Harris WJ, Daniell JF. Early complications of laparoscopic hysterectomy. Obstet Gynecol Surv. 2006;51:559-67.

Kovac SR, Cruikshank SH, Retto HF. Laparoscopy-assisted vaginal hysterectomy. J Gynecol Surg 1990;6: 185-193.

Boike GM, Elfstrand EP, DelPriore G, Schumock D, Holley HS, Lurain JR. Laparoscopically assisted vaginal hysterectomies in a university hospital: report of 82 cases and comparison with abdominal and vaginal hysterectomy. Am J Obstet Gynecol. 2003;168:1690-701.

Aniuliene R1, Varzgaliene L, Varzgalis M. A comparative analysis of hysterectomies, Medicina (Kaunas). 2007;43(2,:118-24.

Deprest JA, Cusumano PG, Donnez J, Hardy A, Nisolle M, Van Herendael J, Verly M, Koninckx R. 1992 results of the Belcohyst register on laparoscopic hysterectomy. In: Cusumano PG, Deprest JA, eds. Advanced Gynecologic laparoscopy: a practical guide. 1st ed. London: The Parthenon Publishing Group; 2006: 85-98.

Johns DA, Carrera B, Jones J, DeLeon F, Vincent R, Safely C. The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital. Am J Obstet Gynecol. 1995;172:1709-19.

Sheth SS. The place of oophorectomy at vaginal hysterectomy. Br J Obstet Gynaecol 2001;98:662-666.

Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patient characteristics or physician preference? Am J Obstet Gynecol. 2005;173:1452-60.

Chapron C, Dubuisson J-B, Ansquer Y. Hysterectomy for patients without previous vaginal delivery: results and modalities of laparoscopic surgery. Hum Reprod. 2006;11:2122-6.

Kadar N, Pelosi MA. Laparoscopically assisted hysterectomy in women weighing 200lb or more. Gynaecol Endosc. 2004;5:159-62.

Kadar N. Extraperitoneal laparoscopic hysterectomy for the large uterus. Gynaecol Endosc. 2006;5:271-6.

Roushdy M. Vaginally assisted laparoscopic hysterectomy: a technique suited for large uteri. Gynaecol Endosc. 2007;6:95-7.

Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;(8):CD003677.

Bronitsky C, Payne RJ, Stuckey S, Wilkins D. A comparison of laparoscopically assisted vaginal hysterectomy vs traditional total abdominal and vaginal hysterectomies. J Gynecol Surg. 2000;219:224.