Surgical approach to hysterectomy for benign gynaecological disease

Return to normal daily activities is shorter after vaginal hysterectomy compared to abdominal hysterectomy and may be shorter after vaginal hysterectomy compared to laparoscopic hysterectomy in benign gyaecological diseases. There may be no difference between the vaginal and laparoscopic hysterectomy. Compared to abdominal hysterectomy, laparoscopic approach appears to have shorter return to daily activities but the operation time may be longer and there may be a greater risk of urinary tract injuries.

A Cochrane review (abstract , review ) included 47 studies with a total of 5 102 subjects. The benefits of vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) were shorter duration of hospital stay (MD 1.1 day, 95% CI 0.9 to 1.2 days; 4 trials, n=295), speedier return to normal activities (MD 9.5 days, 95%CI 6.4 to 12.6 days; 3 RCTs, n=176, statistical heterogeneity I² = 75%). The benefits of laparoscopic hysterectomy (LH) versus abdominal (AH) were 2=58%) and a smaller drop in haemoglobin level (MD 0.55g/L, 95% CI 0.28 to 0.82g/L), "?>shorter duration of hospital stay (MD 2.6 days, 95% CI 1.1 to 4.1 days; 4 trials, n=466, I² = 94%), speedier return to normal activities (MD 13.6 days, 95% CI 11.8 to 15.4 days; 6 RCTs, n=520, low quality evidence, at the cot of longer operation timeI² = 71%)2=96%) "?>, but more urinary tract (bladder or ureter) injuries (OR 2.41, 95% CI 1.2 to 4.8; 13 RCTs, n=2140, I²=0%, low quality evidence). 2=54%) and shorter operation time (MD 25.3 minutes, 95% CI 10.0 to 40.6 minutes). "?>There was no evidence of benefits of laparoscopic versus vaginal hysterectomy (16 RCTs, n=1440). There was a trend of shorter return to normal activites, shorter operation time, and lower costs in the vaginal group compared to the laparoscopic group2=91%) as well as substantial bleeding (OR 2.76, 95% CI 1.02 to 7.42) were increased in LH"?>. For some important outcomes, the analyses were underpowered to detect important differences or they were simply not reported in trials.

Authors' comment: The surgical approach to hysterectomy is best decided by a woman in discussion with her surgeon in light of the relative benefits and hazards.

Ədəbiyyat

1. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009;(3):CD003677 [Assessed as up-to-date: 14 August 2014].