HYSTERECTOMY

COMPARISON OF LAPAROSCOPIC ASSISTED VAGINAL VERSUS TOTAL ABDOMINAL HYSTERECTOMY

Abstract

Abdominal hysterectomy, the procedure by which almost 90% of hysterectomies are currently being done. Laparoscopic
assisted vaginal hysterectomy has been introduced as an alternative to abdominal hysterectomy, and is thought to allow a more rapid return to
normal activity. Laparoscopic assisted vaginal hysterectomy has less postoperative morbidity and quicker recovery than abdominal
hysterectomy. Objective: To compare the laparoscopic assisted vaginal hysterectomy with total abdominal hysterectomy in term of operative
time, per operative blood loss and post-operative wound infection. Study Design: Randomized trial. Setting: This study was carried out in the
department of obstetrics and gynaecology, Shaikh Zayed Hospital, Lahore. Period: Six months (15th September, 2008 to 15th March 2009).
Patients and methods: Eighty patients fulfilling the inclusion criteria were selected for this study. Patients were equally divided in two groups;
group A (laparoscopic assisted vaginal hysterectomy) and group B (total abdominal hysterectomy). Operative time (in minutes), blood loss (in
ml) as estimated and post-operative wound infection was assessed by presence or absence of wound discharge, redness and edema around
the incision on 3rd, 5th and 7th post-operative day. Results: The mean ages of women in group A was 49.13+4.26 and 45.68+4.54 years in
group B. The maximum number of parity between 3-4 was 19 in group A and 20 in group B. Mean weights of cases in group A was 65.60+10.45
kilograms and 70.77+15.59 kilograms in groups B. The per-operative time in group A was 105.13+6.55 minutes and 83.38+14.82 minutes in
group B. The mean blood loss in group A was 178.0+43.51 ml and 228.25+72.49 ml in group B. The wound discharge was not found in group A,
while in group B, 4 cases (10%) on 3rd post-operative day, 6 cases (15%) on 5th post-operative day and 11 cases 27.5% on 7th post-operative.
Conclusions: Laparoscopic assisted vaginal hysterectomy has a quicker post-operative recovery but at the expense of a bit long duration of
surgery. Laparoscopic vaginal assisted hysterectomy is a feasible option in a selected group of patients who would otherwise require an
abdominal hysterectomy. The drug requirement to control pain and level of pain experienced by patients were also significantly less.