Comparison of perioperative outcomes of different routes of hysterectomies- total abdominal, vaginal and laparoscopic, in a tertiary care hospital in Karachi, Pakistan
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20230912Keywords:
Hysterectomy, Routes of hysterectomy, Complications, Length of stayAbstract
Background: This study was conducted to compare the perioperative findings among women undergoing hysterectomy by abdominal (TAH), vaginal (VH) and laparoscopic (TLH) routes.
Methods: A 5-year cross-sectional survey was conducted at the Aga Khan University Hospital from January 2015-December 2020 to compare perioperative outcomes of the different routes of hysterectomies. Medical record review of 385 patients who underwent hysterectomy for benign conditions were reviewed and analysed, out of which 195 (50.6%) underwent TAH, 96 (24.9%) VH and 94 (24.4%) were operated laparoscopically. Patients with uncontrolled medical comorbid, history of 2 or more abdominal surgeries and uterine size of more than 14 weeks were excluded from the study.
Results: revealed significant difference between the mean hospital stay of patients with TAH having the highest mean stay in days (TAH=4.8±1.01, VH=4.4±0.7 and TLH=3.9±0.82 in days; p<0.01) TLH took comparatively significantly longer operating time than TAH (p=0.0005) and VH groups (p=0.004) however, median estimated blood loss was significantly lower in women who underwent TLH as compare to TAH [median (25th-75th percentile); 100 (50-200)] versus 300 (200-500); p<0.01] and VH [100 (50-200)] versus 250 (100-400); p<0.01]. The incidence of post-operative complications was less than 3% and these were observed in women underwent TAH.
Conclusions: VH and TLH have lesser complications and hospitalization days as compared to TAH, making these 2 methods superior. Informed decision making by patient and surgeon’s training together can account for choosing the best method of hysterectomy suitable to the patient.
References
Singh A, Govil D. Hysterectomy in India: Spatial and multilevel analysis. Women’s Health. 2021;17:17455065211017068.
Madueke-Laveaux OS, Elsharoud A, Al-Hendy A. What we know about the long-term risks of hysterectomy for benign indication- a systematic review. J Clin Med. 2021;10(22):5335.
Al Hasan J, Mousa M, Haroun Z, Ghazal K. Comparison between laparoscopic, abdominal, and vaginal hysterectomy in the treatment of gynecological disease: a retrospective review over five years. Int J Women’s Health Care. 2021;6(2):182.
Temkin SM, Kohn EC, Penberthy L, Cronin KA, Rubinsak L, Dickie LA, et al. Hysterectomy-corrected rates of endometrial cancer among women younger than age 50 in the United States. Cancer Causes Control. 2018;29(4):427-33.
Lee NC, Dicker RC, Rubin GL, Ory HW. Confirmation of the preoperative diagnoses for hysterectomy. Am J Obstet Gynecol. 1984;150(3):283-7.
Lee SH, Oh SR, Cho YJ, Han M, Park JW, Kim SJ, et al. Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis. BMC Women’s Health. 2019;19(1):1-12.
Advincula AP. Vaginal hysterectomy: historical footnote or viable route?. Obstet Gynecol. 2020;135(4):759-60.
Lirk P, Thiry J, Bonnet MP, Joshi GP, Bonnet F. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med. 2019;44(4):425-36.
Madhvani K, Curnow T, Carpenter T. Route of hysterectomy: a retrospective, cohort study in English NHS Hospitals from 2011 to 2017. BJOG. 2019;126(6):795-802.
Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013;121(3):654-73.
Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol. 2008;198(1):34.e1-7.
Panda S, Behera AK, Jayalakshmi M, Narasinga Rao T, Indira G. Choosing the route of hysterectomy. J Obstet Gynecol India. 2015;65:251-4.
Kilicci C, Bostanci E, Polat M, Aysen B, Abide CY. Comparison of cost-effectiveness and clinical outcomes of abdominal, vaginal and total laparoscopic hysterectomy in a selected group. Zeynep Kamil Tıp Bülteni. 2018;49(1):24-7.
Aboulfotouh ME, Chaalan F, Mohammed AF. Laparoscopic hysterectomy versus total abdominal hysterectomy: a retrospective study at a tertiary hospital. Gynecol Surg. 2020;17:1-5.
Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patient characteristics or physician preference? Am J Obstet Gynecol. 1995;173(5):1452-60.
Davies A, Hart R, Magos A, Hadad E, Morris R. Hysterectomy: surgical route and complications. Eur J Obstet Gynecol Reprod Biol. 2002;104(2):148-51.
Lim CS, Mowers EL, Mahnert N, Skinner BD, Kamdar N, Morgan DM, et al. Risk factors and outcomes for conversion to laparotomy of laparoscopic hysterectomy in benign gynecology. Obstet Gynecol. 2016;128(6):1295-305.
Malik KN, Afridi H, Riaz B, Shadab W, Afridi IUK. Outcome of total laparoscopic hysterectomy in adult females with benign uterine pathology. Pak J Med Health Sci. 2023;17(01):100.
Carrubba AR, Whitmore GT, Radhakrishnan SJ, Sheeder J, Muffly TM. Postoperative infections in women undergoing hysterectomy for benign indications: a cohort study. Minerva Ginecol. 2019;71(4):263-71.
Thirukumar M. Trends of Hysterectomy in Tertiary Care Teaching Hospital Batticaloa. Sch J Appl Med Sci. 2017;5(11E):4666-71
Moen MD, Noone MB, Elser DM, Network U. Natural orifice hysterectomy. Int Urogynecol J. 2008;19(9):1189-92.
