Utility of laparoscopic hysterectomy compared to vaginal and abdominal hysterectomy for benign gynecological conditions

Abstract

In spite of availability of procedures which are less invasive for hysterectomy, some prefer abdominal approach for the hysterectomy (TAH). Laparoscopic hysterectomy (TLH) is useful for the patients, as they recover fast and the convalescence period is reduced.To compare and evaluate three different methods of hysterectomy for benign gynecological disorders with regard to time for recovery, outcome after surgery, cost-effectiveness and complications due to surgery.Prospective study conducted on 90 patients who underwent hysterectomy for benign gynecological conditions. Patients were assigned to either TAH (n=30), TLH (n=30) or Vaginal hysterectomy (VH) (n=30), with or without salpingo-oophorectomy. All patients presenting in the gynecology OPD with indications for hysterectomy with or without salpingo-oophorectomy were included. Pre-operative parameters like age, basal metabolic index, intra-operative and post-operative parameters like reduction in hemoglobin etc. were compared in three groups.The mean blood loss, Time from surgery to tolerance of normal diet (days), Time from surgery to unassisted ambulation (days), post-operative pain score on day 3, mean reduction in hemoglobin and duration of hospital stay (days) were significantly (p<0.05) higher in patients who underwent total abdominal hysterectomy compared to total laparoscopic or vaginal hysterectomy. In terms of intra-operative and post-operative complications, operative time, hospital bill and satisfaction score the differences were not significant statistically (p>0.05). Total laparoscopic hysterectomy and vaginal hysterectomy are safe and less invasive alternative, compared to abdominal hysterectomy, and show significantly better post-operative reconstitution