BY Dr. Anita Kant
Vaginal hysterectomy, performed for a benign gynecologic disease is associated with less operative time, fewer complications and speedier recovery, even though patients had more postoperative pain on the day of surgery, when compared to laparoscopic hysterectomy, according to a study published in the December 2023 issue of the journal Obstetrics & Gynecology.1
This systematic review and meta-analysis aimed to compare the outcomes in women who underwent laparoscopic hysterectomy and vaginal hysterectomy for a benign gynecologic disease. A total of 23 randomized controlled trials published between 2000 and February 2023 were included in the study following a search of major databases, including PubMed, Scopus, Web of Science, ClinicalTrials.gov, and the Cochrane Library. Out of the 2408 subjects included in the study, 1105 had undergone vaginal hysterectomy and 1303 had undergone laparoscopic hysterectomy.
When the two groups were compared, participants in the vaginal hysterectomy group had fewer postoperative urinary tract infections (UTIs) with odds ratio (OR) of 1.73. The blood loss during the surgery was also lower in this group. The mean difference in blood loss was -68. Although the total duration of surgery including the recovery time were shorter with vaginal hysterectomy, patients experienced greater postoperative pain on the day of surgery. Other complications such as need for conversion to laparotomy, visceral organ damage, or wound dehiscence, were rare.
These findings suggest that vaginal hysterectomy could be the preferred surgical approach for a benign gynecologic disease condition such as leiomyoma, adenomyosis, uterine prolapse. Nevertheless, the decision to opt for a particular surgical approach of hysterectomy, minimally invasive or abdominal, should be based on the individual patient after a careful risk-benefit analysis.
The American College of Obstetricians and Gynecologists (ACOG) also recommends vaginal hysterectomy as “the approach of choice whenever feasible”. It recommends laparoscopic hysterectomy as the preferred approach in patients in whom the vaginal route is not possible.2
References
- Azadi A, et al. Vaginal hysterectomy compared with laparoscopic hysterectomy in benign gynecologic conditions: a systematic review and meta-analysis. Obstet Gynecol. 2023 Dec 1;142(6):1373-1394. doi: 10.1097/AOG.0000000000005434.
- Committee Opinion No 701: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017 Jun;129(6):e155-e159. doi: 10.1097/AOG.0000000000002112.
Dr. Anita Kant Chairman & Head Department of Gynae & Obstetrics, Asian Institute of Medical Sciences, Faridabad