Hysterectomy comparison of laparoscopic assisted vaginal versus total abdominal hysterctomy

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. 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. Randomized trial. This study was carried out in the department of obstetrics and gynaecology, Shaikh Zayed Hospital, Lahore. Six months [15th September, 2008 to 15th March 2009]. 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. 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 Aand 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 Awas 105.13+6.55 minutes and 83.38+14.82 minutes in group B. The mean blood loss in group Awas 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. 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