Publication:

A comparative evaluation of clinical outcome of trans-abdominal hysterectomy, total laparoscopic hysterectomy and vaginal hysterectomy in non-descent cases

Background Hysterectomy is the most common operation performed by the gynaecologists and second most common surgery done after caesarean section all over the world. The objective of this study was to compare the clinical outcome in cases of trans-abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH).

Methods It was a prospective comparative study conducted from November 2013 to June 2015 at Deen Dayal Upadhyay hospital in the department of obstetrics and gynaecology after approval by the ethical committee of the hospital. Intra-operative and post-operative clinical outcome of abdominal, laparoscopic and non-descent vaginal hysterectomies were compared during the study period. The patients were followed for a period of six months after surgery.

Results During the study period we selected total 90 patients as per our inclusion criteria. Among 90 patients, 30 patients underwent total abdominal hysterectomy, 30 total laparoscopic hysterectomy and 30 non-descent vaginal hysterectomy. Patients were allocated to one of the surgical procedures by closed-envelope method. Commonest indication for hysterectomy in our study was dysfunctional uterine bleeding (52.2%). Mean operating time in the TAH, TLH and NDVH group was 126.5±49.8 minutes, 142.3±33.7 minutes and 97.3±23.73 minutes respectively. Mean blood loss in the TAH, TLH and NDVH groups was 319±82.6 ml, 142.2±72.9 ml and 201.7±49.3 ml respectively. Intra-operative complications including haemorrhage, bladder and ureteric injury were maximum in the TAH group (6 patients) and minimum in the NDVH group (2 patients only). Post-operative complications including anaemia, febrile morbidity, wound infection and need for blood transfusion was maximum in the TAH group and minimum in the NDVH group.

Conclusions From the above results it can be concluded that NDVH should be the procedure of choice unless contra-indicated because of it being least time consuming and associated with least intra-operative and post-operative complication rate in addition to being cost-effective and cosmetically appealing.