Laparoscopic hysterectomy versus total abdominal hysterectomy: a retrospective comparative study.

OBJECTIVE: To compare the efficacy of total laparoscopic hysterectomy (TLH) patients in result and safety compare to those of total abdominal hysterectomy (TAH).
DESIGN: Retrospective comparative study.
SETTING: Department of Obstetrics and Gynaecology, Somdejprasangkharaj 17th Hospital, Suphanburi.
SUBJECTS: Thirty TLH patients and thirty TAH controls who were operated on between June 2006 and May 2010. MATERIAL AND
METHOD: Special data forms which were designed to collect the data of all patients involved in the present study were reviewed and analysed Subjects were divided into two groups, 30 TLH and 30 TAH patients with matched to cases regard to time of the operation of TAH done before or next patients within 2 weeks, age (+/- 5 years) and body weight (+/- 10 kg). MAIN OUTCOMES: Amount of estimated blood loss, operative times, postoperative analgesic dosage, pain score (Verbral numeric score = VNS), length of hospital stay, intraoperative and postoperative complications.
RESULTS: There were no differences in demographic characteristics variable between the two groups. The indications were benign condition that could be treated by hysterectomy with or without salpingo-oophorectomy (SO) or bilateral salpingooophorectomy (BSO). Mean age of both groups were 47.1 +/- 8.2 years vs. 49.9 +/- 6.3 years, BMI were 22.5 +/- 4.2 vs. 23.8 +/- 5.6, preoperative Hct were 38.4 +/- 6.3% vs. 41.8 +/- 8.5% (no anemia), uterine size less than 12 weeks of gestation (1867 +/- 89.2 gm vs. 223.0 +/- 68.3 gm). Amount of blood loss (389.9 +/- 125.4 cc vs. 275.5 +/- 189.3 cc) and operative time (218.4 +/- 79.3 min vs. 91.1 +/- 53.6 min) in the TLH group there was significantly more loss and longer time than in the TAH group, respectively Dosage of meperidine (95.4 +/- 43.2 mg vs. 2368 +/- 20.7 mg), pain score (5.4 +/- 0.7 vs. 8.7 +/- 1.3), length of hospital stay (3.2 +/- 1.1 d vs. 5.3 +/- 4.3 d) in the TLH group was significantly less than in the TAH group. The overall intraoperative complication rate was 30% (18 cases), the TLH group [43.33% (13 cases)] was significantly more than the TAH group [16.67% (5 cases)]. The overall postoperative complications rate was 45% (27 cases), TLH group [46.65% (14 cases)], TAH group [43.33% (13 cases)] which showed no significant difference. However, no serious complication caused reoperation or readmission. The most complications of the TLH group were 3 cases of vaginal cuff dehiscence, 4 cases of urinary tract infection, and a case of prolonged retaining Foley catheter for 2 weeks, no conversions to TAH No patient in either group required a blood transfusion.
CONCLUSION: Based on the present results, in women with benign disease of pelvic organ, less than 12 weeks of gestation uterus and nonobese. TLH is a safety, efficacy, improvement in the patient r quality of life, cost-effectiveness procedure and also TLH is an alternative to laparotomy. Up-to-date knowledge of TLH procedure provides good outcome, although it takes longer operative time, more blood loss and higher cost. It offers several benefits over TAH such as smaller incision, less postoperative pain, earlier ambulation, shorter hospital stay, faster recovery time and does not increase more serious complications than TAH Its cost effectiveness of TLH relative to the TAH procedure is finely balanced TLH is the alternative and effective choice in the management of benign gynaecologic disease by a well trained gynaecologist and team.