Kavi Fatania1, Mathew Vithayathil1, Peter Newbold2, Wai Yoong3. 1. 4th Year Medical Students, UCL School of Medicine, Gower Street, London, UK. 2. Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK. 3. Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK. Electronic address: wai.yoong@nmh.nhs.uk.
Abstract
OBJECTIVE: To compare surgical outcomes in women with enlarged uteri >12 weeks' size who underwent vaginal hysterectomy compared to abdominal hysterectomy for non-prolapse indications. STUDY DESIGN: Retrospective cohort study performed between 2007 and 2012 in a North London teaching hospital. The study group comprised 39 women who had vaginal hysterectomy (VH) with uteri >12 weeks size (200g) for non-prolapse indications. The next successive total abdominal hysterectomy (TAH) following the index case for similar indications (and with similar uterine weights) served as control (n=33). The groups were compared for pre- and post-operative demographic data, and main outcome measures were estimated blood loss, operation time, length of stay and complications. RESULTS: Both VH and TAH groups had statistically similar pre-operative mean haemoglobin levels, age, body mass index, previous abdominal surgery, and American Society of Anesthesiologists (ASA) grade. Mean uterine weight (403.1±239.5 vs 460.5±236.2g) was comparable in both groups (both p>0.05). The mean duration of the procedure was similar (123.5±45.8 vs 119.8±44.9min, p=0.580) but women who had TAH lost 117ml more of blood (525.7±427.6 vs 408.2±411.8ml, p=0.039). Although overall complication rates were comparable between the groups (30.8% vs 36.4%, p=0.627), the mean post-operative stay was 55% shorter following VH (40.7±29.4 vs 90.7±46.2h, p<0.0001). CONCLUSION: In women with non-prolapsed uteri >12 weeks' size, VH is a safe and cost effective option. The vaginal route is associated with significantly lower estimated blood loss and 55% shorter post-operative stay, with no increase in complication rates.
OBJECTIVE: To compare surgical outcomes in women with enlarged uteri >12 weeks' size who underwent vaginal hysterectomy compared to abdominal hysterectomy for non-prolapse indications. STUDY DESIGN: Retrospective cohort study performed between 2007 and 2012 in a North London teaching hospital. The study group comprised 39 women who had vaginal hysterectomy (VH) with uteri >12 weeks size (200g) for non-prolapse indications. The next successive total abdominal hysterectomy (TAH) following the index case for similar indications (and with similar uterine weights) served as control (n=33). The groups were compared for pre- and post-operative demographic data, and main outcome measures were estimated blood loss, operation time, length of stay and complications. RESULTS: Both VH and TAH groups had statistically similar pre-operative mean haemoglobin levels, age, body mass index, previous abdominal surgery, and American Society of Anesthesiologists (ASA) grade. Mean uterine weight (403.1±239.5 vs 460.5±236.2g) was comparable in both groups (both p>0.05). The mean duration of the procedure was similar (123.5±45.8 vs 119.8±44.9min, p=0.580) but women who had TAH lost 117ml more of blood (525.7±427.6 vs 408.2±411.8ml, p=0.039). Although overall complication rates were comparable between the groups (30.8% vs 36.4%, p=0.627), the mean post-operative stay was 55% shorter following VH (40.7±29.4 vs 90.7±46.2h, p<0.0001). CONCLUSION: In women with non-prolapsed uteri >12 weeks' size, VH is a safe and cost effective option. The vaginal route is associated with significantly lower estimated blood loss and 55% shorter post-operative stay, with no increase in complication rates.