Comparative Study between Different Methods of Laparoscopic Hysterectomies

Abstract

Background: Hysterectomy is the second most common major surgical procedure performed on women after caesarean section. The incidence of hysterectomy is 4-6% out of which 90% are performed for benign indications. Aim of the work: The aim of this study was to compare intra- and post-operative morbidity associated with two types of laparoscopic hysterectomy. Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) Patients and methods: A total of 80 women scheduled to undergo a hysterectomy for benign disease were subdivided into 2 groups; 40 women for LAVH and 40 women for TLH, Patients were excluded from the study if they had contraindication to laparoscopy. Intra- and post-operative evaluations including the duration of the operation uterine weight, frequency of intraoperative complication, and the difference between hemoglobin level prior to surgery and one day after surgery. Results: LAVH took the longest operating time. As regard hemoglobin deficit that occurred after 24 hours of surgery, our study showed that TLH had largest Hb deficit (1.6 gm/dl) but still the Hb deficit not significantly different. As regard transfusion of blood, one case took blood in group LAVH and one case in group TLH. As regard other complications, the bladder was injured during plunt dissection of the bladder flap in group TLH and this case was having history of one cesarean section 10 years ago. Conclusion: laparoscopic assisted vaginal hysterectomy showed lower complication but longer operative time than total laparoscopic hysterectomy group; also (LAVH) showed shorter hospital stay and need fewer analgesics so we considered this method the best when the patient accepted total removal of the uterus. While total laparoscopic hysterectomy showed the more blood loss and complication intraoperatively and postoperatiovely, but this complication is non-significant in cases of removal of the hole uterus.