Comparison between Laparoscopic, Abdominal, and Vaginal Hysterectomy in the Treatment of Gynecological Disease: A Retrospective Review Over Five Years

Abstract

Background: Hysterectomy is one of the most common gynecological surgery worldwide. It is usually performed through the abdominal, vaginal or laparoscopic routes. The objective of this study was to evaluate the role of laparoscopic, vaginal and abdominal hysterectomy in the management of gynecological conditions in terms of operative outcomes, such as operating time and estimated blood loss, as well as complication rates. Methods: This was a retrospective cohort study carried out over a 5-year period (2016-2020) at Zahraa University Hospital. Patients who underwent abdominal vaginal, and laparoscopic hysterectomies performed for the treatment of multiple gynecological disease during that period were included. Results: A total of 222 patients were included in the study, 168 (75.7%) patients in the abdominal hysterectomy group, 7 (3.2%) in the vaginal group, and 47 (21.1%) in the laparoscopic group. The mean age was 49.83±9.28 years for the abdominal, 67.14±13.79 for the vaginal, and 47.26±6.77 years for the hysterectomy groups. The most common indication for hysterectomy was the presence of uterine fibroids in the abdominal and laparoscopic groups (47.6% vs. 31.9% respectively) whereas it was pelvic organ prolapse for all patients in the vaginal group. Around 18% in the abdominal group had abnormal uterine bleeding compared to 6.4% in the laparoscopic group. Endometrial hyperplasia was the indication for 9.5% of the patients in the abdominal group while it was 25.5% for the laparoscopic group. Surgery duration was significantly the shortest for abdominal hysterectomy (2.30±0.92 hours), followed by vaginal hysterectomy (2.86±0.24 hours), and the longest was for laparoscopic hysterectomy (4.14±0.90 hours) (p-value<0.0001). The size of the uterus was slightly larger in the abdominal hysterectomy group though the difference was not significantly different. There were no significant differences in pre- and post-operative hemoglobin, or in estimated blood loss among the groups. There were no complications in the vaginal group. The rate of complications was similar between the abdominal and laparoscopic groups (15.5% vs. 17.0% respectively). The most common type of intraoperative complication in the abdominal group was bleeding requiring transfusion (34.6%), followed by bladder injury (11.5%). Only one patient in the laparoscopic group had intra-operative complication (bladder injury). As for post-operative complications, urinary retention and pyrexia related to wound infection were the most common in the abdominal group (7.7%). Seven patients in the laparoscopic group had post-operative complications. Most patients were readmitted to the hospital (98.8% vs. 100.0% vs. 95.7% in the abdominal vs. vaginal vs. laparoscopic groups respectively). Conclusion: Laparoscopic hysterectomy is associated with less morbidity, and shorter hospital stay than the other techniques, but it has longer operating time and requires laparoscopic instrument and surgical skills. Advances in equipment, surgical techniques, and training make laparoscopic hysterectomy an efficient and well-tolerated technique.