Abstract
BackgroundDecreased ovarian function and reserve is one of the complications of hysterectomy. In this study, we aimed to compare anti-müllerian hormone (AMH) levels between total abdominal hysterectomy (TAH), and total laparoscopic hysterectomy (TLH).MethodsIn this prospective cohort study, serum levels of AMH were compared between the groups undergoing TAH + bilateral salpingectiomy and TLH, in 66 patients (33 in each group) who referred to the hospitals of Shiraz University of Medical Sciences for hysterectomy during one years of work. The collected information included age, weight, gravidity, parity, regularity of menstrual cycle, uterine weight, blood loss during surgery, and serum levels of AMH before and 6 months after surgery, compared between groups.ResultsMost patients (88% in TAH and 73% in TLH group) aged 40–50 years. Mean age, weight, parity of patients was similar in both groups, while blood loss was significantly less in TLH group (P < 0.01). Median (IQR) of pre-surgical AMH values were 0.40 (0.55) ng/ml in the TLH group and 0.92 (1.23) ng/ml in the TAH group (P = 0.12) that decreased to 0.29 (0.44) ng/ml in the TLH group and 0.15 (0.31) ng/ml in the TAH group (P = 0.02). Also Median (IQR) of the difference between pre and post-surgical AMH values were 0.12 (0.31) and 0.58 (1.17) in TLH and TAH group, respectively (P = 0.003).ConclusionThe serum levels of AMH decreased significantly after both methods of hysterectomy (laparoscopy and laparotomy), while this decrease was greater in TAH group that shows.
Highlights
Decreased ovarian function and reserve is one of the complications of hysterectomy
The inclusion criteria consisted of women who referred to the hospitals of Shiraz university of Medical Sciences with abnormal uterine bleeding (AUB) without anatomical or hormonal reasons with uterine size less than 12 weeks, weight less than 600 g [23, 24], and have not responded to medical treatment were scheduled for abdominal or laparoscopic hysterectomy who had not taken any hormonal medication for at least two months before surgery
The baseline and surgical characteristics of patients were similar in both groups, including mean age, weight, parity, uterine weight and baseline anti-müllerian hormone (AMH) levels (P > 0.05), while blood loss was significantly less in total laparoscopic hysterectomy (TLH) group (P < 0.01) (Table 1)
Summary
Decreased ovarian function and reserve is one of the complications of hysterectomy. In this study, we aimed to compare anti-müllerian hormone (AMH) levels between total abdominal hysterectomy (TAH), and total laparoscopic hysterectomy (TLH). Hysterectomy is the most common gynecological surgery and the second most common surgery in women, after cesarean section [1, 2]. It is used for a wide range of gynecological symptoms and diseases, such as abnormal uterine bleeding, pelvic pain, and myomatous uterus [3, 4]. Different techniques are used for hysterectomy, including total abdominal hysterectomy (TAH), vaginal hysterectomy, and total laparoscopic hysterectomy (TLH) [7]. Some studies suggest higher intra-operative complications, less postoperative pain, and higher quality of life in laparoscopic methods [9], while other studies report no differences in the major complications [8, 10], quality of life and sexual function among different techniques of hysterectomy [11]
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