English

Abstract

BACKGROUND: Hysterectomy is one of the most commonly performed obstetrics and gynecology surgical procedure worldwide, second only to cesarean section. Even with use of conservative therapies, approximately 6 lakh hysterectomies are performed each year in United States. MATERIAL AND METHODS: This was a comparative cross sectional study conducted in the Department of Obstetrics and Gynecology of Chirayu Medical College and Hospital, Bhopal from Jan 2011 to June 2013. A total of 50 patients were selected in each group using inclusion and exclusion criteria. Statistical software (SPSS version 20) was used to analyze the data and level of significance for all types of analytical data was set at 0.05 and p value less than 0.05 was considered significant. RESULTS: 64% patients in our study were in age group 36-45 years with mean age of 43.2 years and most of them were multiparous. Six patients were nulliparous with symptomatic large fibroids and failed medical management. Abnormal Uterine Bleeding (AUB) was the most common indication (43.3%)followed by fibroid uterus(33.3%) and pelvic pain(23.3%).The mean size of uterus in our study was 8.87weeks.The mean operation time was significantly higher in laparoscopic method than other routes (P <0.05).Among the intra operative complications two(1.3%) patients of abdominal hysterectomy with severe endometriosis had bladder injury and one(0.66%) patient of laparoscopic hysterectomy had ureteric injury diagnosed 10 days later. The intraoperative blood loss was significantly lower in LAVH (Laparoscopic Assisted Vaginal Hysterectomy) than NDVH (Non Descent Vaginal Hysterectomy) and AH (Abdominal Hysterectomy) (P <0.05). In AH group, the requirement of blood transfusion, occurrence of febrile morbidity, paralytic ileus and wound dehiscence was much higher. These post-operative complications was much lesser in LAVH group than NDVH and AH and day of discharge was much earlier in LAVH patients. CONCLUSION: Laparoscopic hysterectomy is associated with short hospitalization, less intra operative and post-operative morbidity, quicker recovery, and early mobilization and is easy to perform especially in cases of previous laparotomies, big fibroids, and big ovarian and adnexal tumors.