Laparoscopic versus vaginal hysterectomy for benign indications in women aged 65 years or older: propensity-matched analysis.

Abstract

The present study aimed to evaluate surgical operation-related outcomes of laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) for the treatment of benign uterine diseases, other than pelvic organ prolapse, in women aged 65 years or older. Data of women who underwent LH and VH between 2000 and 2013 were compared using propensity-matched analysis. Postoperative complications were graded according to the Accordion Severity Grading. Martin criteria were applied to improve the quality of complications reporting. The study group included 40 propensity-matched participant pairs (80 women) who underwent VH and LH. No significant differences in baseline characteristics were observed between groups. A trend toward longer median operative time was observed in the LH group, in comparison with the VH group (75 [range, 20-340] vs 60 [range, 30-140] min; P = 0.09), whereas LH correlated with shorter hospital stay and lower blood loss in comparison with VH (P < 0.05). One intraoperative complication occurred during VH (bladder injury); no intraoperative complications were recorded in the LH group. No differences in Accordion grade 2 (or worse) postoperative complications were observed (1 of 40 [2.5%] in the LH group vs 3 of 40 [7.5%] in the VH group; P = 0.61; odds ratio, 3.1; 95% CI, 0.3-31.8), and no postoperative deaths occurred. Our findings suggest the noninferiority of LH to VH. LH improves the postoperative course of older women undergoing surgical operation for benign uterine diseases. If an appropriate indication exists, LH should not be denied based on mere chronological age.