Vaginalna histerektomija u poređenju sa abdominalnom i laparoskopskom histerektomijom kod pacijentkinja bez prolapsa uterusa

Abstract

Introduction: Except for the uterine prolapse indication, vaginal hysterectomy has been less popular than abdominal hysterectomy because the latter is considered safer and easier and surgeons often lack sufficient experience on the former. This study aims at comparing a group of patients without prolapse who underwent vaginal hysterectomy to another group of patients who underwent abdominal and laparoscopic hysterectomies with respect to intraoperative and early postoperative complications. Materials and Methods: We retrospectively reviewed the files of patients who presented to the gynecology outpatient clinic of Ondokuz May2s University (OMU), Turkey, between January 2013 and February 2018 and for whom hysterectomy was decided due to benign indications other than uterine prolapse. A total of 105 patients, 35 from each of the groups who underwent abdominal, laparoscopic and vaginal hysterectomies, were included in the study. The vaginal hysterectomy group was compared to the abdominal and laparoscopic hysterectomy patient groups with respect to duration of operation, decrease in hematocrit, blood transfusion, duration of hospitalization, hospital expenses, postoperative pain, wound site infection, and complications of intestine, bladder and ureter. Results: No statistically significant differences were found between the demographic characteristics of the groups. Vaginal hysterectomy was shown to be superior to laparoscopic and abdominal hysterectomies with respect to mean duration of operation (p < 0.005), decrease in hematocrit showing the amount of bleeding (p < 0.005), duration of hospitalization (p < 0.005), hospital expenses (p < 0.005) and amount of postoperative analgesic need (p < 0.005). Wound site infection was found more in abdominal hysterectomy than in vaginal and laparoscopic hysterectomies (p < 0.005). No statistically significant difference was found between vaginal, abdominal and laparoscopic hysterectomies with respect to blood transfusion and complications of intestine, bladder and ureter (p > 0.005). Conclusion: The most important factor in choosing a hysterectomy method is the experience of the surgeon. However, vaginal hysterectomy should be the primarily preferred method, if possible, for being more advantageous in many respects.