Comparison of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy for Benign Diseases in BMA Medical College and Vajira Hospita

Abstract

Comparison of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy for Benign Diseases in BMA Medical College and Vajira Hospital

Budsaba     Wiriyasirivaj        MD, MSc (Epidemiology), MSc (Clinical Embryology)

Sarwinee    Ratchanon           MD, MSc (Reproductive Biology)

Anusorn      Triwitayakorn      MD

Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital

Objective: To compare the duration of postoperative hospital stay, operative time, operative blood loss, and surgical complications between patients undergoing total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH).

Study design: Retrospective cohort.

Subjects: A total of 150 gynecologic patients, who underwent TLH (n=75) or TAH (n=75) for benign diseases at BMA Medical College and Vajira Hospital between May 2006 and June 2008 were enrolled.

Methods: Data of all patients who underwent TLH during the study period were retrospectively collected from the medical records. Then, data of the patients undergoing TAH consecutively to each TLH case, who had similar preoperative diagnosis and comparable uterine size (i.e. difference of uterine size less than4 weeks of gestation), were obtained.

Main outcome measures: Postoperative hospital stay, operative time, operative blood loss, and surgical complications.

Results: Baseline characteristics of both groups including age, body mass index, uterine size, diagnosis, history of previous abdominal surgery, concurrent gynecologic surgery were not significantly different. Mean postoperative hospital stay of TLH group was significantly shorter than TAH group (3.1 ± 1.0 days vs 4.3 ± 1.0 days, p-value < 0.001). Mean operative time of TLH group was significantly longer than TAH group (299.6 ± 31.8 minutes vs 117.3 ± 30.4 minutes, p-value < 0.001). Mean operative blood loss in TLH group was significantly less than TAH group (270.1 ± 27.1 ml vs 351.1 ± 30.5 ml, p-value = 0.049). Proportion of postoperative meperidine requirement and mean meperidine use in TLH group were significantly less than those in TAH group (78.7 % vs 93.3 %, p-value = 0.010 and 60.0 ± 44.8 mg vs 104.0 ± 55.6 mg, p-value < 0.001). For major surgical complications, there was one case of urinary bladder injury in TLH group but none in TAH group. Blood transfusion and minor surgical complications i.e. postoperative fever, abdominal wound infection, and vaginal cuff infection were not significantly different in both groups.

Conclusion: In comparison to TAH, TLH had shorter postoperative hospital stay, less operative blood loss, and less postoperative meperidine requirement but had longer operative time. Major surgical complication was few and should be further evaluated. Minor surgical complications of TLH were not significantly different from TAH.

Vajira Med J 2009 ; 53 : 7 - 16