Deciding the Appropriate Route and Method of Hysterectomy for Women with Benign Diseases: A Cross-sectional Study at a Tertiary Care Hospital, India

Abstract

Introduction: Different factors may influence the route of hysterectomy for benign indications. Each of the three main approaches of hysterectomy has its own set of risks and benefits. A rational and evidence-based decision to select a right method for a particular patient is necessary to bring about the best possible outcome with least complications. Aim: To compare three groups of hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH), Non-descent Vaginal Hysterectomy (NDVH) and Total Laparoscopic Hysterectomy (TLH), with regard to the patient and clinical factors, surgical outcomes and complications, in order to decide the optimum route and method of hysterectomy in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, 120 women, with 40 patients each in the TAH, NDVH and TLH groups, were admitted due to benign gynaecological conditions in a tertiary care hospital in Kolkata, India from May 2013 to April 2014. They were operated, and then followed-up at 6-12 weeks after surgery. All the relevant information, e.g., clinical diagnosis, operating time, intraoperative blood loss, length of stay in hospital, postoperative pain score, intraoperative and postoperative complications, etc., were recorded. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: The most common indication for hysterectomy was benign diseases in all the groups, 47.5%, 40% and 37.5%, respectively in the TAH, NDVH and TLH groups. The mean operating time (minutes) was significantly higher in the TLH group (163.5) as compared to the TAH (75.03) and NDVH groups (84.88) (p=0.039). A significantly lesser mean intraoperative blood loss (mL) was observed in the NDVH (85.67) and TLH groups (98.63) as compared to the TAH group (168.47) (p=0.021). The observations in regard to other surgical outcome parameters, i.e., postoperative pain score, hospital stay, were also favourable in the NDVH or TLH group. The complication rate was higher in the TAH group (22/40 or 55%) as compared to the NDVH (14/40 or 35%) and TLH (17/40 or 42.5%) groups. Conclusion: NDVH or TLH is the preferred method over TAH in case of benign uterine disease due to lesser operative morbidity and faster recovery.