Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse

Authors: Miskry, Tariq; Magos, Adam

Source: Acta Obstetricia et Gynecologica Scandinavica, Volume 82, Number 4, April 2003 , pp. 351-358(8)

Publisher: Informa Healthcare

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Abstract:

Background.

To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse. Method.

In a two-center prospective, double-blind randomized trial, 36 women with dysfunctional uterine bleeding, uterine fibroids or pelvic pain scheduled for hysterectomy were randomized to abdominal or vaginal hysterectomy. The primary outcome measure was the duration of hospital stay. Secondary outcome measures included analgesic requirements and return to normal health and function. Results.

There were no significant differences in peri-operative patient or surgical characteristics. Vaginal hysterectomy was associated with a reduction in hospital stay compared to abdominal hysterectomy (median stay 3 days vs. 5 days, p = 0.01). In addition, patients undergoing vaginal hysterectomy had reduced analgesic requirements (mean 75.4 mg vs. 131.4 mg morphine equivalent, p = 0.002), shorter need for intravenous hydration (mean 25.3 h vs. 32.7 h, p = 0.05), and faster return of bowel action (median 3 days vs. 4 days, p = 0.002). They also returned to normal domestic activities (mean 4.6 weeks vs. 8.5 weeks, p = 0.01) and work (mean 7.0 weeks vs. 13.9 weeks, p = 0.005), and completed their recovery (mean 7.9 weeks vs. 16.9 weeks, p = 0.008) more quickly. Conclusions.

Vaginal hysterectomy was associated with significant benefits in terms of reduced hospital stay and improved patient recovery. Vaginal hysterectomy should be the route of choice not only for women with genital tract prolapse but also those without.

Keywords: abdominal hysterectomy; hospital stay; prospective randomized trial; recovery; vaginal hysterectomy

Document Type: Research Article

DOI: http://dx.doi.org/10.1034/j.1600-0412.2003.00115.x

Affiliations: From the Minimally Invasive Therapy Unit and Endoscopy Training Center, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK

Publication date: April 1, 2003

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