Vaginal versus abdominal hysterectomy for the enlarged non-prolapsed uterus: a retrospective cohort study
Publication details: 2014Uniform titles:- European Journal of Obstetrics & Gynecology and Reproductive Biology
| Item type | Home library | Collection | Class number | Status | Date due | Barcode | |
|---|---|---|---|---|---|---|---|
| Book | Ferriman information and Library Service (North Middlesex) Shelves | Staff publications for NMDX | Available |
NMUH Staff Publications
174
<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">OBJECTIVE:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">To compare surgical outcomes in women with enlarged uteri &gt;12 weeks' size who underwent vaginal hysterectomy compared to abdominal hysterectomy for non-prolapse indications.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">STUDY DESIGN:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">Retrospective cohort study performed between 2007 and 2012 in a North London teaching hospital. The study group comprised 39 women who had vaginal hysterectomy (VH) with uteri &gt;12 weeks size (200g) for non-prolapse indications. The next successive total abdominal hysterectomy (TAH) following the index case for similar indications (and with similar uterine weights) served as control (n=33). The groups were compared for pre- and post-operative demographic data, and main outcome measures were estimated blood loss, operation time, length of stay and complications.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">RESULTS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">Both VH and TAH groups had statistically similar pre-operative mean haemoglobin levels, age, body mass index, previous abdominal surgery, and American Society of Anesthesiologists (ASA) grade. Mean uterine weight (403.1±239.5 vs 460.5±236.2g) was comparable in both groups (both p&gt;0.05). The mean duration of the procedure was similar (123.5±45.8 vs 119.8±44.9min, p=0.580) but women who had TAH lost 117ml more of blood (525.7±427.6 vs 408.2±411.8ml, p=0.039). Although overall complication rates were comparable between the groups (30.8% vs 36.4%, p=0.627), the mean post-operative stay was 55% shorter following VH (40.7±29.4 vs 90.7±46.2h, p&lt;0.0001).</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">CONCLUSION:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">In women with non-prolapsed uteri &gt;12 weeks' size, VH is a safe and cost effective option. The vaginal route is associated with significantly lower estimated blood loss and 55% shorter post-operative stay, with no increase in complication rates.</span></p>
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