A Comparative Overview of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy

Abstract

Hysterectomy is one of the gynecological operations performed due to benign indications such as uterine leiomyoma, dysfunctional uterine bleeding, endometrial hyperplasia, dysmenorrhea, dyspareunia, and severe endometriosis refractory to medical or conservative surgical management and malignant conditions like cervical, endometrial and ovarian cancer. Hysterectomy can be performed by abdominal, vaginal and laparoscopic method. Abdominal hysterectomy has been the most popular method but it is more invasive and is associated with more blood loss, delayed recovery and longer hospital stay. Since Reich's introduction of laparoscopic hysterectomy in 1989, it has become a widely accepted technique around the world. Laparoscopic hysterectomy was reported to have lower post operative morbidity, improved quality of life, shorter hospital stay and less blood loss when compared to laparotomy. The aim and objectives of the study was to compare the surgical results and intra- operative and post-operative complications between Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH). A retrospective study was conducted at SMGS hospital, GMC Jammu between October 2016 and September 2018 and a total of 252 patients were recruited in the study. Patients were divided into two groups of 126 patients each- Group A consists of patients who underwent TLH and Group B comprises of patients who underwent TAH. We observed that there was no significant difference between the two groups in respect to patient’s age (45.16±4.58 versus 45.23±6.44), parity (4.32±2.08 versus 4.77±3.08) and indication of surgery. Duration of surgery was found to be longer in TLH (116.02±16.38) than TAH (83.18±21.40). The length of hospital stay was significantly less in TLH than TAH ( p value <0.0001). Hb drop was more in TAH group as compared to TLH (1.46±0.64 versus 1.83±0.68). 25(19.8%) patients of TAH were given post op blood transfusion but only 9(7.14%) patients of TLH were given post op blood transfusion and this difference was again statistically significant (p value<0.0001). The time to ambulation in patients of TLH was much shorter than TAH (9.94±4.29 versus 23.03±1.28). Wound infection was more prevalent in TAH than in TLH; 5 patients had wound infection, and 4 patients had wound dehiscence that required resuturing. Laparoscopy was converted to laparotomy in 8 patients due to adhesions, vascular injury, and bowel injury in one case.  This study found that TLH can be performed safely as an alternative to abdominal hysterectomy by an experienced surgeon.It has various advantages over TAH, including a smaller incision, earlier ambulation, a shorter hospital stay, and a faster recovery time, as well as the absence of more serious complications.