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WJOLS

Garima Gupta et al 10.5005/jp-journals-10033-1293
OriginaL articLe

Laparoscopic vs Abdominal Hysterectomy in the

Management of Benign Gynecological Diseases:
A Tertiary Hospital Experience in Punjab

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1 Garima Gupta, Vanlal K Varte, Sunita Goyal
ABSTRACT INTRODUCTION
Objectives: Hysterectomy is one of the most common major operations
• To compare laparoscopically assisted vaginal hysterectomy
(LAVH) with total abdominal hysterectomy (TAH) in a retro- performed in women, next only to cesarean section. In the
spective analysis for the management of benign diseases. United States, approximately 600,000 hysterectomies are
• To evaluate average age, hospital stay, blood loss, intraopera- performed each year. The highest rate of hysterectomy is
tive and postoperative complication rates, and postoperative between the ages of 40 and 49 years, with an average age
pain management.
of 46.1 years. Lower socioeconomic status contributes to
Study design: 1
• A retrospective case–control study in Christian Medical increased hysterectomy rates. In India, the mean age of a
College and Hospital, Ludhiana, was carried out comparing woman undergoing hysterectomy is much lower. A study
LAVH) and TAH for a period of 1 year between November conducted in Haryana state showed that the incidence of
2014 and October 2015. hysterectomy was 7% among married women. Another
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• Sample size: A total of 124 patients (62 for LAVH and 62
for TAH). study from Gujarat pointed out that 7 and 8% of rural
Results: women and 5% of urban women had already undergone
• The LAVH is associated with shorter hospital stay as com- hysterectomy at an average age of 37 years. 3
pared with TAH (3.3 and 5.8 days; p < 0.001), less amount of There are no specific criteria that can be used to
blood loss (176 and 420 mL; p < 0.022), and less number of determine the route of hysterectomy. The vaginal opera-
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postoperative complication rates (4.76 and 14.5%; p = 0.061).
• The LAVH is also associated with less number of blood trans- tion is preferable when there are no contraindications,
fusions. Only 8 patients required blood transfusion intra- or as it has lower morbidity and quicker recovery. When
postoperatively following LAVH, and 25 patients for TAH. laparoscopically assisted vaginal hysterectomy (LAVH) is
• The operation time in LAVH is slightly longer as compared done, it should be surgery should be carried out through
with TAH (173 vs 153 minutes; p = 0.999).
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• Analgesic drug requirement to control pain was significantly vaginal route. The abdominal approach is still being used
less in LAVH. About 38.7% required continous opoid infusion by the majority of surgeons as the operation of choice,
pump following TAH, and only 6.35% following LAVH. particularly when dealing with pelvic malignancy or for
Conclusion: carrying out oophorectomy. 5
• The LAVH is a safe and reliable alternative to open surgery The first LAVH was reported by Reich and De Caprio
in the management of benign gynecological diseases, with 6
significantly reduced hospital stay and complications. in 1989. Since then, it has gained widespread acceptance
throughout the world. Laparoscopic dissection of the para-
Keywords: Analgesia, Blood loss, Complications, Laparo-
scopically assisted vaginal hysterectomy, Total abdominal uterine tissues to the level of the uterine arteries also permits
hysterectomy. oophorectomy or dissection of adhesions under direct vision
How to cite this article: Gupta G, Varte VK, Goyal S. more easily than at vaginal hysterectomy (VH). 5,7

Laparoscopic vs Abdominal Hysterectomy in the Management Laparoscopy reduces the morbidity associated with
of Benign Gynecological Diseases: A Tertiary Hospital Experi-
ence in Punjab. World J Lap Surg 2017;10(1):8-11. laparotomy. It offers superior tissue image and anatomic
Source of support: Nil view of the abdominopelvic cavity and, thus, facilitates
Conflict of interest: None better hemostasis and dissection. It allows the perfor-
mance of adnexal surgery, ureterolysis, retroperitoneal
dissection, and excision of endometriosis. 8
1 Assistant Professor, Resident, Professor Smaller incision, less postoperative pain, shorter
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hospital stay, and quicker return to normal activity are
1-3 Department of Obstetrics and Gynaecology, Christian Medical 8
College and Hospital, Ludhiana, Punjab, India the main advantages of laparoscopy over laparotomy.
Corresponding Author: Garima Gupta, Assistant Professor AIM
Department of Obstetrics and Gynaecology, Christian Medical
College and Hospital, Ludhiana, Punjab, India, e-mail: The aim of our study was to compare LAVH with total
amitygarima@gmail.com
abdominal hysterectomy (TAH) in a retrospective analysis
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