Page 11 - World Journal of Laparoscopic Surgery

WJOLS

Laparoscopic vs Abdominal Hysterectomy in the Management of Benign Gynecological Diseases
for the management of benign diseases, in order to evalu- significantly different between the two groups, and so did
ate the average age of the patient, length of hospital stay, not have significant influence on the course of the study.
blood loss and blood transfusion, intraoperative and The average age in years of patients undergoing LAVH
postoperative complication rates, and postoperative pain and TAH were 46.3 and 46.2 respectively (35–68 for LAVH
management. and 22–89 for TAH), exactly matching the US data. The
maximum number of patients in both groups fell in the
MATERIALS AND METHODS age group of 40 to 49 years (Graph 1 and Table 1).
The average operating time was comparable between
A retrospective case–control study was carried out
in the Department of Christian Medical College and the two groups (LAVH was slightly longer). On an
Hospital, Ludhiana, comparing LAVH with TAH for average, LAVH took 173 minutes (70–320 minutes), while
a period of 1 year spanning from November 2014 to for TAH, it was 153 minutes (60–300 minutes, p = 0.999).
October 2015. Patients undergoing LAVH and TAH Intraoperative complication rates (Table 2) were com-
for benign conditions were identified. Medical records parable between the two groups (LAVH 4.76% and TAH
of the patients identified were then reviewed – factors 6.45%, p = 0.275). However, postoperative complication
examined included demographic details, indications for rates (Table 3) were seen to be slightly higher in TAH as
operation, intraoperative details, length of hospital stay, compared with LAVH (LAVH 4.76% and TAH 14.5%,
blood transfusion, and postoperative pain management p = 0.061). The common complications seen were ureteric
and complications. A total of 124 files were reviewed, 62 injury, bladder injury, wound infection, and hemorrhage.
for LAVH and 62 for TAH. One patient in the LAVH group developed vault sepsis,
Data were processed and analyzed using Statistical and there was no incidence of port site wound infection;
Package for the Social Sciences (SPSS) (version 22.0). Sta- seven patients who underwent TAH developed wound
tistical significance for differences was tested by student’s infection, including one burst abdomen.
2
t-test and χ test, and a p-value <0.05 was considered
statistically significant.

Exclusion Criteria

• Hysterectomy for malignant diseases
• Hysterectomy performed along with other surgical
procedures like pelvic floor repair, cholecystectomy,
hernia repair, etc.

RESULTS
Table 1 shows that the demographic characteristics, such
as age, hemoglobin, and platelets levels were compar-
able between the two groups. The most common indica-
tions for surgery were abnormal uterine bleeding and
fibroid uterus. Previous history of pelvic surgery was not Graph 1: Age distribution

Table 1: Demographic data of patients in both groups Table 2: Intraoperative complications
LAVH (n = 62) TAH (n = 62) p-value LAVH TAH
Age (years) 46.28 ± 7.13* 46.23 ± 11.69 0.51 Intraoperative complications (n = 62) (n = 62) p-value
Hemoglobin 11.20 ± 2.01* 11.40 ± 1.66 0.27 Ureteric injury 1 1 0.275
Platelets 265.32 ± 10.13* 264.98 ± 8.34 0.96
Previous pelvic surgery Bladder injury 0 2
Negative 60 (96.8%)** 58 (93.5%) Hemorrhage 2 1
Positive 2 (3.2%)** 4 (6.5%)
Indication for surgery
AUB 31 (50%)** 11 (17.74%) Table 3: Postoperative complication
Fibroid uterus 22 (35.48%)** 31 (50%)
PMB 4 (6.45%)** 3 (4.84%) LAVH TAH
Others 5 (8.06%)** 17 (27.42%) Postoperative complications (n = 62) (n = 62) p-value
*Values are given as mean ± standard deviation; **Values are Wound infection 1 7 0.061
given as number with percentage in brackets; p value refers Chest complications 1 1
2
to t-test and χ test; AUB: Abnormal uterine bleeding; PMB:
Postmenopausal bleeding Urinary complications 1 1
World Journal of Laparoscopic Surgery, January-April 2017;10(1):8-11 9