Vaginal hysterectomy preferred and safer than laparoscopically-assisted vaginal hysterectomy in obese women

Written By :  Dr. Shravani Dali
Medically Reviewed By :  Dr. Kamal Kant Kohli
Published On 2023-06-20 14:30 GMT   |   Update On 2023-06-21 10:06 GMT
Advertisement

Vaginal hysterectomy preferred and safer than laparoscopically-assisted vaginal hysterectomy in obese women suggests a new study published in the European Journal of Obstetrics and Gynecology.

This prospective randomised control trial aimed to compare outcome measures of vaginal hysterectomy (VH) and laparoscopically-assisted vaginal hysterectomy (LAVH) in obese vs. non-obese women undergoing hysterectomy for benign uterine conditions with a non-prolapsed uterus. The primary objective of the study was to estimate operation time, uterine weight and blood loss amongst obese and non-obese patients undergoing VH and LAVH. The secondary objective was to determine any difference in hospital stay, the need for post-operative analgesia, intra- and immediate post-operative complications, and the rate of conversion to laparotomy for obese vs. non-obese patients undergoing VH and LAVH.

A prospective randomised control study was undertaken in the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Women admitted between January 2017 and December 2019 for hysterectomy due to benign conditions, meeting the inclusion criteria set by the unit (vaginally accessible uterus, uterine size ≤ 12 weeks of gestation or ≤ 280gr on ultrasound examination, pathology confined to the uterus) were included in the study. The VH procedures were performed by the residents in training, under the supervision of specialists with large experience in vaginal surgery. All the LAVHs were performed by one surgeon (AC). In addition to the patient characteristics and surgical approach to hysterectomy, operative time, estimated blood loss, uterine weight, length of hospital stay, intra-operative and immediate post-operative complications were also recorded in obese and non-obese patient groups and comparatively analysed.

Results

A total of 227 women were included in the study. 151 patients underwent VH and 76 LAVH, upon randomisation on a 2:1 basis, reflecting the habitual proportion of hysterectomy cases in the Urogynaecology and Endoscopy Unit at CMJAH.

No significant differences were found in mean shift of pre-operative to post-operative serum haemoglobin, uterine weight, intra- and immediate post-operative complications, and convalescence period when comparing obese and non-obese patients in both the VH and LAVH groups. There was a statistically significant difference in operating time between the two procedures. The LAVHs took longer compared to the VHs to be performed (62.8±9.3 vs. 29.9±6.6 minutes in non-obese patients, and 62.7±9.8 vs 30.0 ± 6,9 minutes for obese patients). All VHs and LAVHs were successfully accomplished without major complications.

VH and LAVH for the non-prolapsed uterus is a feasible and safe alternative for obese patients demonstrating similar perioperative outcome measures as non-obese women undergoing VH and LAVH. Where possible, VH should be preferred to LAVH as it is a safe route of hysterectomy, with operation time being significantly shorter.

Reference:

J.A. Locher, M. Chrysostomou, D. Djokovic, E. Libhaber, B.J. van Herendael, A. Chrysostomou. The impact of obesity on vaginal hysterectomy and laparoscopically-assisted vaginal hysterectomy outcomes: a randomised control trial. European Journal of Obstetrics and Gynecology. Published:June 05, 2023DOI:https://doi.org/10.1016/j.ejogrb.2023.06.001

Keywords:

Vaginal, hysterectomy, preferred, safer, laparoscopically-assisted, vaginal, hysterectomy, obese, women, European Journal of Obstetrics and Gynecology, J.A. Locher, M. Chrysostomou, D. Djokovic, E. Libhaber, B.J. van Herendael, A. Chrysostomou

Tags:    
Article Source : European Journal of Obstetrics and Gynecology

Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.

NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.

Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .

Similar News