Background: Hysterectomy is the most common performed major abdominal surgery among gynaecologic surgeons and the decision is generally based on indications for surgery, surgeons training and preference, uterine size, presence and absence of any associated pelvic pathologies and patients choice. By avoiding laparotomy, laproscopic procedures are associated with less post-operative pain, shorter hospitalization, and with lower infectious morbidity rate than laparotomy.
Aims & Objective: (1) To compare duration of surgery, blood loss and complications during surgery and post-operative pain in each type of hysterectomy. (2) To evaluate the safety, simplicity and acceptability of each type of hysterectomy both to the patient as well as the surgeon.
Materials and Methods: Patients undergoing both the types of hysterectomy i.e. LH and NDVH during May 2009 to September 2011 at Smt. SCL General Hospital, Saraspur, Ahmedabad were included in the study. Those patients having malignancy as diagnosed by Pap smear or by D &C were excluded from the study. All the patients were investigated thoroughly for their cardio respiratory status, fitness for surgery and other medical conditions. Patients were observed vigilantly during the pre-operative, intra-operative and post-operative period for any complications.
Results: In this study 56% of patients underwent AH, 20% had VH for prolapse, 13% had NDVH and 10% had LH. Majority of patients belongs to age group 40-49years in both the groups. Fibroid and DUB were the most common indications of hysterectomy in LH group while DUB was the most common indication in NDVH group. Bladder injury was found in one case of NDVH and 2 cases of LH group and bowel injury in 1 case of LH which was managed by expert by laparotomy. Patients of LH and 4 of NDVH had vaginal bleeding but it was minimal and did not require any surgical management. The average duration of surgery was 2 to 4 hours in TLH group, 30 minutes to 2 hours in LAVH group and 1 to 2 hours in NDVH patients. Average amount of blood loss in LH was 100 to 200 ml and it was 100 to 300 ml in NDVH group. Blood loss in NDVH group was less. The difference in the pain scores of LH and NDVH is statistically significant showing 2.24 Z value.
Conclusion: LH can be considered an alternative to AH for those in whom VH is not feasible. TLH may be comparable to NDVH in terms of post-operative parameters and satisfaction, but it has significantly longer operating time and requires laparoscopic surgical skills. Recent advances in equipment, surgical techniques and training have made TLH a well-tolerated and efficient technique. The future place of LH will be determined by the increased familiarity and skill of surgeons with vaginal procedure, stimulated by doing the difficult part of LAVH. Hence in normal uncomplicated uterus LAVH or even VH has no disadvantages and remain an excellent option
Key words: Laparoscopic Hysterectomy; Vaginal Hysterectomy; Pap Smear
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