Comparison of laparoscopically assisted vaginal hysterectomy and total abdominal hysterectomy

Background: Hysterectomy is the second most common major surgery procedure done after cesarean section by gynecologists in many countries and the most common procedure is total abdominal hysterectomy (TAH). The incidence of laparoscopically assisted vaginal hysterectomy (LAVH) performed for benign lesions has progressively increased in recent years. Our objective was to compare the relative advantages and disadvantages of LAVH and TAH procedures. Methods: A clinical trial was performed on patients who were candidates for hysterectomy with benign reasons in Arash hospital from March 2006 to April 2007. By simple randomization, 90 patients (30 for LAVH and 60 for TAH) were selected. Demographic details and intra-operative and post-operative complications were recorded by the staff and were compared between the two groups. Results: On average, LAVH operations took significantly longer than TAH operations (100.17 ± 39.35 minutes; 145.83 ± 41.55 minutes; P< 0.0001). The total length of hospital stay was significantly shorter after LAVH than after TAH (3.43 ± 0.90 days; 3.94 ± 1.02; P= 0.025). Although the hemoglobin (gr/dl) drop in LAVH was significantly higher than TAH (1.22 ± 0.94 and 0.58 ± 0.82, P=0.0012), blood transfusions were more common in TAH (1 case versus 3 cases). The drug requirement to control pain during hospitalization after the two surgeries was not significantly different between the two groups. Fever was observed more often in the TAH group (P = 0.051). Finally, Intra-operative and post-operative complications were lower in LAVH than TAH. Conclusion: Although operation length is significantly higher in LAVH, this procedure is safer and more comfortable for patients and health care providers.