Comparative Study Between Total Laparoscopic Hysterectomy and Abdominal Hysterectomy in Management of Benign Gynaecological Conditions

Abstract

Background: Hysterectomy is a frequent surgery performed for benign diseases of the reproductive system: fibroids, endometriosis, and abnormal uterine bleeding. The most conventional methods have been the AH; however, the fast-growing minimally invasive alternatives such as TLH have been found to differ significantly regarding recovery and complications.

Aim: The objective of this work will be to assess TLH and AH in terms of effectiveness and adverse effects considering patients’ outcomes in benign gynaecological diseases treatment.

Method: A propensity score matched prospective cohort study was performed among women with benign pathology necessitating hysterectomy at BMC and LUMHS Jamshoro.  The patients were grouped according to type of surgery done, as those who underwent TLH and those who underwent AH. The preoperative, intraoperative, and postoperative factors measured were age, BMI, operative time, volume of blood loss, pain, length of hospital stay, and complications. Descriptive analyses and t-tests and chi-square tests were used in order to assess the differences in the results.

Results: TLH proved to provide direct benefits over AH; less intra operative blood loss of 150 mL as compared with 300 mL; shorter hospital stay of two days as opposed to five days and faster recovery period of three weeks instead of six weeks. Therefore, evaluating the outcome results we can state that both pain scores and postoperative complications were lower in the TLH group. However, TLH was associated with total operative times greater than TLAP (120 minutes compared with 90 minutes). Patient satisfaction was higher in the TLH group as the feasibility score demonstrated (9/10 vs 7/10), besides, the overall costs were lower due to decreased complication rate and faster rehabilitation period.

Conclusion:The systematic review of TLH over AH has outlined numerous traces and representations of benefits of TLH over AH in terms of patient safety, recovery and satisfaction therefore eligible patients are encouraged to opt for TLH. But the longer operative time and the requirement of specialized knowledge and skills bear the issue of routine based surgical planning and execution. The findings of the study should be used for future research based on long-term outcomes of the treatment as well as costs of implementing the approach.