A Randomized Clinical Trial Comparing Laparoscopic and Vaginal Hysterectomy for Benign Disease: An Egyptian University Hospital Experience.
| Autor: | Mohammad, Hayam Fathy, Alqenawy, Hamdy Bakry, Moharram, Ahmed Ezzat, Raafat, Tarek Aly, Abdelrahman, Rehab M. |
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| Předmět: |
SURGICAL blood loss
C-reactive protein HYSTERECTOMY VAGINAL hysterectomy ACADEMIC medical centers FEVER CONFIDENCE intervals UTERINE diseases LAPAROSCOPIC surgery TREATMENT duration SURGERY PATIENTS SURGICAL complications TREATMENT effectiveness RANDOMIZED controlled trials COMPARATIVE studies DESCRIPTIVE statistics STATISTICAL sampling POSTOPERATIVE pain EVALUATION |
| Zdroj: | Journal of Gynecologic Surgery; Dec2022, Vol. 38 Issue 6, p400-407, 8p |
| Abstrakt: | Objective: This research compared laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) for operative time, complications, postoperative pain, inflammatory response, hospital stay, and costs. Materials and Methods: A randomized controlled trial compared LH and VH for 80 patients equally allocated to undergo either for benign pathology (Canadian Task Force Classification I). Results: Mean operative time was significantly higher for LH (127.5 ± 25.9 minutes; 95% confidence interval [CI]: 119.2, 135.8) than for VH (104 ± 30.8 minutes; 95% CI: 94.2, 113.9); p = 0.0004. There was no significant difference in median blood loss (LH: 250 mL and VH: 235 mL); p = 0.7983). There was a strong positive correlation between operative time and estimated uterine weight, especially for VH. Adnexal surgery was performed as planned preoperatively in 62.5% of LHs versus 27.5% of VHs; p < 0.0035. Both groups were comparable regarding intra- and postoperative complications (p = 1.0). Median postoperative pain intensity was lower in LH than in VH at 2 hours (51 versus 64.5; p = 0.0038), 6 hours (38.5 versus 46; p = 0.0009), and 24 hours (24.5 versus 36.5; p < 0.0001). Inflammatory response did not differ between the groups, neither as postoperative fever (7.5% of LH versus 2.5% of VH; p = 0.6153) nor as postoperative C-reactive protein rise (median: 57.4 mg/L for LH; 41.6 mg/L for VH; p = 0.1489). There was no difference in hospital stay (LH median: 35.5 hours; VH median: 30 hours; p = 0.6991). Costs for LH were higher (LH median: 5525 Egyptian pounds (EGPs), 335 US dollars (USD); VH median: 3400 EGPs, 207 USD; p < 0.0001). Conclusions: LH has longer operative time, yet better postoperative pain profile, than VH. However, cost considerations make LH fall behind VH as a primary choice for benign hysterectomy, especially in low-resource settings. (J GYNECOL SURG 38:400) [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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