Total Laparoscopic Hysterectomy Versus Vaginal Hysterectomy: A Systematic Review and Meta-Analysis
| Autor: | Frank Willem Jansen, Andries R.H. Twijnstra, Evelien M. Sandberg, Sara R.C. Driessen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Complications Visual analogue scale medicine.medical_treatment Operative Time Blood Loss Surgical Dehiscence Hysterectomy law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Ureter Randomized controlled trial Surgical approach to hysterectomy law Laparotomy Hysterectomy Vaginal medicine Humans 030212 general & internal medicine Randomized Controlled Trials as Topic 030219 obstetrics & reproductive medicine business.industry Obstetrics and Gynecology Surgical outcomes Length of Stay Surgery Treatment Outcome medicine.anatomical_structure Meta-analysis Female Laparoscopy business Cohort study |
| Zdroj: | Journal of Minimally Invasive Gynecology, 24(2), 206-217 |
| DOI: | 10.1016/j.jmig.2016.10.020 |
| Popis: | Hysterectomies performed laparoscopically have greatly increased within the last few decades and even exceed the number of vaginal hysterectomies (VHs). This systematic review, conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines, compares surgical outcomes of total laparoscopic hysterectomy (TLH) and VH to evaluate which approach offers the most benefits. A literature search was performed in PubMed, Embase, and Web of Science for all relevant publications from January 2000 to February 2016. All randomized controlled trials and cohort studies for benign indication or low-grade malignancy comparing TLH with VH were considered for inclusion. From the literature search, 24 articles were found to be relevant and included in this review. The results of our meta-analysis showed no difference between the 2 groups for overall complications (OR 1.24 [.68, 2.28] for major complications; OR .83 [.53, 1.28] for minor complications), risk of ureter and bladder injuries (OR .81 [.34, 1.92]), intraoperative blood loss (mean difference [MD] -30 mL [-67.34, 7.60]), and length of hospital stay (-.61 days [-1.23, -.01]). VH was associated with a shorter operative time (MD 42 minute [29.34, 55.91]) and a lower rate of vaginal cuff dehiscence (OR 6.28 [2.38, 16.57]) and conversion to laparotomy (OR 3.89 [2.18, 6.95]). Although not significant, the costs of procedure were lower for VH (MD 3889.9 dollars [2120.3, 89 000]). Patients in the TLH group had lower postoperative visual analog scale scores (MD -1.08, [-1.74, -.42]) and required less analgesia during a shorter period of time (MD -.64 days, [-1.06, -.22]). Defining the best surgical approach is a dynamic process that requires frequent re-evaluation as techniques improve. Although TLH and VH result in similar outcomes, our meta-analysis showed that when both procedures are feasible, VH is currently still associated with greater benefits, such as shorter operative time, lower rate of vaginal dehiscence and conversion to laparotomy, and lower costs. Many factors influence the choice for surgical approach to hysterectomy, and shared decision-making is recommended. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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