Abstract
Hysterectomy is a very common gynaecological procedure. The vaginal route is considered
preferable for hysterectomy, although the ideal route for women unsuitable for the
vaginal approach remains unclear. We performed a meta-analysis of published randomised
controlled trials to compare outcomes in total abdominal hysterectomy (TAH) and total
laparoscopic hysterectomy (TLH) for benign disease. Pooled odds ratios (OR) were calculated
for categorical variables using random effects models as per Der Simonian and Laird.
Continuous variables were compared by means of weighted mean differences (WMD). TLH
is associated with reduced overall peri-operative complications (pooled OR 0.19; 95%
CI 0.07–0.50) and reduced estimated blood loss (WMD −183 ml; 95% CI −346 ml to −21 ml; p = 0.03). Additionally, there are trends towards shorter hospital stay (WMD −2.5 days;
95% CI −5.1 days to 0.01 days; p = 0.05) and post-operative haematoma formation (pooled OR 0.17; 95% CI 0.03–1.01) compared
to TAH. The only trade-off appears to be a longer operating time in the TLH group
(WMD 22 min; 95% CI 5–39 min; p = 0.01). Rates of major complication were not statistically different (pooled OR 1.35;
95% CI 0.32–5.73) though this analysis is likely underpowered to detect many major
complications. As such, TLH appears to offer benefits to women requiring total hysterectomy
for benign indications compared to TAH, particularly regarding minor complications,
blood loss and hospital stay. However, larger studies are needed to assess the impact
on major intra-operative complications and long-term clinical outcomes, particularly
pelvic organ prolapse.
Keywords
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Article info
Publication history
Published online: February 02, 2009
Accepted:
January 8,
2009
Received in revised form:
January 5,
2009
Received:
July 4,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
