Vaginal versus abdominal hysterectomy for the enlarged non-prolapsed uterus: a retrospective cohort study

ObjectiveTo compare surgical outcomes in women with enlarged uteri >12 weeks’ size who underwent vaginal hysterectomy compared to abdominal hysterectomy for non-prolapse indications.Study designRetrospective cohort study performed between 2007 and 2012 in a North London teaching hospital. The study group comprised 39 women who had vaginal hysterectomy (VH) with uteri >12 weeks size (200 g) for non-prolapse indications. The next successive total abdominal hysterectomy (TAH) following the index case for similar indications (and with similar uterine weights) served as control (n = 33). The groups were compared for pre- and post-operative demographic data, and main outcome measures were estimated blood loss, operation time, length of stay and complications.ResultsBoth VH and TAH groups had statistically similar pre-operative mean haemoglobin levels, age, body mass index, previous abdominal surgery, and American Society of Anesthesiologists (ASA) grade. Mean uterine weight (403.1 ± 239.5 vs 460.5 ± 236.2 g) was comparable in both groups (both p > 0.05). The mean duration of the procedure was similar (123.5 ± 45.8 vs 119.8 ± 44.9 min, p = 0.580) but women who had TAH lost 117 ml more of blood (525.7 ± 427.6 vs 408.2 ± 411.8 ml, p = 0.039). Although overall complication rates were comparable between the groups (30.8% vs 36.4%, p = 0.627), the mean post-operative stay was 55% shorter following VH (40.7 ± 29.4 vs 90.7 ± 46.2 h, p < 0.0001).ConclusionIn women with non-prolapsed uteri >12 weeks’ size, VH is a safe and cost effective option. The vaginal route is associated with significantly lower estimated blood loss and 55% shorter post-operative stay, with no increase in complication rates.