ABDOMINAL HYSTERECTOMY VERSUS TRANSVAGINAL MORCELLATION FOR THE REMOVAL OF ENLARGED UTERI

OBJECTIVE: The purpose of this study was to compare the intraoperative and postoperative complications of transvaginal morcellation and abdo minal hysterectomy for the removal of moderately enlarged uteri. STUDY DESIGN: An observational study was performed on all uteri weighing > 200 gm removed transvaginally from July 1, 1987, to June 30, 1993. An abdominal hysterectomy control group was selected. RESULTS: There were 50 patients in the vaginal group and 112 in the abdominal group. At a p value < 0.05 there was no statistically significant difference betw een the two groups for age, parity, obesity, hypertension, insulin-dep endent diabetes mellitus, or prior genitourinary surgery. The mean ope rative time in the vaginal hysterectomy group was 122 minutes and in t he abdominal hysterectomy group 148 minutes (p < 0.05). The mean estim ated blood loss was 527 and 586 ml, respectively (not significant). Tw enty-two percent of the vaginal group and 70% of the abdominal group u nderwent bilateral oophorectomy (p < 0.05). The mean uterine weights w ere 335 and 336 gm, respectively (not significant). The mean day of st arting a regular diet was 2.1 and 3.6, respectively (p < 0.05). The me an day of discharge was 3.6 and 5.1, respectively (p < 0.05). Complica tions were similar for the two groups. CONCLUSIONS: In selected patien ts transvaginal morcellation is a safe and effective alternative to ab dominal hysterectomy for the removal of moderately enlarged uteri. The two procedures are comparable in operative time, blood loss, and comp lications. Both ovaries are more likely to be removed with abdominal h ysterectomy. Cosmesis and recuperation may be advantages of the vagina l approach.