LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY - A CASE-CONTROL COMPARATIVE-STUDY WITH TOTAL ABDOMINAL HYSTERECTOMY

We compared laparoscopic-assisted vaginal hysterectomy (LAVH) with tot al abdominal hysterectomy (TAH) in a case control study that evaluated length of operation, blood loss, length of hospital stay, drug requir ements for pain, and postoperative pain and activity levels. Of 81 wom en who underwent nonradical hysterectomy for a primary diagnosis of pe lvic pain between lune 1 and December 31, 1992, 19 who underwent each procedure were chosen for inclusion in the study. Patients were matche d in a case control manner for age, weight, diagnosis, and uterine wei ght All 38 hysterectomies were completed without incident. When indica ted, unilateral or bilateral oophorectomies were performed. The averag e surgery time for LAVH was 144 minutes and for TAH 98 minutes, a sign ificant difference (p <0.005). There were no significant differences b etween estimated blood loss and change in hemoglobin from preoperative levels to postoperative day 1 levels between the groups. Women having TAH reported significantly more pain after their release from the hos pital. There was no significant difference in pain during hospitalizat ion apparently because patients who had TAH self-medicated to maintain acceptable levels. That group in fact used an average of 436 mg meper idine during their hospital stay significantly more than the 197 mg us ed by the LA VH group (p <0.005). The length of stay was 2.125 days fo r LA VH and 3.542 days for TAH (p <0.001). On a scale of 1 to 10 (10 b eing complete normal activity) the activity level of women undergoing LAVH was 9.2 by day 14 compared with 6.4 for those having TAH (p <0.00 5). By the sixth postoperative week the latter group reported an activ ity level of only 8.5, indicating that the ability to function is much more severely limited after TAH than LAVH.