Vaginal hysterectomy versus total laparoscopic hysterectomy for benign disease: a metaanalysis of randomized controlled trials

Am J Obstet Gynecol. 2011 May;204(5):388.e1-8. doi: 10.1016/j.ajog.2010.12.059. Epub 2011 Mar 4.

Abstract

Objective: Recent randomized trials comparing total laparoscopic hysterectomy (TLH) and vaginal hysterectomy (VH) have produced conflicting results. The role of TLH in women suitable for VH remains uncertain.

Study design: This study was a metaanalysis of randomized studies comparing TLH and VH for benign disease. Pooled outcome measures (odds ratio [OR] and weighted mean difference [WMD]) were calculated using random-effects models.

Results: No differences in perioperative complications, either total (pooled odds ratio, 0.87; P = .74) or by grade of severity, were demonstrated. TLH was associated with reduced postoperative pain scores (WMD -2.1; P = .03) and reduced hospital stay (WMD -0.62 days; P < .0001) but took longer to perform (WMD 29.3 minutes; P = .003). No differences in blood loss, rate of conversion to laparotomy, or urinary tract injury were identified.

Conclusion: TLH may offer benefits compared with VH for benign disease, although this analysis is likely underpowered for rare complications. Further studies of long-term outcomes, including prolapse, urinary incontinence, and sexual function, are required.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Female
  • Humans
  • Hysterectomy / adverse effects
  • Hysterectomy / methods*
  • Hysterectomy, Vaginal / methods
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Pain, Postoperative / etiology
  • Randomized Controlled Trials as Topic