NEW YORK (Reuters Health) – In cases of benign disease, hysterectomy performed laparoscopically is associated with less postop pain and faster recovery compared with vaginal hysterectomy, according to a meta-analysis of randomized trials comparing the two techniques.

Dr. Colin A. Walsh, at St. George Hospital in Kogarah, New South Wales, Australia, and colleagues explain in the American Journal of Obstetrics & Gynecology online March 7 that the vaginal route is the current standard for benign hysterectomy, with total laparoscopic hysterectomy reserved for cases where vaginal hysterectomy is not feasible.

Now, the role of total laparoscopic hysterectomy in women otherwise suitable for vaginal hysterectomy is being debated, the authors note, but trials comparing the two strategies have had conflicting results.

They therefore analyzed data from five randomized clinical trials comparing total laparoscopic hysterectomy in 332 women with vaginal hysterectomy in 331 women.

“Overall, no differences in the rate of any complication were found between vaginal hysterectomy (89 of 331) and total laparoscopic hysterectomy (113 of 332; pooled OR, 0.87), Dr. Walsh and colleagues report.

For urinary tract injury specifically — one of the concerns with laparoscopic hysterectomy — there was no significant difference between the groups, the researchers found.

However, operating time was a mean of 29.31 minutes longer with total laparoscopic hysterectomy than vaginal hysterectomy, although there was no significant difference in terms of operative blood loss, according to the report.

Pain scores at 3 hours postoperatively were significantly lower with total laparoscopic hysterectomy than vaginal hysterectomy, by a mean of -2.13 on a 0-10 visual analog scale. Furthermore, length of postop stay was a mean of 0.62 days shorter with laparoscopic compared to vaginal hysterectomy, Dr. Walsh and colleagues report.

They conclude, “Total laparoscopic hysterectomy may offer benefits compared with vaginal hysterectomy for benign disease, although this analysis is likely underpowered for rare complications.” They add, “Further studies of long-term outcomes, including prolapse, urinary incontinence, and sexual function, are required.”

Reference:

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

Am J Obstet Gynecol 2011.