Abdominal hysterectomy for the enlarged myomatous uterus compared with vaginal hysterectomy with morcellation.
OBJECTIVE
The purpose of this study was to compare intraoperative and postoperative complications of abdominal hysterectomy for the enlarged, myomatous uterus with vaginal hysterectomy with morcellation.


METHODS
Medical records of 139 patients who underwent vaginal hysterectomy with morcellation and 244 patients who underwent total abdominal hysterectomy for an enlarged, myomatous uterus between August 1990 and July 2001 were reviewed. Uterine weights of >982 g were excluded because this was the largest uterus removed vaginally, which left 208 evaluable cases of total abdominal hysterectomy. The perioperative and postoperative course of the two groups was compared. The Student t test was used for continuous variables, and the Fisher exact test was used for binary or categoric data.


RESULTS
There were no significant differences between the two groups in surgical or anesthetic risk factors (P>.05). Operative time was similar between the groups (P>.05). Length of hospital stay was increased significantly with total abdominal hysterectomy (mean, 3.9 days vs 2.6 days; P<.001). Perioperative complications were increased with the abdominal route (10% vs 25%, P<.001).


CONCLUSIONS
In this large series, uterine morcellation at the time of vaginal hysterectomy is safe and facilitates the removal of moderately enlarged and well-supported uteri and is associated with decreased hospital stay and perioperative morbidity rate compared with the abdominal route.
Taylor
Susan M
SM
Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, 2211 Lomas Boulevard NE, Albuquerque, NM 87131, USA.
Romero
Audrey A
AA
Kammerer-Doak
Dorothy N
DN
Qualls
Clifford
C
Rogers
Rebecca G
RG
D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology; D011183:Postoperative Complications; D011336:Probability; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*