Tissue trauma after vaginal hysterectomy and colporrhaphy versus abdominal hysterectomy: a randomised controlled study.
OBJECTIVE
As the magnitude of tissue trauma can be detected by measuring the blood levels of acute phase reactants, we aimed to evaluate tissue trauma markers after abdominal hysterectomy (AH) and vaginal hysterectomy (VH). We hypothesised that VH will be associated with a reduced increase in the level of acute phase reactants than AH.


METHODS
Thirty women out of 92 patients scheduled for hysterectomies between June 2002 and June 2003 were randomised into two equal groups (n = 15) of VH and AH. Their levels of C-reactive protein (CRP), alpha1-antitrypsin (alpha1-AT) and myoglobin (M) were analysed preoperatively and on the second, fourth and sixth days.


RESULTS
In both methods of hysterectomy, the operating time (85.3 +/- 6.57 min in the VH group vs 69 +/- 7.54 min in the AH group, P < 0.0001), and hospital stay duration (7.2 +/- 2.5 days in the AH group, 3.1 +/- 1.1 days in the VH group, P < 0.0001) were highly significantly different from each other. Demographic parameters and other parameters which may affect tissue trauma markers were not statistically significantly different in each group. Postoperative increases in all markers were markedly high and showed a high statistical difference in both groups (P < 0.05). The postoperative CRP and M values in both groups were significantly higher in the AH group on the second and fourth days and on the sixth day for M only, whereas alpha1-AT levels were only statistically different on the second day. The tissue trauma markers returned to normal levels on the sixth postoperative day for M, although there still was a statistically significant difference, but remained higher than normal for alpha1-AT and CRP.


CONCLUSIONS
Whenever possible, VH should replace AH because this technique leads to a shorter hospital stay and less tissue trauma, enabling patients to return to their normal lives.
Department of Obstetrics and Gynecology, Haydarpassa Numune Education and Research Hospital, Istanbul, Turkey. mecati.gonenc@jotun.com
Nurettin
N
Aka
Gültekin
G
Kose
Isik
I
Gonenc
Murat
M
Api
D002097:C-Reactive Protein / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood; D017695:Soft Tissue Injuries / Q000097:blood / Q000209:etiology*; D013997:Time Factors; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D000515:alpha 1-Antitrypsin / Q000032:analysis
D009211:Myoglobin; D000515:alpha 1-Antitrypsin; D002097:C-Reactive Protein