A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri.
OBJECTIVE
To compare the operative data and early postoperative outcome of vaginal hysterectomy (VH), laparoscopic-assisted vaginal hysterectomy (LAVH), and minilaparotomy hysterectomy (MiniLPT).


METHODS
A total of 150 women who required hysterectomy for enlarged myomatous uteri were randomly allocated into 3 treatment groups: VH (n=50), LAVH (n=50), and MiniLPT (n=50). The primary outcome was hospital discharge time. The secondary outcomes were operative time, blood loss, paralytic ileus, postoperative pain, and intraoperative and early postoperative complications.


RESULTS
Mean hospital discharge time was longest with MiniLPT, and shortest with VH (P<0.01). VH was the fastest operating technique, was associated with less blood loss, and resulted in shortest duration of paralytic ileus (P<0.01). No intraoperative complications occurred.


CONCLUSIONS
VH should be the preferred surgical approach in patients with enlarged myomatous uteri. When VH is not feasible, LAVH should be considered an alternative to MiniLPT. Further controlled prospective studies are required to confirm these results.
Sesti
Francesco
F
Section of Gynecology and Obstetrics, School of Medicine, Tor Vergata University Hospital, Rome, Italy. Francesco.Sesti@uniroma2.it
Calonzi
Francesca
F
Ruggeri
Velia
V
Pietropolli
Adalgisa
A
Piccione
Emilio
E
D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D008875:Middle Aged; D009214:Myoma / Q000601:surgery*; D011183:Postoperative Complications; D014594:Uterine Neoplasms / Q000601:surgery*; D014621:Vagina / Q000601:surgery