title: Vaginal versus abdominal hysterectomy for the enlarged non-prolapsed uterus: a retrospective cohort study.
abstract: OBJECTIVE
  To compare surgical outcomes in women with enlarged uteri >12 weeks' size who underwent vaginal hysterectomy compared to abdominal hysterectomy for non-prolapse indications.
  
  
  METHODS
  Retrospective cohort study performed between 2007 and 2012 in a North London teaching hospital. The study group comprised 39 women who had vaginal hysterectomy (VH) with uteri >12 weeks size (200g) for non-prolapse indications. The next successive total abdominal hysterectomy (TAH) following the index case for similar indications (and with similar uterine weights) served as control (n=33). The groups were compared for pre- and post-operative demographic data, and main outcome measures were estimated blood loss, operation time, length of stay and complications.
  
  
  RESULTS
  Both VH and TAH groups had statistically similar pre-operative mean haemoglobin levels, age, body mass index, previous abdominal surgery, and American Society of Anesthesiologists (ASA) grade. Mean uterine weight (403.1±239.5 vs 460.5±236.2g) was comparable in both groups (both p>0.05). The mean duration of the procedure was similar (123.5±45.8 vs 119.8±44.9min, p=0.580) but women who had TAH lost 117ml more of blood (525.7±427.6 vs 408.2±411.8ml, p=0.039). Although overall complication rates were comparable between the groups (30.8% vs 36.4%, p=0.627), the mean post-operative stay was 55% shorter following VH (40.7±29.4 vs 90.7±46.2h, p<0.0001).
  
  
  CONCLUSIONS
  In women with non-prolapsed uteri >12 weeks' size, VH is a safe and cost effective option. The vaginal route is associated with significantly lower estimated blood loss and 55% shorter post-operative stay, with no increase in complication rates.
authors.affiliation: 4th Year Medical Students, UCL School of Medicine, Gower Street, London, UK.
authors.forename: Kavi
authors.initials: K
authors.lastname: Fatania
authors.affiliation: 4th Year Medical Students, UCL School of Medicine, Gower Street, London, UK.
authors.forename: Mathew
authors.initials: M
authors.lastname: Vithayathil
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Newbold
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK. Electronic address: wai.yoong@nmh.nhs.uk.
authors.forename: Wai
authors.initials: W
authors.lastname: Yoong
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000379:methods*; D007902:Length of Stay; D008131:London; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000473:pathology* / Q000601:surgery*; D014599:Uterus / Q000473:pathology*
keywords: Uterine size; Vaginal hysterectomy