title: Laparoscopic versus vaginal hysterectomy for benign indications in women aged 65 years or older: propensity-matched analysis.
abstract: OBJECTIVE
  The present study aimed to evaluate surgical operation-related outcomes of laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) for the treatment of benign uterine diseases, other than pelvic organ prolapse, in women aged 65 years or older.
  
  
  METHODS
  Data of women who underwent LH and VH between 2000 and 2013 were compared using propensity-matched analysis. Postoperative complications were graded according to the Accordion Severity Grading. Martin criteria were applied to improve the quality of complications reporting.
  
  
  RESULTS
  The study group included 40 propensity-matched participant pairs (80 women) who underwent VH and LH. No significant differences in baseline characteristics were observed between groups. A trend toward longer median operative time was observed in the LH group, in comparison with the VH group (75 [range, 20-340] vs 60 [range, 30-140] min; P = 0.09), whereas LH correlated with shorter hospital stay and lower blood loss in comparison with VH (P < 0.05). One intraoperative complication occurred during VH (bladder injury); no intraoperative complications were recorded in the LH group. No differences in Accordion grade 2 (or worse) postoperative complications were observed (1 of 40 [2.5%] in the LH group vs 3 of 40 [7.5%] in the VH group; P = 0.61; odds ratio, 3.1; 95% CI, 0.3-31.8), and no postoperative deaths occurred.
  
  
  CONCLUSIONS
  Our findings suggest the noninferiority of LH to VH. LH improves the postoperative course of older women undergoing surgical operation for benign uterine diseases. If an appropriate indication exists, LH should not be denied based on mere chronological age.
authors: From the Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors: Giorgio
authors: G
authors: Bogani
authors: Antonella
authors: A
authors: Cromi
authors: Stefano
authors: S
authors: Uccella
authors: Maurizio
authors: M
authors: Serati
authors: Jvan
authors: J
authors: Casarin
authors: Ciro
authors: C
authors: Pinelli
authors: Chiara
authors: C
authors: Lazzarini
authors: Fabio
authors: F
authors: Ghezzi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000706:statistics & numerical data; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data*; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries; D014591:Uterine Diseases / Q000601:surgery*