Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Vaginal hysterectomy leads to better outcomes than abdominal surgery

24.01.2005


A review of recent studies concludes that surgeons should perform vaginal rather than abdominal hysterectomies whenever possible in order to cut down on complications and the length of hospital stays.1



According to the systematic evidence review by Dr. Neil Johnson of the University of Auckland in New Zealand and colleagues, women who had vaginal hysterectomies had fewer infections and high temperatures after surgery compared to those who had abdominal hysterectomies. Women with vaginal hysterectomies also returned to their normal activities quicker than those who had the abdominal surgery, the researchers found.

The better outcomes associated with vaginal hysterectomy suggest it "should be performed in preference to abdominal hysterectomy where possible," Johnson says. But "the surgical approach to hysterectomy should be decided by a woman in discussion with her surgeon in light of the relative benefits and hazards," he adds.


The review appears in the January issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

In a vaginal hysterectomy, surgeons remove the uterus through the vaginal opening. Vaginal hysterectomies are usually performed when the uterus is a normal size. Abdominal hysterectomies, where the uterus is removed through an abdominal opening, has traditionally been used when a woman has an enlarged uterus, malignant tumors or conditions such as endometriosis.

The Cochrane researchers also reviewed the evidence comparing laparoscopic and abdominal hysterectomy. In laparoscopic hysterectomies, the uterus is removed with the help of specialized instruments and a small fiber optic camera inserted through a small incision in the abdomen. Some laparoscopic hysterectomies also include a vaginal surgical component.

Johnson and colleagues concluded that the laparoscopic procedure had some of the same advantages as vaginal hysterectomies, such as shorter hospital stays and fewer complications like infection. They also noted, however, that laparoscopic hysterectomies are longer operations than abdominal or vaginal hysterectomies and may carry a greater risk of damaging the bladder or ureter, the tube that leads from the kidney to the bladder. "There were conflicting data on which was the quickest operation to perform and this presumably relates to the prior experience with these procedures of the surgeons involved in the trials," Johnson says.

None of the studies reported a significant cost difference between laparoscopic and abdominal hysterectomies, but one study found that laparoscopic hysterectomies were significantly more costly than vaginal hysterectomies. The Cochrane researchers reviewed data from 27 studies that included 3,643 women, most of whom were between age 41 and 50. Each of the studies included in the analysis was a randomized controlled trial directly comparing one type of hysterectomy with another. "The introduction of the newer techniques of laparoscopic hysterectomy has, we feel, made us all look more critically, not only at the newer approaches, but indeed at all approaches to hysterectomy," Johnson says.

According to a 2002 report by the Centers for Disease Control and Prevention, hysterectomy is the second most frequently performed surgery, after caesarean section, for women of reproductive age. About 600,000 hysterectomies are performed each year in the United States. More than 60 percent of hysterectomies performed between 1994 and 1999 were abdominal, according to the CDC report.

Johnson says the percentage of hysterectomies performed by each of the surgical approaches "varies markedly across countries, within the same country and even between individual surgeons working within the same unit." Lower rates of vaginal hysterectomy do not necessarily mean that the technique is being avoided, but rather underutilized, Johnson says, "perhaps because some gynecologists have had insufficient training in the vaginal approach to hysterectomy."

Amanda Hall, a spokesperson for the American College of Gynecologists, says the organization has no official recommendation. "It’s really a case-by-case basis," she says. According to the 2002 CDC study, rates of laparoscopy-assisted vaginal hysterectomies more than doubled between 1994 and 1999, from 13 percent of all vaginal hysterectomies to 28 percent. "Where vaginal hysterectomy is not possible, a laparoscopic approach may avoid the need for an abdominal hysterectomy," Johnson says, but he stresses that more research on laparascopic techniques is needed.

Johnson says future studies comparing hysterectomy type should focus on long-term effects, such as urinary and sexual dysfunction and the formation of fistulas, holes in the vagina, bladder or rectum that often lead to incontinence.

1. Johnson et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane Database of Systematic Reviews 2005, Issue 1

Neil Johnson | EurekAlert!
Further information:
http://www.cfah.org
http://www.cochrane.org
http://www.hbns.org

More articles from Health and Medicine:

nachricht New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM

nachricht A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

Scientist invents way to trigger artificial photosynthesis to clean air

26.04.2017 | Materials Sciences

Ammonium nitrogen input increases the synthesis of anticarcinogenic compounds in broccoli

26.04.2017 | Agricultural and Forestry Science

SwRI-led team discovers lull in Mars' giant impact history

26.04.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>