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 Hot cars can hit deadly temperatures in as little as one hour
24.05.2018 | Arizona State University

nachricht 3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg

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: Powerful IT security for the car of the future – research alliance develops new approaches

The more electronics steer, accelerate and brake cars, the more important it is to protect them against cyber-attacks. That is why 15 partners from industry and academia will work together over the next three years on new approaches to IT security in self-driving cars. The joint project goes by the name Security For Connected, Autonomous Cars (SecForCARs) and has funding of €7.2 million from the German Federal Ministry of Education and Research. Infineon is leading the project.

Vehicles already offer diverse communication interfaces and more and more automated functions, such as distance and lane-keeping assist systems. At the same...

Im Focus: Molecular switch will facilitate the development of pioneering electro-optical devices

A research team led by physicists at the Technical University of Munich (TUM) has developed molecular nanoswitches that can be toggled between two structurally different states using an applied voltage. They can serve as the basis for a pioneering class of devices that could replace silicon-based components with organic molecules.

The development of new electronic technologies drives the incessant reduction of functional component sizes. In the context of an international collaborative...

Im Focus: LZH showcases laser material processing of tomorrow at the LASYS 2018

At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.

At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...

Im Focus: Self-illuminating pixels for a new display generation

There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?

At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...

Im Focus: Explanation for puzzling quantum oscillations has been found

So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics

Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

In focus: Climate adapted plants

25.05.2018 | Event News

Save the date: Forum European Neuroscience – 07-11 July 2018 in Berlin, Germany

02.05.2018 | Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

 
Latest News

In focus: Climate adapted plants

25.05.2018 | Event News

Flow probes from the 3D printer

25.05.2018 | Machine Engineering

Less is more? Gene switch for healthy aging found

25.05.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>