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 Study tracks inner workings of the brain with new biosensor
16.08.2018 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht Foods of the future
15.08.2018 | Georg-August-Universität Göttingen

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: Color effects from transparent 3D-printed nanostructures

New design tool automatically creates nanostructure 3D-print templates for user-given colors
Scientists present work at prestigious SIGGRAPH conference

Most of the objects we see are colored by pigments, but using pigments has disadvantages: such colors can fade, industrial pigments are often toxic, and...

Im Focus: Unraveling the nature of 'whistlers' from space in the lab

A new study sheds light on how ultralow frequency radio waves and plasmas interact

Scientists at the University of California, Los Angeles present new research on a curious cosmic phenomenon known as "whistlers" -- very low frequency packets...

Im Focus: New interactive machine learning tool makes car designs more aerodynamic

Scientists develop first tool to use machine learning methods to compute flow around interactively designable 3D objects. Tool will be presented at this year’s prestigious SIGGRAPH conference.

When engineers or designers want to test the aerodynamic properties of the newly designed shape of a car, airplane, or other object, they would normally model...

Im Focus: Robots as 'pump attendants': TU Graz develops robot-controlled rapid charging system for e-vehicles

Researchers from TU Graz and their industry partners have unveiled a world first: the prototype of a robot-controlled, high-speed combined charging system (CCS) for electric vehicles that enables series charging of cars in various parking positions.

Global demand for electric vehicles is forecast to rise sharply: by 2025, the number of new vehicle registrations is expected to reach 25 million per year....

Im Focus: The “TRiC” to folding actin

Proteins must be folded correctly to fulfill their molecular functions in cells. Molecular assistants called chaperones help proteins exploit their inbuilt folding potential and reach the correct three-dimensional structure. Researchers at the Max Planck Institute of Biochemistry (MPIB) have demonstrated that actin, the most abundant protein in higher developed cells, does not have the inbuilt potential to fold and instead requires special assistance to fold into its active state. The chaperone TRiC uses a previously undescribed mechanism to perform actin folding. The study was recently published in the journal Cell.

Actin is the most abundant protein in highly developed cells and has diverse functions in processes like cell stabilization, cell division and muscle...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

LaserForum 2018 deals with 3D production of components

17.08.2018 | Event News

Within reach of the Universe

08.08.2018 | Event News

A journey through the history of microscopy – new exhibition opens at the MDC

27.07.2018 | Event News

 
Latest News

Smallest transistor worldwide switches current with a single atom in solid electrolyte

17.08.2018 | Physics and Astronomy

Robots as Tools and Partners in Rehabilitation

17.08.2018 | Information Technology

Climate Impact Research in Hannover: Small Plants against Large Waves

17.08.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>