Comparison of perioperative outcomes of different routes of hysterectomies- total abdominal, vaginal and laparoscopic, in a tertiary care hospital in Karachi, Pakistan

Background: This study was conducted to compare the perioperative findings among women undergoing hysterectomy by abdominal (TAH), vaginal (VH) and laparoscopic (TLH) routes. Methods: A 5-year cross-sectional survey was conducted at the Aga Khan University Hospital from January 2015-December 2020 to compare perioperative outcomes of the different routes of hysterectomies. Medical record review of 385 patients who underwent hysterectomy for benign conditions were reviewed and analysed, out of which 195 (50.6%) underwent TAH, 96 (24.9%) VH and 94 (24.4%) were operated laparoscopically. Patients with uncontrolled medical comorbid, history of 2 or more abdominal surgeries and uterine size of more than 14 weeks were excluded from the study. Results: revealed significant difference between the mean hospital stay of patients with TAH having the highest mean stay in days (TAH=4.8±1.01, VH=4.4±0.7 and TLH=3.9±0.82 in days; p<0.01) TLH took comparatively significantly longer operating time than TAH (p=0.0005) and VH groups (p=0.004) however, median estimated blood loss was significantly lower in women who underwent TLH as compare to TAH [median (25th-75th percentile); 100 (50-200)] versus 300 (200-500); p<0.01] and VH [100 (50-200)] versus 250 (100-400); p<0.01]. The incidence of post-operative complications was less than 3% and these were observed in women underwent TAH. Conclusions: VH and TLH have lesser complications and hospitalization days as compared to TAH, making these 2 methods superior. Informed decision making by patient and surgeon’s training together can account for choosing the best method of hysterectomy suitable to the patient.