Our Summary

This study looked at the safety of two types of hysterectomy surgeries (removal of the uterus): vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). Traditionally, doctors have considered VH to be safer, but newer data suggests that LH might actually have fewer complications.

The researchers looked at data from nearly 28,000 surgeries performed between 2010 and 2018. They found that while most of these surgeries (72%) were done through the vagina, the use of this method has been decreasing over time, from 89% in 2010 to 64% in 2018.

When they analyzed the data, they found that LH was linked with fewer major and minor complications than VH, even after taking into account patient factors and the type and number of additional pelvic reconstructive procedures a patient needed.

In conclusion, the researchers suggest that doctors should consider the relative safety of these two methods when discussing surgical options with women who need prolapse repair. They also suggest that LH can be safely used in older and sicker patients who are usually advised to opt for a VH.

FAQs

  1. What are the two types of hysterectomy surgeries discussed in the study?
  2. How has the use of vaginal hysterectomy changed over time according to the study?
  3. Based on the study, which type of hysterectomy surgery is linked with fewer complications?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is that laparoscopic hysterectomy (LH) may have fewer complications compared to vaginal hysterectomy (VH). Patients should discuss with their doctor about the potential benefits and risks of each method, taking into consideration their individual health and circumstances.

Suitable For

Patients who may be recommended hysterectomy include those with:

  1. Uterine fibroids: Fibroids are noncancerous growths in the uterus that can cause symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel.

  2. Endometriosis: Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus, causing pain and other symptoms.

  3. Adenomyosis: Adenomyosis is a condition where the tissue that lines the uterus grows into the muscular wall of the uterus, causing heavy menstrual bleeding, pelvic pain, and pressure.

  4. Uterine prolapse: Uterine prolapse occurs when the uterus slips down into the vaginal canal due to weakened pelvic floor muscles.

  5. Gynecologic cancers: In cases of uterine, cervical, or ovarian cancer, a hysterectomy may be recommended as part of the treatment plan.

  6. Chronic pelvic pain: Chronic pelvic pain that does not respond to other treatments may be alleviated with a hysterectomy.

  7. Dysfunctional uterine bleeding: Persistent, heavy, or irregular menstrual bleeding that does not respond to other treatments may warrant a hysterectomy.

It is important for patients to discuss their individual medical history, symptoms, and treatment goals with their healthcare provider to determine if a hysterectomy is the right option for them.

Timeline

Before hysterectomy:

  • Patient may experience symptoms such as pelvic pain, heavy menstrual bleeding, or pelvic organ prolapse
  • Patient consults with a gynecologist to discuss treatment options
  • Gynecologist recommends hysterectomy as a treatment option
  • Patient undergoes pre-operative evaluations and tests to ensure they are a suitable candidate for surgery

After hysterectomy:

  • Patient undergoes either VH or LH surgery
  • Patient stays in the hospital for a few days for recovery
  • Patient may experience pain and discomfort post-surgery
  • Patient follows up with their gynecologist for post-operative care and monitoring
  • Patient gradually resumes normal activities and may experience improvements in their symptoms

What to Ask Your Doctor

  1. What are the potential risks and benefits of vaginal hysterectomy compared to laparoscopic hysterectomy in my specific case?
  2. How experienced are you in performing both types of hysterectomy surgeries?
  3. Will I need any additional pelvic reconstructive procedures during the surgery, and if so, how will that affect the choice between vaginal and laparoscopic hysterectomy?
  4. What is the recovery time like for each type of hysterectomy, and how long can I expect to be in the hospital after surgery?
  5. Are there any long-term effects or complications associated with either type of hysterectomy that I should be aware of?
  6. Are there any specific factors in my medical history or current health status that make one type of hysterectomy more favorable for me than the other?
  7. What are the success rates for each type of hysterectomy in terms of resolving my specific condition?
  8. Are there any alternative treatment options to consider before moving forward with a hysterectomy?
  9. How will my overall quality of life be impacted by having a hysterectomy, and are there any lifestyle changes I should anticipate making post-surgery?
  10. Can you provide me with any additional resources or information to help me make an informed decision about which type of hysterectomy is right for me?

Reference

Authors: Luchristt D, Kenton K, Bretschneider CE. Journal: Int Urogynecol J. 2022 Nov;33(11):3005-3011. doi: 10.1007/s00192-021-05069-2. Epub 2022 Jan 12. PMID: 35020034