Vaginal vs laparoscopic hysterectomy shortens recovery time at expense of greater postoperative pain

In the treatment of benign gynaecologic conditions, vaginal hysterectomy is associated with shorter total operative and recovery time compared with laparoscopic hysterectomy but has the disadvantage of greater postoperative pain, according to a study.

Researchers performed a systematic review and meta-analysis of randomized controlled trials (RCTs) wherein vaginal hysterectomy was compared with laparoscopic hysterectomy for treating patients with benign gynaecologic conditions.

Multiple online databases were searched for relevant studies. Of the 3,249 articles retrieved, 23 were included in the final systematic review and 22 in the meta-analysis. The 23 studies comprised a total population of 2,408 women, including 1,105 in the vaginal hysterectomy group and 1,303 in the laparoscopic hysterectomy group.

Compared with the laparoscopic hysterectomy group, the vaginal hysterectomy group had significantly less blood loss (mean difference, −68, 95 percent confidence interval [CI], −104.29 to −31.7; p<0.01; I2=95%) and lower postoperative urinary tract infection rates (odds ratio, 1.73, 95 percent CI, 0.92–3.26; p=0.03; I2=0 percent).

Vaginal hysterectomy was associated with shorter total operative time and recovery time but greater postoperative pain on the day of surgery. Other complications such as conversion to laparotomy, visceral organ damage, or wound dehiscence were infrequent.

The lack of data led to the inability to stratify by surgical indication.