A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo‐oophorectomy

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Abstract
Objective To identify differences in the peri-operative outcome of women undergoing hysterectomy with bilateral salpingo-oophorectomy performed either by abdominal hysterectomy and bilateral salpingo-oophorectomy or by laparoscopic-assisted salpingo-oophorectomy and vaginal hysterectomy. To identify any potential management implications, including financial differences, between these two forms of operations. Subjects and methods Eighty women undergoing hysterectomy and bilateral salpingo-oophorectomy for benign gynaecological conditions were prospectively randomised to have the procedure by laparoscopic-assisted bilateral salpingo-oophorectomy and vaginal hysterectomy or total abdominal hysterectomy and bilateral salpingo-oophorectomy. The peri-operative and post-operative courses of both groups were compared. Results Although laparoscopic-assisted bilateral salpingo-oophorectomy and vaginal hysterectomy took longer (100 (SD 5.6) versus 57 (SD 4.7) min, P < 0.0001), the women undergoing this procedure had a shorter time in hospital (3.5 versus six days, P < 0.0001) quicker recovery (three versus six weeks, P < 0.0001) and returned to work earlier. There were minimal complications in both groups and they were not significantly different. The cost of the laparoscopic-assisted procedure was greater during the operation with longer operating time and cost of disposable instruments. However, the total cost of treatment was less in this group because of shortened post-operative stay. Conclusion The study shows laparoscopic-assisted bilateral salpingo-oophorectomy and vaginal hysterectomy is a safe and cost-effective procedure for women requiring a hysterectomy and bilateral salpingo-oophorectomy.

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