Effect of vaginal estriol use in total laparoscopic hysterectomy with gonadotropin-releasing hormone agonist therapy

Abstract

Study Objectives:The aim of this study is to evaluate the effects of vaginal estriol therapy in total laparoscopic hysterectomy (TLH) with gonadotropin-releasing hormone agonist (GnRH-a) treatment.Design:Retrospective analysis.Design Classification:Canadian Task Force classification II-2.Settings:Department of Gynecology, Yokohama City University Medical Center, Japan.Methods:We retrospectively investigated 50 fibroid cases that had TLH with preoperative GnRH-a treatment and compared the surgical outcome with or without vaginal estriol use (1mg). Estriol was used administered for two weeks before TLH.Measurements and Main Results:A total of 12 patients (27%) received vaginal estriol (1 mg) for 14 days before TLH. As a result of vaginal estriol treatment, there were no group differences in uterus size reduction with GnRH-a treatment (22% vs. 15%, P = 0.20), uterine removal time through the vagina (12.5 min vs. 18.5 min, P = 0.18), rate of vaginal dehiscence (3% vs. 0%, P = 0.76) or in the rate of perineal laceration (33% vs. 34%, P = 0.55).Conclusion:The use of vaginal estriol treatment before TLH with GnRH-a therapy did not improve surgical outcomes.

Risk Factors Associated with Perineal and Vaginal Lacerations and Vaginal Removal in Total Laparoscopic Hysterectomy

“…[ 14 ] Unfortunately, GnRHa use has the side effect of vaginal atrophy, which causes difficulty in removing the uterus through the vagina. [ 6 ] During TLH, removing the uterus through the birth canal could lead to perineal or vaginal lacerations, depending on the size of the myoma. In addition, a large newborn head circumference is a risk factor for birth canal lacerations during vaginal birth.…”

“…[ 4 5 ] Currently, manual vaginal morcellation is performed to remove the uterus from the abdominal cavity after TLH. [ 5 6 ] Manual vaginal morcellation remains safe despite occult malignancies and does not appear to negatively impact prognosis or relapse;[ 7 ] therefore, it is the first choice of intervention for TLH. [ 8 ] Moreover, vaginal morcellation is faster than other treatment options.…”