Retrospective Comparison of Non-descent Vaginal Hysterectomy and Total Laparoscopic Hysterectomy for Bulky Uterine Fibroids

Abstract

Objective: To compare perioperative consequences and costs in patients with a bulky fibroid uterus sizing ≥ 12 weeks who underwent either non-descent vaginal hysterectomy (NDVH) or underwent total laparoscopic hysterectomy (TLH) for nondescent uteri. Patients and methods: A retrospective analysis included 105 patients with a bulky fibroid uterus sizing ≥ 12 weeks; it was performed between January 2015 and April 2023 in Benha University Hospital. NDVH and TLH groups enrolled 56 and 49 patients respectively. Results: Both groups' participants were analogous as regards age, parity, pre-operative mean hemoglobin levels, hematocrit value, accompanying comorbidities, previous CS numbers and parallel indications for hysterectomy, but higher preoperative HBA1c and briefer preoperative hospital admittance (p<0.0001) were noticed in NDVH group. There was no variance between both clusters concerning operative time, blood loss, intra-operative complications, necessity for blood transfusion and rates of incidental cystotomy (p>0.05). An elevated variances (p<0.0001) inspiring consequence of NDVH involved need for general anesthesia, shorter LOS, lesser need for analgesics consumption as well as briefer demand for postoperative venous thromboembolic prophylaxis (VTE), former ambulation, to pass flatus and return to daily activity. Estimated hospital costs were lower in the NDVH group (p<0.0001). Conclusion: In patients with a bulky fibroid uterus who may undergo hysterectomy, NDVH is a safe and efficient choice, and the bulky fibroid uterus shouldn't deliberate any more as a frontier to execute NDVH, even more endorsing the NDVH trial as our study results are appeasing NDVH over TLH especially regarding total costs and perioperative consequences.