A Randomized Clinical Trial Comparing Laparoscopic and Vaginal Hysterectomy for Benign Disease: An Egyptian University Hospital Experience

Abstract

Objective: This research compared laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) for operative time, complications, postoperative pain, inflammatory response, hospital stay, and costs. Materials and Methods: A randomized controlled trial compared LH and VH for 80 patients equally allocated to undergo either for benign pathology (Canadian Task Force Classification I). Results: Mean operative time was significantly higher for LH (127.5 ± 25.9 minutes; 95% confidence interval [CI]: 119.2, 135.8) than for VH (104 ± 30.8 minutes; 95% CI: 94.2, 113.9); p = 0.0004. There was no significant difference in median blood loss (LH: 250 mL and VH: 235 mL); p = 0.7983). There was a strong positive correlation between operative time and estimated uterine weight, especially for VH. Adnexal surgery was performed as planned preoperatively in 62.5% of LHs versus 27.5% of VHs; p < 0.0035. Both groups were comparable regarding intra- and postoperative complications (p = 1.0). Median postoperative pain intensity was lower in LH than in VH at 2 hours (51 versus 64.5; p = 0.0038), 6 hours (38.5 versus 46; p = 0.0009), and 24 hours (24.5 versus 36.5; p < 0.0001). Inflammatory response did not differ between the groups, neither as postoperative fever (7.5% of LH versus 2.5% of VH; p = 0.6153) nor as postoperative C-reactive protein rise (median: 57.4 mg/L for LH; 41.6 mg/L for VH; p = 0.1489). There was no difference in hospital stay (LH median: 35.5 hours; VH median: 30 hours; p = 0.6991). Costs for LH were higher (LH median: 5525 Egyptian pounds (EGPs), 335 US dollars (USD); VH median: 3400 EGPs, 207 USD; p < 0.0001). Conclusions: LH has longer operative time, yet better postoperative pain profile, than VH. However, cost considerations make LH fall behind VH as a primary choice for benign hysterectomy, especially in low-resource settings. (J GYNECOL SURG 20XX: 000)