Morbidity of 10 110 hysterectomies by type of approach

TLDR

Laparoscopic hysterectomy, introduced in the late 1980s, has prompted debate over the optimal surgical approach for hysterectomy. The study aimed to assess how the surgical approach influences operation‑related morbidity in benign hysterectomies across Finland in 1996. The authors prospectively collected data on 10,110 benign hysterectomies—5,875 abdominal, 1,801 vaginal, and 2,434 laparoscopic—to compare operation‑related morbidity and postoperative complications. Overall complication rates were low (17.2% abdominal, 23.3% vaginal, 19.0% laparoscopic), with infections most common, but ureter injuries were seven‑fold higher in laparoscopic cases, while experienced surgeons (>30 procedures) had markedly lower rates of ureter and bladder injuries, underscoring the importance of surgical experience.

Abstract

Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most suitable approach to hysterectomy.To evaluate the influence of the type of approach, in causing or avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all hysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest were the operation-related morbidity, common surgical details and post-operative complications.A total of 10 110 hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate of overall complications, 17.2, 23.3 and 19.0% respectively. Infections were the most common complications with incidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively. The most severe type of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic group respectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared with abdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal). Surgeons who had performed >30 laparoscopic hysterectomies had a significantly lower incidence of ureter and bladder injuries (0.5 and 0.8% respectively) than those who had performed < or =30 operations (2.2 and 2.0% respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginal hysterectomies.This large-scale observational study on hysterectomies provides novel information on operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importance of the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginal hysterectomies.