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BMC Women's Health Jun 2019There are various surgical approaches of hysterectomy for benign indications. This study aimed to compare vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There are various surgical approaches of hysterectomy for benign indications. This study aimed to compare vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH) with respect to their complications and operative outcomes.
METHODS
We selected randomised controlled trials that compared VH with LH for benign gynaecological indications. We included studies published after January 2000 in the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library). The primary outcome was comparison of the complication rate. The secondary outcomes were comparisons of operating time, blood loss, intraoperative conversion, postoperative pain, length of hospital stay and duration of recuperation. We used Review Manager 5.3 software to perform the meta-analysis.
RESULTS
Eighteen studies of 1618 patients met the inclusion criteria. The meta-analysis showed no differences in overall complications, intraoperative conversion, postoperative pain on the day of surgery and at 48 h, length of hospital stay and recuperation time between VH and LH. VH was associated with a shorter operating time and lower postoperative pain at 24 h than LH.
CONCLUSIONS
When both surgical approaches are feasible, VH should remain the surgery of choice for benign hysterectomy.
Topics: Female; Gynecology; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Operative Time; Pain, Postoperative; Postoperative Complications
PubMed: 31234852
DOI: 10.1186/s12905-019-0784-4 -
Surgery Journal (New York, N.Y.) Dec 2021Recently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the...
Recently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.
PubMed: 35111936
DOI: 10.1055/s-0041-1739120 -
BMJ (Clinical Research Ed.) Sep 2019To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in... (Comparative Study)
Comparative Study Observational Study Randomized Controlled Trial
Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial.
OBJECTIVE
To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery.
DESIGN
Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial.
SETTING
Four non-university teaching hospitals, the Netherlands.
PARTICIPANTS
204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years.
MAIN OUTCOME MEASURES
Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning.
RESULTS
At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference-6.7%, 95% confidence interval -12.8% to-0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions.
CONCLUSIONS
At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures.
TRIAL REGISTRATION
trialregister.nl NTR1866.
Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Hysterectomy, Vaginal; Ligaments; Middle Aged; Netherlands; Quality of Life; Recurrence; Reoperation; Severity of Illness Index; Suture Techniques; Treatment Outcome; Uterine Prolapse
PubMed: 31506252
DOI: 10.1136/bmj.l5149 -
JAMA Aug 2023Surgical repairs of apical/uterovaginal prolapse are commonly performed using native tissue pelvic ligaments as the point of attachment for the vaginal cuff after a... (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Surgical repairs of apical/uterovaginal prolapse are commonly performed using native tissue pelvic ligaments as the point of attachment for the vaginal cuff after a hysterectomy. Clinicians may recommend vaginal estrogen in an effort to reduce prolapse recurrence, but the effects of intravaginal estrogen on surgical prolapse management are uncertain.
OBJECTIVE
To compare the efficacy of perioperative vaginal estrogen vs placebo cream on prolapse recurrence following native tissue surgical prolapse repair.
DESIGN, SETTING, AND PARTICIPANTS
This randomized superiority clinical trial was conducted at 3 tertiary US clinical sites (Texas, Alabama, Rhode Island). Postmenopausal women (N = 206) with bothersome anterior and apical vaginal prolapse interested in surgical repair were enrolled in urogynecology clinics between December 2016 and February 2020.
INTERVENTIONS
The intervention was 1 g of conjugated estrogen cream (0.625 mg/g) or placebo, inserted vaginally nightly for 2 weeks and then twice weekly to complete at least 5 weeks of application preoperatively; this continued twice weekly for 12 months postoperatively. Participants underwent a vaginal hysterectomy (if uterus present) and standardized apical fixation (either uterosacral or sacrospinous ligament fixation).
MAIN OUTCOMES AND MEASURES
The primary outcome was time to failure of prolapse repair by 12 months after surgery defined by at least 1 of the following 3 outcomes: anatomical/objective prolapse of the anterior or posterior walls beyond the hymen or the apex descending more than one-third of the vaginal length, subjective vaginal bulge symptoms, or repeated prolapse treatment. Secondary outcomes included measures of urinary and sexual function, symptoms and signs of urogenital atrophy, and adverse events.
RESULTS
Of 206 postmenopausal women, 199 were randomized and 186 underwent surgery. The mean (SD) age of participants was 65 (6.7) years. The primary outcome was not significantly different for women receiving vaginal estrogen vs placebo through 12 months: 12-month failure incidence of 19% (n = 20) for vaginal estrogen vs 9% (n = 10) for placebo (adjusted hazard ratio, 1.97 [95% CI, 0.92-4.22]), with the anatomic recurrence component being most common, rather than vaginal bulge symptoms or prolapse repeated treatment. Masked surgeon assessment of vaginal tissue quality and estrogenization was significantly better in the vaginal estrogen group at the time of the operation. In the subset of participants with at least moderately bothersome vaginal atrophy symptoms at baseline (n = 109), the vaginal atrophy score for most bothersome symptom was significantly better at 12 months with vaginal estrogen.
CONCLUSIONS AND RELEVANCE
Adjunctive perioperative vaginal estrogen application did not improve surgical success rates after native tissue transvaginal prolapse repair.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02431897.
Topics: Aged; Female; Humans; Middle Aged; Administration, Intravaginal; Estrogens, Conjugated (USP); Gynecologic Surgical Procedures; Hysterectomy; Hysterectomy, Vaginal; Pelvic Organ Prolapse; Secondary Prevention; Treatment Outcome; Uterine Prolapse; Vagina; Vaginal Creams, Foams, and Jellies
PubMed: 37581673
DOI: 10.1001/jama.2023.12317 -
Obstetrics and Gynecology Aug 2020
Topics: Female; Humans; Hysterectomy, Vaginal
PubMed: 32732753
DOI: 10.1097/AOG.0000000000004028 -
Surgery Journal (New York, N.Y.) Dec 2021Abdominal radical trachelectomy is a fertility-sparing surgery for early invasive cervical cancer. The surgical steps involved in abdominal radical trachelectomy are...
Abdominal radical trachelectomy is a fertility-sparing surgery for early invasive cervical cancer. The surgical steps involved in abdominal radical trachelectomy are similar to those for radical hysterectomy prior to removal of the uterus. The difference is that in trachelectomy, the uterine corpus and infundibulopelvic ligament are conserved and the cervical remnant is connected to the vaginal wall. Surgeons should pay close attention to avoiding postsurgical complications such as infection and ileus, which might interfere with subsequent fertility treatments.
PubMed: 35111935
DOI: 10.1055/s-0041-1728750