By Diana Barnes-Brown for Uterus1
Recently, scientists in New Zealand researched a group of previous studies on vaginal versus abdominal hysterectomy and found that vaginal hysterectomy is by far preferable to the abdominal option, which alternately results in long, painful recovery times and more complications overall.
Hysterectomy, or the surgical removal of the uterus, while once the “gold standard” in medical care for any chronic ailments of the female reproductive tract, has now taken a backseat to such minimally-invasive treatments as uterine fibroid embolization, balloon ablation, and others. But for certain diseases and disorders, hysterectomy may still be necessary as a last-ditch effort to prevent continuing health problems.
The two main methods of hysterectomy are vaginal and abdominal hysterectomy. As their names suggest, vaginal hysterectomy involves removing the uterus through the vagina by way of the cervix, while abdominal hysterectomy involves the removal of the uterus through an incision in the abdomen. Some forms of hysterectomy leave the cervix itself intact, while in other cases, it may be necessary to remove the cervix to prevent the spread of diseases such as cancer.
Vaginal hysterectomy, also known as laparoscopic hysterectomy, is generally performed through the cervix with the help of a tool called a laparoscope and a set specialized small devices for cutting and sewing tissue; the procedure is typically most successful in cases where the uterus remains normal in size. Abdominal hysterectomy – which allows doctors to work through a larger opening, an abdominal incision of the size they choose – is preferred for patients with enlarged uteruses, such as those with a significant amount of tumor growth or endometriosis.
In their review of previous findings, Dr. Neil Johnson and colleagues of the University of Auckland in New Zealand examined the data of more than 3,500 women who had participated in 27 different studies. They found that women who had undergone vaginal hysterectomy suffered fewer infections and high temperatures than those who had undergone abdominal hysterectomy.
In conducting their review, the team considered both content and quality of the studies, trying to determine whether each study’s findings were significant when both of these factors were at play.
Hysterectomy is currently listed as the second most common surgery for women of reproductive age. The first most common surgery is caesarian section. Estimates from 2002 by the Centers for Disease Control and Prevention (CDC) indicate that roughly 600,000 hysterectomies are performed annually in the United States. Between 1994 and 1999, more than 60 percent of these were performed abdominally.
Johnson and his team think that this figure could change, if doctors are given better access to, and training about, the alternative of vaginal hysterectomy. The researchers argue that the favorable outcomes of vaginal versus abdominal hysterectomy indicate that vaginal hysterectomy “should be performed in preference to abdominal hysterectomy where possible.”
He added that the best way to come to good decisions about appropriate surgical approaches for hysterectomy is for women to consult with their doctors, being careful to ask for all the options available, not only the most popular or common approaches.
The findings are published the January issue of The Cochrane Library, a journal focused on evaluating medical research.