ABDOMINAL HYSTERECTOMY FOR THE ENLARGED MYOMATOUS UTERUS COMPARED WITH VAGINAL HYSTERECTOMY WITH MORCELLATION

S. Taylor, MD, D. Kammerer-Doak, MD, A. Romero, MD, C. Qualls, PhD, R. Rogers, MD

   Objective: To compare intraoperative and postoperative complications of abdominal hysterectomy (TAH) for the enlarged, myomatous uterus with vaginal hysterectomy with morcellation (VHM).

   Materials and Methods: Medical records of 244 patients who underwent TAH for an enlarged, myomatous uterus and 152 patients who underwent VHM between August 1990 and July 2001 were reviewed. Thirty-six cases with uterine weights greater than 982 gm. were excluded as this was the weight of the largest uterus removed vaginally in this series. The intraoperative and postoperative course of the two groups was compared. Students t-test for continuous variables and Fisher’s exact test for binary or categorical were used.

   Results: No difference was found between the two groups in surgical or anesthetic risk factors (Fisher’s exact, all p>.05). Operative time was similar in both groups (t(358)=0.40, p=.68). Length of hospital stay was significantly increased with TAH (mean 3.9 versus 2.6 days, t(357)= -5.78, p<.001). Intraoperative complications occurred equally between the two groups (4.8% both, Fisher’s exact, p=.16). Postoperative complications were increased with TAH (6% versus 23%, Fisher’s exact, p<.001).

   Conclusion: This large series demonstrates that uterine morcellation at the time of vaginal hysterectomy is safe, facilitating the removal of moderately enlarged uteri and is associated with decreased hospital stay and postoperative morbidity compared to the abdominal route.
  
   Keywords: Hysterectomy, leiomyomata, morcellation