Archives of Gynecology and Obstetrics

, Volume 284, Issue 2, pp 385–389 | Cite as

Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity

  • Melike DoğanayEmail author
  • Yasemin Yildiz
  • Esra Tonguc
  • Turgut Var
  • Rana Karayalcin
  • Ozlem Gun Eryιlmaz
  • Orhan Aksakal
General Gynecology



The aim of our retrospective study was to assess and to compare the surgical complications of hysterectomy regarding the choice of procedure [abdominal (AH), vaginal (VH), and total laparoscopic hysterectomy (TLH)].


A total of 6,480 patient charts undergone hysterectomy were retrospectively analyzed. Data including transfusion, bladder, ureteral and bowel injury, cuff dehiscence, pulmoner embolus, febrile morbidity, hematoma, reoperation, pelvic wall problems were gathered. The Chi-square test and Student’s t test were used in the statistical analysis.


The most common perioperative complication was blood transfusion which occurred in 114 patients (2.6%). VH patients required significantly less blood transfusion than AH (2.1, 2.6%, respectively). AH had significantly more bladder injury than VH (0.7, 0.4%, respectively). AH had significantly more ureteral injury than VH (0.2, 0.1%, respectively). AH had the same bowel injury as VH (0.1%). AH and VH necessitated significantly more reoperation than TLH (0.4, 0.2, 0.0%, respectively).


To our study, VH ensures less complication rates than AH. In experienced centers, VH can be a reliable alternative to AH. Controlled prospective studies with large patient volumes are required to compare TLH and VH according to complication rates.


Hysterectomy Complication Laparoscopic Vaginal Abdominal 


Conflict of interest



  1. 1.
    Garry R (2005) The future of hysterectomy. BJOG 112(2):133–139PubMedCrossRefGoogle Scholar
  2. 2.
    McCracken G, Hunter D, Morgan D, Price JH (2006) Comparison of laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy and vaginal hysterectomy. Ulster Med J 75(1):54–58PubMedGoogle Scholar
  3. 3.
    Hwang JL, Seow KM, Tsai YL, Huang LW, Hsieh BC, Lee C (2002) Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger then 6 cm in diameter or uterus weighting at least 450 g: a prospective randomized study. Acta Obstet Gynecol Scand 81(12):1132–1138PubMedCrossRefGoogle Scholar
  4. 4.
    Ottosen C, Lingman A, Ottosen L (2000) Three methods for hysterectomy: a randomized, prospective study of short term outcome. BJOG 107(11):1380–1385PubMedCrossRefGoogle Scholar
  5. 5.
    Sutton C (1997) Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol 11(1):1–22PubMedCrossRefGoogle Scholar
  6. 6.
    Reich H (1989) New techniques in advanced laparoscopic surgery. Baillieres Clin Obstet Gynaecol 3(3):655–681PubMedCrossRefGoogle Scholar
  7. 7.
    Gyr T, Ghezzi F, Arslanagic S, Leidi L, Pastorelli G, Franchi M (2001) Minimal invasive laparoscopic hysterectomy with ultrasonic scalpel. Am J Surg 181(6):516–519PubMedCrossRefGoogle Scholar
  8. 8.
    Makinen J, Johansson J, Tomas C, Tomas E, Heinonen PK, Laatikainen T et al (2001) Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 16(7):1473–1478PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R (2005) Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 330(7506):1478PubMedCrossRefGoogle Scholar
  10. 10.
    HoVman CP, Kennedy J, Borschel L, Burchette R, Kidd A (2005) Laparoscopic hysterectomy: the Kaiser Permanente San Diego experience. J Minim Invasive Gynecol 12(1):16–24CrossRefGoogle Scholar
  11. 11.
    Schindlbeck C, Klauser K, Dian D, Janni W, Friese K (2008) Comparison of total laparoscopic, vaginal and abdominal hysterectomy. Arch Gynecol Obstet 277(4):331–337PubMedCrossRefGoogle Scholar
  12. 12.
    Soriano D, Goldstein A, Lecuru F, Daraï E (2001) Recovery from vaginal hysterectomy compared with laparoscopic-assisted vaginal hysterectomy: a prospective, randomized, multicenter study. Acta Obstet Gynecol Scand 80(4):337–341PubMedGoogle Scholar
  13. 13.
    Farquhar CM, Steiner CA (2002) Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 99(2):229–234PubMedCrossRefGoogle Scholar
  14. 14.
    Gimbel H, Settnes A, Tabor A (2001) Hysterectomy on benign indication in Denmark 1988–1998. A register based trend analysis. Acta Obstet Gynecol Scand 80(3):267–272PubMedGoogle Scholar
  15. 15.
    Young W, Cohen MM (1997) Laparoscopically assisted vaginal hysterectomy. A review of current issues. Int J Technol Assess Health Care 13(2):368–379PubMedCrossRefGoogle Scholar
  16. 16.
    Sesti F, Calonzi F, Ruggeri V, Pietropolli A, Piccione E (2008) A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri. Int J Gynaecol Obstet 103(3):227–231PubMedCrossRefGoogle Scholar
  17. 17.
    Silva-Filho AL, Werneck RA, de Magalhaes RS, Belo AV, Triginelli SA (2006) Abdominal vs vaginal hysterectomy: a comparative study of the postoperative quality of life and satisfaction. Arch Gynecol Obstet 74(1):21–24CrossRefGoogle Scholar
  18. 18.
    Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, Clayton R, Phillips G, Whittaker M, Lilford R et al (2004) The evaluate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 328:129PubMedCrossRefGoogle Scholar
  19. 19.
    Boukerrou M, Lambaudie E, Collinet P, Crepin G, Cosson M (2004) Previous caesarean section is an operative risk factor in vaginal hysterectomy. Gynecol Obstet Fertil 32(6):490–495PubMedCrossRefGoogle Scholar
  20. 20.
    Carley ME, McIntire D, Carley JM, Schaffer J (2002) Incidence, risk factors and morbidity of unintended bladder or ureter injury during hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct 13(1):18–21PubMedCrossRefGoogle Scholar
  21. 21.
    Donnez O, Jadoul P, Squifflet J, Donnez J (2009) A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures. BJOG 116(4):492–500PubMedCrossRefGoogle Scholar
  22. 22.
    Walsh CA, Walsh SR, Tang TY, Slack M (2009) Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 144(1):3–7PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Melike Doğanay
    • 1
    • 2
    Email author
  • Yasemin Yildiz
    • 1
  • Esra Tonguc
    • 1
  • Turgut Var
    • 1
  • Rana Karayalcin
    • 1
  • Ozlem Gun Eryιlmaz
    • 1
  • Orhan Aksakal
    • 1
  1. 1.Department of Obstetrics and GynecologyZekai Tahir Burak Mother Health Training and Research HospitalAnkaraTurkey
  2. 2.Yuzuncuyιl-AnkaraTurkey

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