Short and long term complications of abdominal and vaginal hysterectomy for benign disease

OBJECTIVE: To describe the indications, short, intermediate and long term complications for total abdominal versus vaginal hysterectomy, in women with benign pelvic disease.

METHODS: This study was carried out at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Chart review was conducted from 1995 to 1999, for all patients who had hysterectomy for benign disease. We compared indications, short, intermediate and long term complications of total abdominal versus vaginal hysterectomy. A total of 108 patients who had hysterectomy were available for analysis. Group one consisted of patients who had total abdominal hysterectomy (N=82), and group 2 consisted of patients who had vaginal hysterectomy (N=26).

RESULTS: The principle indication for the vaginal hysterectomy was uterine prolapse 81%, which occurs in women >45-years-old. While, the most common indications for the total abdominal hysterectomy were menstrual disorders and uterine fibroids 56%, which occur in women <45-years-old. The overall complication rates were 51.2% and 23.1%, in women who underwent total abdominal hysterectomy and vaginal hysterectomy (p=0.01, odds ratio = 3.5). Twelve patients (14.6%) required 2nd intervention or rehospitalization, or both, in the total abdominal hysterectomy group, while none were required in the vaginal hysterectomy group. Febrile morbidity formed the major category of the postoperative complications in our study, total incidence was 27.8% (30/108). No statistically significant differences were noted between the total abdominal hysterectomy [30.1% (25/82)] and the vaginal hysterectomy groups [19.2% (5/26), (p=0.3)], nor for women who received antibiotic prophylaxis [25.5% (14/55)] and women who did not [28.3% (15/53), (p=0.7)].

CONCLUSION: Vaginal hysterectomy is associated with less intraoperative, intermediate and late complication rates than total abdominal hysterectomy. No significant differences in postoperative febrile morbidity, but significantly shorter hospitalization were noted among women who received antibiotic prophylaxis compared to those who did not.