Korean J Obstet Gynecol.  2012 Jun;55(6):384-391. 10.5468/KJOG.2012.55.6.384.

The comparison of postoperative pain: total laparoscopic hysterectomy versus vaginal hysterectomy

Affiliations
  • 1Department of Obstetrics and Gynecology, Hallym University College of Medicine, Seoul, Korea. vth2000@naver.com

Abstract


OBJECTIVE
The purpose of this study was to evaluate postoperative pain of total laparoscopic hysterectomy (TLH) compared with vaginal hysterectomy (VH).
METHODS
From June 2010 to August 2010, 122 patients were enrolled, of whom 56 underwent TLH and 66 underwent VH for benign diseases at Kangnam Sacred Heart Hospital. Postoperative pain degree was compared in non-randomized, prospective method and preoperative, intraoperative, postoperative characteristics were considered. Postoperative pain was measured using the visual analog scale (VAS) score at 1-hour, 1-day, 3-day postoperative periods and the additional consumption of analgesic units (vials and tablets) required by patients for pain relief at all hospital stay.
RESULTS
For the first 3 postoperative days, the median total consumption of analgesics was considerably lower in the TLH group than in the VH group (pethidine, P<0.05; non-steroidal anti-inflammatory drug [Ketorolac Tromethamine], P<0.05). The VAS score also was higher for the VH group than in the TLH group (VAS 1-hour, P<0.05; VAS 1-day, P<0.05; VAS 3-day, P<0.05). No significant difference was found between groups in respect to preoperative, intraoperative and postoperative characteristics except operation time, prior intra-abdominal surgery and pelvic adhesion.
CONCLUSION
In this study, since TLH is a less painful procedure in comparison to VH, TLH may be a good alternative to VH for the benign gynecologic diseases with expert surgeons.

Keyword

Postoperative pain; Total laparoscopic hysterectomy; Vaginal hysterectomy

MeSH Terms

Analgesics
Female
Genital Diseases, Female
Heart
Humans
Hysterectomy
Hysterectomy, Vaginal
Pain, Postoperative
Postoperative Period
Prospective Studies
Analgesics

Reference

1. Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988-1990. Obstet Gynecol. 1994. 83:549–555.
2. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, et al. Hysterectomy surveillance: United States, 1980-1993. MMWR CDC Surveill Summ. 1997. 46:1–15.
3. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007. 110:1091–1095.
4. Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2002-03. AIHW cat. no. HSE 32. 2004. Canberra: AIHW.
5. Cosson M, Querleu D, Crepin G. Cosson M, Querleu D, Crepin G, editors. Hysterectomies for benign disorders. Gynecology. 1997. Paris: Williams and Wilkins;160–173.
6. Reich H. Laparoscopic hysterectomy. Surg Laparosc Endosc. 1992. 2:85–88.
7. Vaisbuch E, Goldchmit C, Ofer D, Agmon A, Hagay Z. Laparoscopic hysterectomy versus total abdominal hysterectomy: a comparative study. Eur J Obstet Gynecol Reprod Biol. 2006. 126:234–238.
8. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009. (3):CD003677.
9. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynaecol Obstet. 2003. 83:37–43.
10. Soriano D, Goldstein A, Lecuru F, Daraï E. Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study. Acta Obstet Gynecol Scand. 2001. 80:337–341.
11. Rosenquist RW, Rosenberg J. United States Veterans Administration. Postoperative pain guidelines. Reg Anesth Pain Med. 2003. 28:279–288.
12. Bonica JJ. The need of a taxonomy. Pain. 1979. 6:247–248.
13. Kovac SR. Guidelines to determine the route of hysterectomy. Obstet Gynecol. 1995. 85:18–23.
14. Sheth SS. Vaginal hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2005. 19:307–332.
15. Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004. 328:129.
16. Summitt RL Jr, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstet Gynecol. 1992. 80:895–901.
17. Nascimento MC, Kelley A, Martitsch C, Weidner I, Obermair A. Postoperative analgesic requirements - total laparoscopic hysterectomy versus vaginal hysterectomy. Aust N Z J Obstet Gynaecol. 2005. 45:140–143.
18. Doğanay M, Yildiz Y, Tonguc E, Var T, Karayalcin R, Eryilmaz OG, et al. Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity. Arch Gynecol Obstet. 2011. 284:385–389.
19. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ. 2005. 330:1478.
20. Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol. 2009. 200:368.e1–368.e7.
21. Schindlbeck C, Klauser K, Dian D, Janni W, Friese K. Comparison of total laparoscopic, vaginal and abdominal hysterectomy. Arch Gynecol Obstet. 2008. 277:331–337.
22. Silva-Filho AL, Rodrigues AM, Vale de Castro Monteiro M, da Rosa DG, Pereira e Silva YM, Werneck RA, et al. Randomized study of bipolar vessel sealing system versus conventional suture ligature for vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2009. 146:200–203.
23. Hefni MA, Bhaumik J, El-Toukhy T, Kho P, Wong I, Abdel-Razik T, et al. Safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles in vaginal hysterectomy: randomised controlled trial. BJOG. 2005. 112:329–333.
24. Sculpher M, Manca A, Abbott J, Fountain J, Mason S, Garry R. Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial. BMJ. 2004. 328:134.
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