Table 16, Vaginal versus abdominal hysterectomy - Management of Uterine Fibroids

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Author, Year	Groups	N	Operative Time (min ± SD)	Decrease in Hemoglobin/ Hematocrit	Blood Transfusions n (%)	Perioperative Complications n (%)*		Hospital Stay (mean days ± SD)
						Intraoperative Complications n (%)^†‡	Postoperative Complications n (%)**, ^††
Benassi et al., 2002¹⁵⁵	Vaginal hysterectomy	60	86 ± 25.32	No difference in hemoglobin levels at postoperative day 1 (P= 0.897), or in the difference between pre- and postoperative levels (P = 0.848)	2 (3.3)	0	2 (3.3)	3.4 ± 0.7
	Abdominal hysterectomy	59	102 ± 31.02		4 (6.8)	0	6 (10.1)	4.3 ± 1.5
			P < 0.001		P NR	NA	P = 0.136	P < 0.001

Harmanli et al., 2004¹⁶¹	Vaginal hysterectomy	88	114.3 ± 46.3	1.9 ± 1.2 (decrease in Hgb)	8 (9.2)	Only risk of ileus (OR, 2.42; 95% CI, 1.08–5.43) was significantly higher for women who underwent abdominal hysterectomy compared to vaginal hysterectomy		1.9 ± 0.9
	Abdominal hysterectomy	200	137.4 ± 69.8	1.6 ± 1.4 (decrease in Hgb)	23 (11.5)			3.7 ± 1.3
			P NS	P = 0.03	P NS			P = 0.0001

Taylor et al., 2003¹⁶⁶	Vaginal hysterectomy	139	172 ± 70.0	7.5 ± 4.6 (decrease in hematocrit)	Intraoperative and postoperative transfusion reported separately, no significant differences between groups	8 (5.8)	10 (7.2)	2.6 ± 1.5
	Abdominal hysterectomy	208	173 ± 66.6	8.3 ± 5.9 (decrease in hematocrit)		16 (7.7)	48 (23.1)	3.9 ± 2.6
			P = 0.88	P = 0.18		P = 0.53; OR, 1.4 (0.6, 3.3)	P < 0.001; OR, 3.9 (1.9, 7.9)	P < 0.001

: CI, confidence interval; Hgb, hemoglobin; min, minutes; NA, not applicable; NR, not reported; n, number; NS, not significant; OR, odds ratio; SD, standard deviation.
*: Postoperative febrile morbidity, bleeding requiring transfusion, ureteral injury, bladder injury, venous thromboembolism, ileus, hematoma, urinary tract infection, readmission.
†: Major vessel injury, ureteral injury, bladder injury, bowel injury.
‡: Intraoperative transfusion, conversion to total abdominal hysterectomy, cystotomy, ureteral obstruction, bowel laceration.
**: Vaginal cuff hematoma, pelvic hematoma, wound infection, wound dehiscence.
††: Postoperative transfusion, pelvic hematoma, reoperation, febrile morbidity, other.

Management of Uterine Fibroids: An Update of the Evidence.

Evidence Reports/Technology Assessments, No. 154.

Viswanathan M, Hartmann K, McKoy N, et al.

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