Australian and New Zealand Journal of Obstetrics and Gynaecology 2004; 44: 328 –331
Original Article
Blackwell Publishing, Ltd.
Tissue trauma after hysterectomies
Tissue trauma after vaginal hysterectomy and colporrhaphy versus abdominal hysterectomy: A randomised controlled study Nurettin AKA, Gültekin KÖSE, Isik GÖNENÇ and Murat API Department of Obstetrics and Gynecology, Haydarpaßa Numune Education and Research Hospital, Istanbul, Turkey
Abstract Objective: As the magnitude of tissue trauma can be detected by measuring the blood levels of acute phase reactants, we aimed to evaluate tissue trauma markers after abdominal hysterectomy (AH) and vaginal hysterectomy (VH). We hypothesised that VH will be associated with a reduced increase in the level of acute phase reactants than AH. Methods: Thirty women out of 92 patients scheduled for hysterectomies between June 2002 and June 2003 were randomised into two equal groups (n = 15) of VH and AH. Their levels of C-reactive protein (CRP), α1-antitrypsin (α1-AT) and myoglobin (M) were analysed preoperatively and on the second, fourth and sixth days. Results: In both methods of hysterectomy, the operating time (85.3 ± 6.57 min in the VH group vs 69 ± 7.54 min in the AH group, P < 0.0001), and hospital stay duration (7.2 ± 2.5 days in the AH group, 3.1 ± 1.1 days in the VH group, P < 0.0001) were highly significantly different from each other. Demographic parameters and other parameters which may affect tissue trauma markers were not statistically significantly different in each group. Postoperative increases in all markers were markedly high and showed a high statistical difference in both groups (P < 0.05). The postoperative CRP and M values in both groups were significantly higher in the AH group on the second and fourth days and on the sixth day for M only, whereas α1-AT levels were only statistically different on the second day. The tissue trauma markers returned to normal levels on the sixth postoperative day for M, although there still was a statistically significant difference, but remained higher than normal for α1-AT and CRP. Conclusion: Whenever possible, VH should replace AH because this technique leads to a shorter hospital stay and less tissue trauma, enabling patients to return to their normal lives. Key words: α1-antitrypsin, abdominal hysterectomy, C-reactive protein, myoglobulin, vaginal hysterectomy.
Introduction The magnitude of the inflammatory response to surgery depends on the degree of injury during surgical procedures.1–8 In the current prospective, randomised clinical study, we aimed to assess and to compare tissue damage for alternative methods of hysterectomy. As vaginal hysterectomy (VH) is generally associated with less postoperative pain and shorter hospital stay compared with the abdominal procedure, presumably as a result of less tissue trauma and reduced inflammatory response, we expected to find lower levels of myoglobin (M), C-reactive protein (CRP), α1-antitrypsin (α1-AT) in the VH group, postoperatively.
uterine fibroids, pelvic floor relaxation, uterine prolapse and endometrial hyperplasia. The VH group consisted of one patient with uterine descent and simple endometrial hyperplasia, three patients with uterine fibroids and cystocoeles and 11 patients with uterine descent and cystocoeles. In the abdominal hysterectomy (AH) group, 12 patients had uterine fibroids, two patients had simple endometrial hyperplasia and one patient had uterine descent. All patient parameters which may affect the tissue damage, such as trauma history or exercise within the last 48 h and acute or chronic infections and systemic disease, were recorded preoperatively (Table 1). In addition, blood samples were collected from all patients for a white blood
Materials and methods Thirty out of 92 women scheduled for hysterectomy because of non-malignant conditions were randomised into two equal groups (n = 15). The indications for these operations were 328
Correspondence: Dr Nurettin Aka, Feneryolu mah. Hüseyinpasa sk. no: 32/7–A-Blok Kaptan apt., Kadiköy, Istanbul, Turkey. Email:
[email protected] Received 26 June 2003; accepted 16 January 2004.
Tissue trauma after hysterectomies
Table 1 The distribution of parameters, which may affect tissue damage
History of recent trauma History of recent exercise Infections Systemic disease
Colporaphy and vaginal hysterectomy group
Abdominal hysterectomy group
P
None 2 None None
None 1 None None
>0.05 >0.05 >0.05 >0.05
Table 2 The characteristics of study groups for the vaginal hysterectomy and abdominal hysterectomy group
Age Body mass index Operation time (min) Hospital stay (days)
Vaginal hysterectomy and colporaphy group
Abdominal hysterectomy group
P
59.7 ± 6.19 27.3 ± 5.23 85.3 ± 6.57 3.1 ± 1.1
56.2 ± 8.3 26.0 ± 6.41 69.1 ± 7.54 7.2 ± 2.5
>0.05 >0.05
