Major surgery in a minor way

Abstract

Background: Hysterectomy is one of the most common gynaecology operations performed in the UK and is often the chosen management in benign conditions that has not responded to conservative or medical treatment . This is commonly the case in the treatment of large uterine fibroids where the size of the fibroid uterus is a major factor for consideration in the determination of hysterectomy technique. Objective: The aim of this study is to evaluate the relevance of laparoscopic subtotal hysterectomy (LSH) in the treatment of large uterine fibroids as a safe alternative to total laparoscopic (TLH) and abdominal hysterectomy (AH). Method: A retrospective collection of all patients who underwent a LSH under one surgeon between 2009 and 2011 was analysed. Patients with a uterus which clinically measured as ‡16 weeks and a uterus weight of ‡240 g also confirmed on histology were included. Data was collected for intra-operative complications, operation duration, estimated blood loss and length of hospital stay, which includes the time the patient is admitted to the time she is discharged. Results: Fifty-three patients were included, 52 patients had successful LSH and one patient was converted to AH due to a large broad ligament fibroid (775 g). Mean weight of the uterus was 467 g (%) [245–410 g: 28 (53%), 450–649 g: 13 (25%), 650–849 g: 7 (13%), 850–1400 g: 5 (9%)]. Mean operation time was 83.83 min (40–117 min). There were no significant major intra-operative complications recorded. Fifty-two (98.1%) patients had insignificant blood loss and 1 (1.8%) had significant blood loss requiring blood transfusion. Mean hospital stay was 1.45 days [1 day: 36 (67.9%), 2 days (22.6%): 12, 3 days: 3 (5.6%), 4 days: 2 (3.8%)]. Conclusion: In the case of large uterine fibroids, LSH provide a safe and better alternative to TLH and AH