Cochrane review favors vaginal hysterectomy: shorter hospital stays, faster recovery cited.(News)

Vaginal rather than abdominal hysterectomy should be performed "whenever technically feasible" to reduce complications and to speed hospital discharge and patients' return to normal activities, according to a review of randomized controlled trials that have compared hysterectomy techniques.

"The many advantages demonstrated from avoiding abdominal hysterectomy ... suggest that [it] should be avoided if it is possible and safe to do," wrote Neil Johnson, M.D., of the University of Auckland in New Zealand, and his colleagues.

The investigators also concluded that when vaginal hysterectomy is not possible, laparoscopic hysterectomy has advantages over abdominal hysterectomy, including a speedier recovery. These advantages can be "offset," however, by longer operating times and more urinary tract injuries, they said.

The "systematic evidence review" of surgical approach to hysterectomy for benign gynecologic disease was conducted by the Cochrane Collaboration, an international organization that evaluates medical research and draws evidence-based conclusions about medical practice.

Leading ob.gyns. in the United States predicted that--however significant and informative--the conclusions of the metaanalysis will likely fall flat at home, particularly as they concern the issue of vaginal versus abdominal hysterectomy.

Physicians' choice of approach for hysterectomy is so tightly tied with experience and with physicians' "comfort" level that the predominance of the abdominal approach in the United States is unlikely to change, they said.

"I don't think there's ever been an economic incentive for one route over another. It's a training and comfort issue," said Thomas Stovall, M.D., president of the Society of Gynecologic Surgeons. "I think we'll continue to see [choices] based on practice patterns and training."