Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis

Hysterectomy is a very common gynaecological procedure. The vaginal route is considered preferable for hysterectomy, although the ideal route for women unsuitable for the vaginal approach remains unclear. We performed a meta-analysis of published randomised controlled trials to compare outcomes in total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) for benign disease. Pooled odds ratios (OR) were calculated for categorical variables using random effects models as per Der Simonian and Laird. Continuous variables were compared by means of weighted mean differences (WMD). TLH is associated with reduced overall peri-operative complications (pooled OR 0.19; 95% CI 0.07-0.50) and reduced estimated blood loss (WMD -183ml; 95% CI -346ml to -21ml; p=0.03). Additionally, there are trends towards shorter hospital stay (WMD -2.5 days; 95% CI -5.1 days to 0.01 days; p=0.05) and post-operative haematoma formation (pooled OR 0.17; 95% CI 0.03-1.01) compared to TAH. The only trade-off appears to be a longer operating time in the TLH group (WMD 22min; 95% CI 5-39min; p=0.01). Rates of major complication were not statistically different (pooled OR 1.35; 95% CI 0.32-5.73) though this analysis is likely underpowered to detect many major complications. As such, TLH appears to offer benefits to women requiring total hysterectomy for benign indications compared to TAH, particularly regarding minor complications, blood loss and hospital stay. However, larger studies are needed to assess the impact on major intra-operative complications and long-term clinical outcomes, particularly pelvic organ prolapse.