Laparoscopically assisted vaginal hysterectomy vs vaginal hysterectomy: meta analysis

Vaginal hysterectomy (VH) is generally considered the surgical approach of choice for treatment of benign uterine disease. Laparoscopically assisted vaginal hysterectomy (LAVH) has been introduced as a surgical alternative to the standard methods of VH. A meta-analysis of randomized controlled trials was conducted to compare LAVH vs VH. Medline, Embase, ISI Web of Knowledge CPCI-S, and the Cochrane Library were searched, and the methodologic quality of trials included was evaluated. Outcomes evaluated were complications, conversion rate, operative time, hospital stay, blood loss, paralytic ileus duration, and weight of the surgically treated uterus. Results were pooled in meta-analyses as odds ratio and weighted mean difference. Of 629 patients in 9 randomized controlled trials, 312 were allocated to the VH group, and 317 to the LAVH group. LAVH required longer operating time than VH did (weighted mean difference, 39.59; 95% confidence interval, 20:00-59.18 minutes; p < .001; χ(2) p < .001; I(2) = 97%), with evidence of significant heterogeneity (χ(2) = 209.14; p < .001). Complications, conversion rate, hospital stay, blood loss, paralytic ileus duration and weight of the surgically treated uterus were similar in both groups. Clinical outcomes with LAVH were comparable to those with VH; however, operative time was longer with LAVH. Currently, VH should be routinely used.