AHY, VHY or LAVHY?

Overview

Objective:
To evaluate the way of the surgical treatment of uterine fibroids in two 5 year long periods.In the first period (1987 - 1991) the operative procedures - hysterectomies - were performed usuallyby the classical abdominal aproach. In the second period (1997 - 2001) the modern trend of minimalinvasive surgery was applied. Through analysis of three surgical procedures used (AHY, VHY,LAVHY) the conclusions concerning the advantages, disadvantages and correct indications for theselection of hysterectomy in cases of uterine fibroids are presented.Study Design: Retrospective study.Study Setting: Department of Obstetrics and Gynecology, Medical Faculty and University Hospital,Palacký University, Olomouc.Methods: The total of 1172 patients (604 in the first period and 568 in the second period) wereoperated by abdominal hysterectomy (AHY), vaginal hysterectomy (VHY) or laparoscopically assistedvaginal hysterectomy (LAVHY). The factors influencing the mode of hysterectomy (body mass,weight of uterus, parity, adnexal finding, previous surgery) were analyzed. The type of anesthesiaand per and postoperation complications (blood loss, conversion of vaginal to abdominal approach,inflammatory complications and administration of antibiotics) were also evaluated.Results: Each of the chosen surgical procedures has advantages and disadvantages. Abdominalhysterectomy as the most invasive procedure is indicated only in extremely unfavourable findings.The least invasive procedure is VHY, which therefore is the optimal solution for the patient. LAVHYrepresents the operation which combines advantages of both AHY and VHY and fulfils also thecriteria for minimal invasive surgery.Conclusion: The choice of the optimal surgical procedure in patients with uterine fibroids dependson the complex assessment of the preoperative finding, the technical possibilities of the setting andthe experience of the surgeon. The goal is to chose the safest but at the same time least invasivesurgical procedure.

Key words:
uterine fibroids, abdominal hysterectomy, vaginal hysterectomy, laparoscopically assistedvaginal hysterectomy.