ORIGINAL ARTICLE
Agnaldo L. Silva-Filho Æ Roge
´
ria Andrade Werneck
Ru
´
bia Sena de Magalha
˜
es Æ Andrezza V. Belo
Se
´
rgio A. Triginelli
Abdominal vs vaginal hysterectomy: a comparative study
of the postoperative quality of life and satisfaction
Received: 27 October 2005 / Accepted: 25 November 2005 / Published online: 12 January 2006
Ó Springer-Verlag 2006
Abstract Objective: To compare the short-term results of
the quality of life and satisfaction of patients submitted
to total abdominal hysterectomy (TAH) and vaginal
hysterectomy (VH) for benign uterine disease. Methods:
Women referred for hysterectomy for uterine myoma
were randomized to TAH (n=30) or VH (n=30). The
exclusion criteria were uterine prolapse, indication
associated surgical procedures and uterine size
‡300 cm
3
. After a month, follow-up questionnaires had
a response rate of 100%, and consisted of an interview
with application of SF-36 questionnaire (functional
capacity, physical aspect and pain) and evaluation of
satisfaction rate. Results: There were no differences in
the patients’ mean age, parity, body mass index, pre-
operative hemoglobin levels and uterine size between
groups. Lower postoperative quality-of-life scores were
found in the TAH group when compared to the VH
group in functional capacity (P=0.002), physical aspect
(P=0.008) and pain (P=0.002). The general satisfaction
rate with the surgery was similar in the two groups of
patients (P=0.147). However, a higher rate of patients
submitted to VH would choose the same therapeutic
modality (65.5 vs 90%; P=0.021). Conclusions: A better
postoperative quality of life (functional capacity, phys-
ical aspect and pain) and higher satisfaction rate was
found in the VH when compared to TAH.
Keywords Hysterectomy Æ Vaginal hysterectomy Æ
Surgical procedures
Introduction
Hysterectomy is one of the most frequently performed
major surgical procedures and, therefore, its conse-
quences concern a large number of women. Currently, in
the US, abdominal hysterectomy exceeds vaginal hys-
terectomy (VH) by at least a 3:1 ratio for the treatment
of benign disease, whereas the vaginal route is mainly
restricted to the treatment of prolapse [1]. The route for
hysterectomy is based on clinical and technical factors,
such as uterine weight, previous pelvic surgery, previous
vaginal deliveries or the need for morcellation or con-
comitant adnexectomy [2]. The VH is associated with
significant benefits in terms of reduced hospital stay,
improved patient recovery and return to work [3].
Quality of life became an important priority and has
increasingly been recognized as an important outcome
that is variable in surgical procedures [4]. However,
there is no universally accepted definition or indicator of
the quality of life. The medical outcomes study short
form 36-item health survey (SF-36) is a generic instru-
ment for assessing health-related quality of life not
specific to any age, disease or treatment group. The SF-
36 includes one multi-item scale that assesses eight do-
mains of health including limitations in physical activi-
ties because of health problems (functional capacity),
limitations in usual role activities because of physical
health problems (physical aspect) and bodily pain (pain)
[5–7]. Thus, it has been useful in assessing the health of
general and specific populations, differentiating the
health benefits produced by a wide range of treatments.
The aim of the present study was to compare short-
term results of the quality of life and the satisfaction of
patients submitted to total abdominal hysterectomy
(TAH) and VH for the treatment of uterine myoma.
Methods
Sixty patients averaging 45.1±0.6 years (range 34–54
years) referred for hysterectomy for uterine myoma were
A. L. Silva-Filho (&) Æ R. A. Werneck Æ R. S. de Magalha
˜
es
A. V. Belo Æ S. A. Triginelli
Department of Gynecology and Obstetrics, School of Medicine,
Federal University of Minas Gerais, Avenida Professor Alfredo
Balena 190, Santa Efigeˆ nia, 30130100 Belo Horizonte,
Minas Gerais, Brazil
E-mail: agsilvaf@terra.com.br
Tel.: +55-31-32489300
Fax: +55-31-32965490
Arch Gynecol Obstet (2006) 274: 21–24
DOI 10.1007/s00404-005-0118-7