Laparoscopic Hysterectomy Best for Refractory Menorrhagia

Laurie Barclay, MD

January 30, 2003

Jan. 30, 2003 — Laparoscopic hysterectomy should be the procedure of choice for menorrhagia when medical therapy is not effective, according to the results of a prospective randomized trial reported in the January issue of the American Journal of Obstetrics and Gynecology. This approach was preferred to hysteroscopic endometrial ablation.

"Laparoscopic supracervical hysterectomy (LSH) was designed with the purpose of being the least invasive, least traumatic, and the quickest way to remove the uterus," write Erico Zupi, MD, from the University of Rome in Italy, and colleagues. "LSH is usually associated with lower risk of injury to the ureter or bladder and without adverse effects to either vaginal support or sexual function."

The investigators randomized 181 patients with menorrhagia refractory to medical treatment to LSH or hysteroscopic endometrial ablation. Operative time was significantly shorter in the hysteroscopic group (41.7 ± 19.2 vs. 71.5 ± 28.1 minutes; P<.01). However, perioperative complications, length of hospital stay, convalescent period, and resumption of activities of daily living were similar in both groups.

Over a two-year follow-up, patient satisfaction was significantly higher in the laparoscopic group. There was no cost difference between the two groups.

"For the treatment of menorrhagia, hysterectomy has the distinct advantage of being curative but the disadvantage of being more invasive than the hysteroscopic approach," the authors write. "However, laparoscopic supracervical hysterectomy preserves the curative effect of hysterectomy without its increased surgical invasiveness."

Am J Obstet Gynecol. 2003;188:7-12

Reviewed by Gary D. Vogin, MD


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