MONDAY, Oct. 26 (HealthDay News) -- Hysterectomies for benign disease should be performed via the vaginal route when possible, according to an opinion statement from the American College of Obstetricians and Gynecologists published in the November issue of Obstetrics & Gynecology.
The authors write that roughly 600,000 hysterectomies were performed annually during a recent period, and the surgeon can perform the procedure abdominally, laparoscopically, or vaginally. These methods are used in 66, 12, and 22 percent of cases, respectively.
According to the statement, nulliparity and an enlarged uterus aren't necessarily contraindications for the vaginal procedure. Many nulliparous women have successfully undergone the procedure, and an enlarged uterus can be reduced in size before removal. Nor is salpingoophorectomy a contraindication. However, the authors note, severe endometriosis and other extrauterine disease may preclude this option. Research has proven repeatedly that vaginal hysterectomy is also the most cost-effective method.
"Evidence demonstrates that, in general, vaginal hysterectomy is associated with better outcomes and fewer complications. A Cochrane review of 34 randomized trials of abdominal hysterectomy, laparoscopic hysterectomy, and vaginal hysterectomy, including 4,495 patients, concluded that vaginal hysterectomy has the best outcomes of these three routes," the authors write. "The choice of when to perform prophylactic oophorectomy at the time of hysterectomy is based on the patient's age, risk factors, and informed wishes, but not on the route of hysterectomy."
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