A Comparative Study of Patients Comfort and Satisfaction in Terms of Intra-Operative and Post-Operative Outcome of Patient Undergone Vaginal and Abdominal Hysterectomy

Hysterectomy is one of the most common surgeries performed in gynecology. Abdominal and vaginal hysterectomies are the two predominant operative modalities for various uterine conditions. A large scale survey of hysterectomy has shown that 70.0% to 80.0% of hysterectomies are performed by the abdominal route and only 10.0% of hysterectomy done by vaginal rout. But many studies show the rate of morbidity and complications are comparatively less in vaginal hysterectomies than Abdominal. This study was undertaken to evaluate the patient comfort and satisfaction in two routes of hysterectomy (abdominal or vaginal) in a hospital population for women with benign disease by comparing intra-operative and post-operative complications.

Methodology: The study is a quasi-experimental design, which was undertaken at the SUM hospital, a tertiary teaching hospital, Bhubaneswar, Odisha, India from April 2012 to January 2013. 100 subjects were selected by convenience (non-probability) sampling and equally divided into vaginal and abdominal hysterectomy groups. The intra-operative and post-operative outcomes were compared between two groups which were measured by operative time, blood loss, post-operative pain, wound infection, febrile morbidity, self- care abilities, ambulation, hospital stay and secondary hemorrhage, estimated cost, post-operative complications, re-admission, and re-opening.

Results: There were no differences in the patients' mean age, parity, body mass index, and preoperative hemoglobin levels between two groups. Main indication for women having abdominal operation was leiomyoma, whereas vaginal hysterectomy had done for women having dysfunctional uterine bleeding and utero-vaginal prolapsed. The level of patient comport and satisfaction was more in VH compared to AH patients as because VH patients could exhibit early ambulation, independent self- care activities, good wound healing and was associated with comparatively less postoperative pain, febrile morbidity, wound infection, operative time, economic cost, bleeding requiring less transfusion and low rate of re-admission than abdominal hysterectomy.

Conclusion: Patients are more comfortable and satisfied in terms of postoperative pain, early return to work, less hospital stay and cost in vaginal rout of hysterectomy than abdominal. Hence patients requiring a hysterectomy can be offered vaginal route for surgery in case of desirable conditions.