Postoperative Outcomes and Quality of Life: Laparoscopic Versus Abdominal Hysterectomy

Abstract

Background: Hysterectomy remains the most frequently performed major gynaecological surgery worldwide for benign uterine pathology. Although total abdominal hysterectomy (TAH) has long been regarded as a standard approach, total laparoscopic hysterectomy (TLH) has emerged as a minimally invasive alternative with potential advantages for postoperative recovery and quality of life (QoL). The present study was undertaken to compare short-term postoperative outcomes and QoL between TLH and TAH in women undergoing surgery for benign uterine pathology. Methods: A prospective comparative observational study was conducted over one year in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital. Sixty women aged 35-60 years who were scheduled for hysterectomy for benign uterine indications were recruited and allocated to two groups of 30 each: Group A underwent TLH and Group B underwent TAH. Intraoperative parameters, postoperative pain measured using the Visual Analogue Scale, analgesic requirement, hospital stay, return to routine activities, complications and QoL, assessed using the SF-36 at baseline and six weeks postoperatively, were recorded. Statistical analysis was performed using SPSS version 25, and p < 0.05 was considered statistically significant. Results: Mean operative time was significantly longer in the TLH group (112.4 ± 18.6 min versus 84.7 ± 15.2 min; p < 0.001), whereas intraoperative blood loss (146.3 ± 42.1 mL versus 285.7 ± 68.4 mL; p < 0.001), VAS pain score at 24 hours (3.2 ± 0.9 versus 5.6 ± 1.1; p < 0.001), analgesic consumption, hospital stay (3.1 ± 0.7 versus 5.4 ± 1.0 days; p < 0.001) and time to resume routine activities (10.6 ± 2.4 versus 21.8 ± 3.7 days; p < 0.001) were significantly lower in the TLH group. Wound-related complications were more frequent after TAH (16.7% versus 0%; p = 0.020). At six weeks, all eight SF-36 domains showed significantly higher scores in the TLH group. Conclusion: Total laparoscopic hysterectomy was associated with superior short-term postoperative recovery and quality-of-life outcomes compared with total abdominal hysterectomy for benign uterine pathology, despite a longer operative time, supporting its preferential use when appropriate expertise and infrastructure are available.