Laparoscopic Subtotal Hysterectomy Found Effective for Menorrhagia

Researchers of the Princess Royal University Hospital (Orpington, United Kingdom) conducted a prospective observational study and investigated the outcomes (including complication rates and patient acceptability) of 400 consecutive LSHs for menorrhagia resistant to medical treatment (96%), dysfunctional uterine bleeding not responding to hormonal treatment, known symptomatic myomas, or failed previous endometrial ablation. The mean duration of surgery was 46.4 minutes and the mean operative blood loss was 126 ml. Three quarters of the procedures were performed as day cases.

The study results showed that three women (0.75%) sustained bladder entry that was repaired laparoscopically and two (0.5%) incurred bowel injury, and only 7 women (1.7%) developed postoperative infections. There were no postoperative transfusions or returns to the operating theater because of excessive blood loss. Five women ultimately required laparoscopic removal of the cervix because of persistent cyclical vaginal bleeding after the procedure. Women returned to work after an average of two weeks, and most women resumed sexual activity 3 to 4 weeks after surgery; 98% of the women reported satisfaction with the operation and would recommend the procedure to a friend. The study was published in the May 2008 issue of the British Journal of Obstetrics and Gynaecology (BJOG).

"LSH is a safe and effective treatment for menorrhagia and other menstrual disorders when hysterectomy is indicated,” concluded John Erian, M.D., and colleagues of the department of obstetrics and gynecology. "Women appreciate the quick recovery period, reduced time off work and faster return to normal activity. Our data suggest that LSH can replace abdominal hysterectomy in selected cases.”

Menorrhagia (also known as hypermenorrhea) is an abnormally heavy and prolonged menstrual period at regular intervals. Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods, or disorders of the endometrial lining of the uterus. If a normal menstrual cycle is 21-35 days in duration, with bleeding lasting an average of 5 days and total blood flow between 25 and 80 ml, a blood loss of greater than 80 ml or lasting longer than 7 days constitutes menorrhagia. Treatment options include pharmaceutical or surgical and radiological options.


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