Design: Systematic Review and Meta-Analysis

Setting: N/A

Patients or Participants: Twenty-three RCTs fulfilled our inclusion criteria with a total population of 2408, 1105 in the VH group and 1303 in the LH group. There was an insignificant difference in terms of intraoperative and short-term complications except for blood loss and urinary tract infection (UTI) which were lower in the VH group (Mean difference (MD) -68, 95% CI; -104.29 to -31.7, p=0.0002, I2=95%) and (Odds ratio (OR) 1.73, 95% CI; 0.92 to 3.26, p=0.03, I2=0%), respectively. Also, VH was associated with less operation time, recovery time, and postoperative pain on the same postoperative day.

Interventions: We searched for randomized controlled trials (RCTs) that compared vaginal hysterectomy (VH) versus laparoscopic hysterectomy (LH) in benign gynecological conditions. Our primary outcomes were surgical complications, and secondary outcomes included operation time, length of hospital stay, recovery time, and effectiveness.

Measurements and Main Results: Twenty-three RCTs fulfilled our inclusion criteria with a total population of 2408, 1105 in the VH group and 1303 in the LH group. There was an insignificant difference in terms of intraoperative and short-term complications except for blood loss and urinary tract infection (UTI) which were lower in the VH group (Mean difference (MD) -68, 95% CI; -104.29 to -31.7, p=0.0002, I2=95%) and (Odds ratio (OR) 1.73, 95% CI; 0.92 to 3.26, p=0.03, I2=0%), respectively. Also, VH was associated with less operation time, recovery time, and postoperative pain on the same postoperative day.

Conclusion: When feasible, vaginal hysterectomy seems to remain the preferred approach of hysterectomy as it requires less time during surgery, results in less blood loss, lower urinary tract infection, and postoperative pain, and promotes faster recovery. This is consistent with the findings of earlier meta-analyses with fewer studies.