Work

Perioperative outcomes and tissue trauma after uncomplicated total hysterectomy for benign uterine disease: a retrospective study

Year: 2026

Type: article

Abstract: Background Hysterectomy is the most frequently performed non-obstetric gynecological surgery for benign disease, and the surgical route affects perioperative outcomes and recovery. While minimally invasive approaches reduce surgical morbidity, their relative effect on the systemic inflammatory response remains incompletely characterized, particularly when indication and case complexity are accounted for. We compared tissue trauma, operative data, and early postoperative outcomes after uncomplicated vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and abdominal hysterectomy (AH). Methods We retrospectively reviewed women aged 25–80 years who underwent total hysterectomy for benign indications at our institution (2021–2024). Patients with malignant disease, chronic inflammatory conditions, prophylactic drains, or complicated postoperative courses were excluded. Primary endpoints were postoperative C-reactive protein (CRP) levels and white blood cell (WBC) and neutrophil (Neu) count trajectories over the first three postoperative days; secondary endpoints were hemoglobin drop, operative time, blood loss, bowel function recovery, and length of stay. Multivariable models adjusted for age, body mass index, American Society of Anesthesiologists (ASA) physical status, surgical indication, and previous abdominal surgery, with uterine weight assessed in a sensitivity analysis; trajectories were modelled with linear mixed-effects models, and the route effect was examined within a single-indication (fibromatosis) subgroup. Results We included 281 patients (84 VH, 86 LH, 111 AH). AH and LH required longer operative times than VH, and AH was additionally associated with higher blood loss, delayed gastrointestinal recovery, and longer hospitalization. In unadjusted analyses AH showed the highest CRP at all three days and higher WBC and neutrophil counts on Days 1 and 2; the haematological differences were attenuated after adjustment, whereas the CRP elevation persisted. Because route, indication, and uterine size were strongly collinear, the route effect was examined within the fibromatosis subgroup, where AH remained independently associated with higher CRP than LH across all postoperative days. Conclusions After uncomplicated hysterectomy for benign disease, surgical route was independently associated with the postoperative systemic inflammatory response. AH carried a greater inflammatory burden and slower functional recovery, whereas VH and LH were broadly comparable; compared with LH, VH showed faster recovery and certain perioperative advantages. Minimally invasive techniques should be prioritized when clinically feasible.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.1877169