The role of total vaginal hysterectomy versus total abdominal hysterectomy in surgical management of uterine myomas: A retrospective single center cohort study.

Total vaginal hysterectomy (TVH) has been performed even for enlarged uterine myoma, but it is regarded as more inferior than total abdominal hysterectomy (TAH). The aim of this study was to compare the role of surgical choice in patients undergoing either TVH or TAH for uterine myoma. In this retrospective cohort study, 140 hysterectomies with bilateral adnexectomy were planned for postmenopausal women with uterine myoma between 2020 and 2024, in a tertiary center hospital. The diagnosis was established after clinical symptomatology and transvaginal ultrasound, with histopathological confirmation obtained postoperatively. The patients were divided into 2 groups: the TVH group (n = 70) and the TAH group (n = 70). Patient features such as age, uterine weight, body mass index (BMI), parity, operative time, intraoperative blood loss, hospital stay, medical history, surgical history, intra and postoperative complications, and adhesions were assessed. Mean age, uterine weight, BMI, and parity showed no significant difference between the groups. Instead, the TVH group was linked with significantly shorter operative time, lower intraoperative blood loss, and reduced hospital stay compared to the TAH group (P < .001). However, there were more medical and surgical histories in patients from the TAH group compared with the TVH group, including postoperative complications (11.44% vs 4.29%) and adhesions (32.86% vs 20%). In most cases, uterine hemisection, tactical myomectomy, or morcellation were used in order to reduce uterine size for the TVH group (78.57%). Our findings sustain that shorter operating time, lower intraoperative blood loss, and reduced hospital stay recommend TVH as a suitable choice in carefully selected postmenopausal women with enlarged uterine myoma.