Post-operative haemoglobin drop : laparoscopic versus abdominal hysterectomies

Abstract

Background: Cervical cancer, is the 4th most prevalent cancer in women (International Agency for Research on Cancer, 2018). According to Roque, Wysham and Soper, (2014), an abdominal radical hysterectomy is the treatment of choice. However, this treatment is associated with a higher number of post-operative complications such as bleeding. This has influenced researchers to focus on laparoscopic hysterectomies as an alternative. The aim of this review is to evaluate whether laparoscopic hysterectomies is a safe and effective alternative treatment to abdominal hysterectomies for oncological patients in terms of the post-operative haemoglobin drop. The Research Question: “In woman undergoing a hysterectomy, does a laparoscopic approach reduce the post-operative haemoglobin drop when compared to an abdominal approach?” The PICO Elements: The Population (P) studied was adult women patients with a malignant uterine disease undergoing hysterectomy. The Intervention (I) carried out was a laparoscopic hysterectomy which was Compared (C) with an abdominal hysterectomy. The Outcome (O) analysed was the post-operative haemoglobin drop. Method: The key elements of the PICO question were used to formulate synonyms. These were combined with Boolean Operators and limiters were applied to obtain a comprehensive search of relevant articles published between 2012 and 2018. Various databases were used to search for the key studies and the PRISMA 2009 checklist enabled the elimination of irrelevant articles. Seven key-studies met the inclusion and exclusion criteria and were critically appraised with the use of the CASP tools. Only women with malignant indications for surgery were included in the studies of this dissertation. Laparoscopic and abdominal hysterectomies were also included along with the post-operative haemoglobin drop as the outcome of choice. All other groups of the population, types of exposure and outcomes were excluded. Results: From the seven key-studies found, six were retrospective cohort studies and one was a randomised controlled trial. Three studies found a statistically significant result with a lower post-operative haemoglobin drop in the laparoscopic group rather than in the abdominal group. The remaining four studies found no statistical difference in the haemoglobin drop obtained between the two surgical approaches. Due to these inconsistencies and the observed methodological weakness in most of the studies involved, it was concluded that the results need to be interpreted with caution. Conclusion: Laparoscopic hysterectomy seems to offer a safe and effective surgical procedure for a specific group of patients, as laparoscopic hysterectomies might offer a comparable if not a better post-operative haemoglobin drop than abdominal hysterectomies. However, more research is required to obtain a definitive conclusion. Implications and Recommendations: More research utilising bigger samples and better methods is needed to ascertain the safety and efficacy of laparoscopic hysterectomies. Furthermore, health care professionals need to be given better access to educational material to improve the evidence-based practice approach to hysterectomies and related peri-operative care.