Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review.

The objective of this study was to investigate the randomized studies reporting on quality of life after laparoscopic hysterectomy as compared to abdominal hysterectomy. A systematic qualitative review was performed on published studies identified by the databases PubMed and EMBASE, as well as cross-references. Randomized clinical trials on laparoscopic versus abdominal hysterectomy were assessed for the methods in which studies reported on postoperative health or quality of life as an outcome measure. Study results were described qualitatively. Thirty papers, published between 1994 and 2004, were identified. Only seven studies, incorporating data on 1450 patients, reported on postoperative health or quality of life. Four of these studies used eight different validated quality of life questionnaires. Two of these four studies reported significant differences between the treatment groups, with better quality of life in the first 6 weeks after laparoscopic hysterectomy when compared to the abdominal approach. Although, the main reason for performing a laparoscopic hysterectomy instead of an abdominal hysterectomy is the improvement of quality of life, only a few studies have used this as an outcome measure. The data available show that laparoscopic hysterectomy performs equally or better in terms of postoperative health and quality of life in the first weeks after surgery. In the decision for an approach to hysterectomy, the advantage of better quality of life should be offset against the increased risk of complications in laparoscopic hysterectomy.