Perioperative outcomes and tissue trauma after uncomplicated total hysterectomy for benign uterine disease: a retrospective study
4 affiliations
- 1Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- 2Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- 3Natl. Center for Radioprotection and Computational Physics, Istituto Superiore di Sanità, Roma, Italy
- 4Department of Physics, University of Rome “Tor Vergata”, Rome, Italy
Abstract
BackgroundHysterectomy 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).MethodsWe 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.ResultsWe 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.ConclusionsAfter 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.
Related
- Preoperative ultrasound-estimated uterine weight predicts operative complexity in v-NOTES hysterectomy: A multicenter retrospective study
- Temporary Uterine Artery Clamping During Laparoscopic Myomectomy and Perioperative Hemoglobin Decline: A Retrospective Single-Center Comparative Study
- Association of a multimodal perioperative nutritional/ERAS care pathway with postoperative infectious complications following radical hysterectomy for cervical cancer: a retrospective nonconcurrent cohort study
- Uterine Fibroids in Pregnancy: Maternal, Obstetric, and Neonatal Outcomes in a Retrospective Cohort Study
- Pararectal Leiomyosarcoma Following Total Laparoscopic Hysterectomy (TLH) for Initially Diagnosed Uterine Leiomyoma
BibTeX
@article{terranova2026perioperative,
title = {{Perioperative outcomes and tissue trauma after uncomplicated total hysterectomy for benign uterine disease: a retrospective study}},
author = {Corrado Terranova and Corrado Terranova and Andi Stermasi and Andi Stermasi and Roberto Montera and Roberto Montera and Carlo De Cicco Nardone and Carlo De Cicco Nardone and Daniela Luvero and Daniela Luvero and Federica Guzzo and Federica Guzzo and Gianna Barbara Cundari and Adele Silvagni and Adele Silvagni and Arianna Martinelli and Arianna Martinelli and Erika Notaro and Erika Notaro and Nicola Alboré and Nicola Alboré and Roberto Angioli and Roberto Angioli and Francesco Plotti and Francesco Plotti},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1877169},
url = {https://doi.org/10.3389/fsurg.2026.1877169},
note = {CC BY},
}
RIS
TY - JOUR
TI - Perioperative outcomes and tissue trauma after uncomplicated total hysterectomy for benign uterine disease: a retrospective study
AU - Corrado Terranova
AU - Corrado Terranova
AU - Andi Stermasi
AU - Andi Stermasi
AU - Roberto Montera
AU - Roberto Montera
AU - Carlo De Cicco Nardone
AU - Carlo De Cicco Nardone
AU - Daniela Luvero
AU - Daniela Luvero
AU - Federica Guzzo
AU - Federica Guzzo
AU - Gianna Barbara Cundari
AU - Adele Silvagni
AU - Adele Silvagni
AU - Arianna Martinelli
AU - Arianna Martinelli
AU - Erika Notaro
AU - Erika Notaro
AU - Nicola Alboré
AU - Nicola Alboré
AU - Roberto Angioli
AU - Roberto Angioli
AU - Francesco Plotti
AU - Francesco Plotti
PY - 2026
DA - 2026/10/23
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1877169
UR - https://doi.org/10.3389/fsurg.2026.1877169
AB - BackgroundHysterectomy 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).MethodsWe 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.ResultsWe 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.ConclusionsAfter 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.
SN - 2296-875X
ER -