Time-stratified comparison of quality of life following laparoscopic vs abdominal hysterectomy

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Abstract
Background/Aim: Hysterectomy is a widely used surgical procedure for benign gynecologic conditions. Although total abdominal hysterectomy (TAH) has traditionally been the standard, total laparoscopic hysterectomy (TLH) is increasingly preferred due to its minimally invasive nature. Despite extensive research on perioperative outcomes, longitudinal data on quality of life (QoL) and urinary function remain limited. Methods: A retrospective cohort study was conducted including 252 perimenopausal women who underwent either TLH (n=134) or TAH (n=118) at a tertiary hospital in Türkiye between 2014 and 2021. QoL was assessed using validated Turkish versions of the SF-36 and UDI-6 questionnaires at three postoperative intervals: early (≤3 months), mid-term (4–12 months), and long-term (>12 months). Additional parameters included hospital stay duration and postoperative complications. Results: TLH patients reported significantly better QoL outcomes in the early and mid-term periods, particularly in physical functioning, bodily pain, and social functioning (P<0.05). Early urinary distress scores also favored the TLH group. However, these differences had diminished at the long-term follow-up. TLH was also associated with shorter hospital stays and fewer febrile episodes. Conclusion: TLH offers superior short-term improvements in QoL and urinary outcomes compared to TAH. These advantages tend to decrease over time, resulting in similar long-term recovery. Time-stratified assessment provides a more nuanced understanding of postoperative recovery and may aid in personalized surgical planning.

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