Perioperative Outcomes of Total Vaginal Hysterectomy Versus Total Abdominal Hysterectomy: A Study of the Enlarged Uterus with Uterine Prolapse from Romania

<i>Background and Objectives:</i> Total vaginal hysterectomy (TVH) has been performed quite often for a uterus with prolapse, although less used than total abdominal hysterectomy (TAH). The purpose of this study was to compare the perioperative outcomes of patients who underwent either TVH or TAH for a uterus with a weight between 250 and 300 g and uterine prolapse (UP). <i>Materials and Methods:</i> In this retrospective study, 180 hysterectomies were planned for women with UP between 2020 and 2024 in a tertiary center in Romania. Patients were diagnosed based on clinical symptomatology and transabdominal ultrasound. All hysterectomies were performed by the same surgeon and were divided into two groups: TVH group (<i>n</i> = 90) and TAH group (<i>n</i> = 90). Patients' characteristics like age, uterine weight, body mass index (BMI), parity, operative time, intra-operative blood loss, hospital stay, medical history, surgical history, intra- and post-operative complications, and adhesions were evaluated. <i>Results:</i> No significant differences were found between groups in terms of mean age, uterine weight, BMI, or parity. TVH was associated with significantly shorter operative time, lower intra-operative blood loss, and reduced hospital stay compared to TAH (<i>p</i> < 0.001). Both medical and surgical histories were more common in the TAH group compared with the TVH group. However, post-operative complications were slightly more frequent in the TAH group (9.99% vs. 3.33%), as were adhesions (33.33% vs. 13.33%). Uterine hemisection, tactical myomectomy, or morcellation were used in most cases to obtain a reduction in uterine size for the TVH group (81.11%). <i>Conclusions:</i> Our results showed that shorter operating time, lower intra-operative blood loss, and reduced hospital stay support the use of TVH in the case of an enlarged uterus with UP. The present study showed that all patients requiring hysterectomy for such conditions can be offered TVH, which could represent a better therapy option.