A comparison of abdominal versus vaginal hysterectomy for leiomyoma and adenomyosis Kenji ARAHORI, Hisasi KATAYAMA, Suminori NIOKA Department of Obstetrics and Gnecology, National Maizuru Hospital,Kyoto, Japan It is well known that there are two different methods of simple total hysterectomy, i. e. abdominal (AT) and vaginal hysterectomy (VT). Because of the smoother postoperative course and cosmetic result, our main procedure (over 90 percent) has been vaginal hysterectomy since 1985. That has been regardless of uterine size and the existence of intraperitoneal adhesions. Eighty three patients (of whom 75 had been operated upon before 1984) underwent abdominal hysterectomy. One hundred and ten patients were operated upon by vaginal hysterectomy after 1985. The indications in all cases were either leiomyoma or adenomyosis. The two operations were compared with respect to intraperitoneal adhesions, operation time, bleeding, uterine weight and postoperative fever. The mean ages of the two groups were about the same (AT 44. 0, VT43. 6) with a range of from 30 to 59 years. In AT there was a direct correlation between the operation time and the bleeding. In VT the same correlation was observed ; but there was also a direct correlation of operation time with bleeding and uterine size. Thus in VT, the presence of a large uterus increased operation time and bleeding. The number of patients who had a previous intraperitoneal operation made no differences between the two goups. The association of adhesions with adenomyosis suggests that there were more adhesions in the VT group than the AT. This is because adenomyosis was found by microscopic examination in 32. 7 percent in the VT and 28. 9 percent in the AT group. None the less, the operation time and amout of bleeding in AT was significantly greater than in VT. Fever in AT patients was significantly higher on the first postoperative day. There was no significant difference between the incidences of postoperative infections in two groups. From this experience, it is concluded that VT compared with AT, was safer in spite of intraperitoneal adhesions ; but where the uterus is very large, a vaginal approach should be well planned.