الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The commonest gynaecological surgery was done around the world is hysterectomy. The three major indications were: uterine fibroids, AUB and uterine descend. It was done via several approaches: abdominal, vaginal, laparoscopy, and rob-assisted laparoscopy (1). A lot of criteria may affect the approach of hysterectomy to patients for an example: Nulliparity, last surgeries, and suspicion of ectopic endomterium, for instance, are always belonged to abdominal or laparoscopic manoeuvres, whereas small uteruine size, multigravidity and parity and descent are nearer to the vaginal technique. As well as, surgeon‘s experience and his or her skills will stump and select hysterectomy surgical methods Aim of the work This study was done to press and focused on the sureness and efftiveness of laparoscopy and laparotomy in dealing with abnormal uterine bleeding cases including: hospitalization period, loss of blood, and duration of operation. Patients & Methods An observational comparative cohort study was conducted on appropriate number of girls from the patients attending: 1- Departments of obstetrics and gynaecology, Tanta university hospitals. 2- Departments of surgical sciences, institutes of obstetrics and gynaecology, Cagliari university hospitals Forty patients were classified into two groups: group 1: open hysterectomy (20 patients). group 2: LH (20 patients); were classified into three subdivisions: (TLH, LASH, and LAVH). First: (TLH) was done, (n =12) Second: (LAVH) was done, (n = 4) 89 Third: (SCLH) was done, (n = 4) Inclusion criteria: Patients with • Tissue-proven atypical endometrial hyperplasia. • Mobile uterus amenable to laparoscopic approach. • No previous chemotherapy or therapy. • Pre or postmenopausal women. Exclusion criteria: • Nowdays illness not fit Trendelenburg site. • Patient contraindicated to surgery (laparoscopy) like patients with severe respiratory diseases or decompensated cardiac failure. • Ultrasound shows hugh fibroid more than twelve cm. • Repeated difficult laparotomies history. • Malignancy Known or suspected. • Fibroids Extracorporeal. Our attained data revealed the following: Laparotomy was replaced by LH which made fair outcome, although it takes more operative time, and better price. A lot of pros in LH over TAH as smaller opening, less postoperative pain, earlier return to work, minimize loss of blood, less hospital presence, rapid return time and post-operative wound infection or more serious outcomes didn’t increase. Otherwise, several criteria may impact on the surgeon‘s obligation of manoeuvres to hysterectomy as no parity, last surgeries, and suspicion of ectopic endometrium, for instance, were associated with an abdominal or lap approach, whereas multiparty and tiny size uterus and prolapse are always belonged to the vaginal technique. Also, the surgeon‘s experience and skills were large seriously choose the type of H. rapidly resume the activities of daily living postoperatively. However, the total operation time in TLH was significantly longer than that in AH because presence of careful practising of meticulous hemostasis using 90 a hugh vision field and the application of manipulation and morcellation take longer time. In the future, shortening of the operation time can be expected along with improvement of the technique of the operator.