Overall complications were not significantly different between the two groups. In a study conducted by Summitt et al. also the operative time averaged 30 minutes longer in LAVH and estimated blood loss averaged 100mL greater in abdominal hysterectomy with no difference in the rate of overall complications . While in another study by Marana et al. there was no difference between the operating time Volasertib supplier between the two groups. However, the estimated blood loss was around 89mL higher in the abdominal hysterectomy group . Similar to our observation, Marana et al. also found a significant reduced pain perception on second and third postoperative days in patients who underwent LAVH . A recent meta-analysis which compared 23 randomized controlled trials concluded that LAVH has a significantly longer operation time than abdominal hysterectomy.
This may be due to the learning curve for laparoscopy requiring a high level of skill and good hand-eye coordination. However, we also agree with the authors (Yi et al) that comprehensive training of surgeons and the development of surgical instruments may lead to a decrease in the operation time for LAVH in the future. Similar to our results in the meta-analysis also postoperative pain and hemoglobin drop were reduced significantly, and return to normal activities was significantly quicker following LAVH compared with abdominal hysterectomy . It is supported by the observation that in the literature we found that the mean time taken to perform LAVH had a very wide range with a minimum of 77 minutes  to 179.8 minutes . 5.
Conclusion This study showed that LAVH had a disadvantage of longer operation time but had a definitive advantage of less blood loss and less postoperative pain. The skill of laparoscopy though has a learning curve but can be mastered over time, which will lead to combating the one and only negative issue of greater operative time. Acknowledgment The authors would like to acknowledge the help extended by Dr. Rajesh Bhakta during the surgical procedures. Conflict of Interests None of the authors have conflict of interests.
Gastroesophageal reflux disease was not formerly a very significant problem but its incidence has shown an absolute increase in the last 20�C30 years . The diagnosis of gastroesophageal reflux disease is difficult to make on clinical grounds alone and relies on investigations like upper gastrointestinal endoscopy, esophageal manometry, and 24-hour pH studies. Apart from the physical symptoms attributed to the disease, the disease also has a profound effect on the quality of life of the patient Cilengitide . Gastroesophageal reflux disease can be managed both medically as well as surgically.