Total versus subtotal hysterectomy for benign gynaecological conditions
Abstract
Background
Hysterectomy using an abdominal approach removes either the uterus alone (subtotal hysterectomy) or both the uterus and the cervix (total hysterectomy). The latter is more common but outcomes have not been systematically compared.
Objectives
To assess and compare outcomes with subtotal hysterectomy versus total abdominal hysterectomy for benign gynaecological conditions.
Search methods
We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of controlled trials (December 2005), Central (December 2005), Medline (1966 to December 2005), EmBase (1980 to December 2005), Biological Abstracts (1980 to December 2005), the National Research Register and relevant citation lists.
Selection criteria
Only randomised controlled trials of women undergoing either total or subtotal hysterectomy for benign gynaecological conditions were included.
Data collection and analysis
Three trials that included 733 women were included. Independent selection of trials and data extraction were undertaken by 2 reviewers and results compared.
Main results
There was no evidence of a difference in the rates of incontinence, constipation or measures of sexual function. In one unblinded trial, a significantly greater proportion of women indicated that they had frequent episodes of urinary incontinence after subtotal hysterectomy when compared with total hysterectomy (OR=2.1, 1.02 to 4.3), but these results were not confirmed by the other two trials that measured both stress and urge incontinence and urinary frequency. . Length of surgery and amount of blood lost during surgery were significantly reduced during subtotal hysterectomy when compared with total hysterectomy, but there was no evidence of a difference in the odds of transfusion. Febrile morbidity was less likely (OR=0.43, 0.25 to 0.75) and ongoing cyclical vaginal bleeding one year after surgery was more likely (OR=11.3, 4.1 to 31.2) after subtotal when compared with total hysterectomy. There was no evidence of a difference in the rates of other complications, recovery from surgery or readmission rates.
Authors' conclusions
This review has not confirmed the perception that subtotal hysterectomy offers improved outcomes for sexual, urinary or bowel function when compared with total abdominal hysterectomy. Surgery is shorter and intraoperative blood loss and fever are reduced but women are more likely to experience ongoing cyclical bleeding up to a year after surgery with subtotal hysterectomy compared to total hysterectomy.
Plain language summary
Total versus subtotal hysterectomy for benign gynaecological conditions
When abdominal hysterectomy is required for non cancerous conditions, either the uterus alone (subtotal hysterectomy) or the uterus and the cervix (total hysterectomy) are removed. Some people have suggested that not removing the cervix (subtotal hysterectomy) would reduce the chance of sexual difficulties and/or problems with passing urine or solids. This review has found no evidence of a difference between these 2 types of surgery for these outcomes. Surgery is faster with subtotal hysterectomy and there is less blood loss and fever during or just after surgery but women are more likely to have long term ongoing menstrual bleeding, when compared with total hysterectomy.
