Total Versus Subtotal Hysterectomy for Benign Gynaecological Conditions

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 STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group's specialized 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 randomized controlled trials of women undergoing either total or subtotal hysterectomy for benign gynaelogical conditions were included. DATA COLLECTION AND ANALYSIS: Three trials that included 733 participants were included. Independent selection of trials and data extraction were undertaken by two 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 (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.02-4.3), 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, 95% CI 0.25-0.75), and ongoing cyclical vaginal bleeding one year after surgery was more likely (OR 11.3, 95% CI 4.1-31.2) after subtotal hysterectomy 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 with total hysterectomy. Lethaby A, Ivanova V, Johnson NP. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004993. DOI: 10.1002/14651858.CD004993.pub2. Copyright The Cochrane Collaboration, reproduced with permission. 10.1097/01.AOG.0000280283.83502.e8