Similar outcomes after supracervical vs. total hysterectomy

1. At 14 years of follow-up, there were no differences in rates of pelvic organ prolapse, constipation, pain, sexuality, quality of life or vaginal bleeding between women who underwent supracervical compared to total hysterectomy.

2. Those who underwent supracervical hysterectomy were more likely to report urinary incontinence, but this difference was nonsignificant after accounting for missing data.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Hysterectomy is a common gynecological surgery in which the uterus (subtotal hysterectomy) or the uterus and cervix (total hysterectomy) are surgically removed. Indications for hysterectomy include abnormal uterine bleeding due to leiomyomas, endometrial pathology (e.g. polyps, hyperplasia) or malignancy as well as pelvic organ prolapse and pelvic pain, to name a few. Hysterectomy can be performed abdominally or vaginally and can be performed with the assistance of laparoscopy or via an “open” technique. Complications of hysterectomy include cuff dehiscence or infection, pelvic hematoma, pelvic organ fistula as well as thromboembolic events. While vaginal hysterectomy is associated with fewer complications, lower cost and shorter hospital stay, abdominal hysterectomy continues to be more commonly performed in the U.S. The majority of women in the U.S. undergo supracervical abdominal hysterectomies (SAH), formerly known as subtotal hysterectomies. Prior research has not demonstrated a significant advantage for SAH or total abdominal hysterectomy (TAH), though some have postulated that SAH is associated with improved sexual function and lower risk for pelvic organ prolapse. However, because the cervix is left intact, continued cervical cancer screening is required among women who undergo SAH. In the present work, authors employed the longest follow-up period for SAH and TAH to-date and found that women undergoing SAH were more likely to report urinary incontinence but that this finding became insignificant after accounting for missing data. Overall, the findings of this study support the conclusion that SAH is not superior to TAH.

Strengths of this study included randomized controlled design and large sample size with long follow-up period. Low response rate and a higher prevalence of smokers among non-responders limit generalizability and may bias results. Replication of results in other populations would solidify the findings presented herein.

Click to read the study in AJOG

Relevant Reading: Randomized controlled trial of total compared with subtotal hysterectomy with one-year follow up results

In-Depth [randomized controlled trial]: This study compared long-term outcomes among women randomized to receive supracervical (n=97) and total abdominal hysterectomy (n=100) for benign uterine pathologies. The primary outcome of interest was self-reported urinary incontinence at 14 years. Secondary outcomes included pelvic organ prolapse, constipation, pain, sexuality, quality of life, hospitalizations and vaginal bleeding at 14 years.

Women who underwent SAH were more likely to report incontinence (RR 1.67, CI 1.02-2.70). However, this became insignificant when a multiple imputation model was used to account for missing data. No differences were observed with regard to pelvic organ prolapse, constipation, pain, sexuality, quality of life or vaginal bleeding at 14 years.

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