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Surgical complications and clinical outcomes are similar for total and supracervical hysterectomy

More than a half million hysterectomies are performed on U.S. women each year. Between 1988 and 1998, the rate of total abdominal hysterectomy, which includes removal of both the uterus and cervix, has declined, and supracervical hysterectomy, in which only the uterus is removed, increased substantially.

Proponents of supracervical hysterectomy argue that total abdominal hysterectomy may damage nerve structures important to bladder and sexual function and increase operative time and blood loss. However, a recent study supported by the Agency for Healthcare Research and Quality (HS09478) found that surgical complications and adverse clinical outcomes 2 years after surgery were not less frequent in women who received supracervical hysterectomy.

The researchers, who are members of the Total or Supracervical Hysterectomy Research Group, randomly assigned 135 women at four clinical centers to receive a total (67) or supracervical hysterectomy (68) for symptomatic fibroids, abnormal uterine bleeding unresponsive to hormonal treatment, or both. They compared surgical complications and clinical outcomes for both groups 2 years after surgery.

Hysterectomy by either technique led to significant reductions in most symptoms, including pelvic pain or pressure, back pain, urinary incontinence, and voiding dysfunction. There were no significant differences in the rate of complications, degree of symptom improvement, or activity limitation between the two groups. However, women weighing more than 220 pounds at study entry were twice as likely to be readmitted to the hospital during the 2-year followup period.

More details are in "A randomized comparison of total or supracervical hysterectomy: Surgical complications and clinical outcomes," by Lee A. Learman, M.D., Ph.D., Robert L. Summitt, Jr., M.D., R. Edward Varner, M.D., and others, in the September 2003 Obstetrics & Gynecology 102, pp. 453-462.

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