Outcomes after total versus subtotal abdominal hysterectomy. Outcomes of total versus subtotal abdominal hysterectomy. The psychosocial outcomes of total and subtotal hysterectomy: A randomized controlled trial. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. Hysterectomy and women satisfaction: total versus subtotal technique. A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse. A randomized trial comparing changes in sexual health and psychological well-being after subtotal and total hysterectomies. A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function.
It is uncertain whether subtotal abdominal hysterectomy results in better bladder, bowel, or sexual function than total abdominal hysterectomy.
                We conducted a randomized, double-blind trial comparing total and subtotal abdominal hysterectomy in 279 women referred for hysterectomy because of benign disease; most of the women were premenopausal. The main outcomes were measures of bladder, bowel, and sexual function at 12 months. We also evaluated postoperative complications.
                The rates of urinary frequency (urination more than seven times during the day) were 33 percent in the subtotal-hysterectomy group and 31 percent in the total-hysterectomy group before surgery, and they fell to 24 percent and 20 percent, respectively, at 12 months (P=0.03 for the change over time within each group; P=0.84 for the interaction between the treatment assignment and time). The reduction in nocturia and stress incontinence and the improvement in bladder capacity were similar in the two groups. The frequency of bowel symptoms (as indicated by reported constipation and use of laxatives) and measures of sexual function (including the frequency of intercourse and orgasm and the rating of the sexual relationship with a partner) did not change significantly in either group after surgery. The women in the subtotal-hysterectomy group had a shorter hospital stay (5.2 days, vs. 6.0 in the total-hysterectomy group; P=0.04) and a lower rate of fever (6 percent vs. 19 percent, P<0.001). After subtotal abdominal hysterectomy, 7 percent of women had cyclical bleeding and 2 percent had cervical prolapse.
                Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.
                Copyright 2002 Massachusetts Medical Society There is still controversy about the best technique for hysterectomy to reduce postoperative adverse effects. This randomized clinical study in Babol, Islamic Republic of Iran, compared some clinical complications and sexual functioning following subtotal (SAH) and total abdominal hysterectomy (TAH). A total of 150 women (50 allocated to SAH and 100 to TAH) were followed up at 6 months postoperatively. Length of hospitalization was 4.40 (SD 1.90) days after SAH and 4.48 (SD 1.67) days after TAH. Haemoglobin level, postoperative fever, symptoms of dyspareunia and frequency of sexual intercourse were not significantly different between the 2 groups of women. SAH did not show any significant benefits over TAH. Current controversies involve the adverse effects of hysterectomy on women's psychosocial functioning and whether subtotal as opposed to total hysterectomy mitigates these effects.
                To investigate the psychosocial effects of hysterectomy by examining sexual, pain, and psychological outcomes of total vs. subtotal hysterectomy in a randomized controlled trial.
                Patients suffering from benign gynecological conditions were randomly assigned to one of two groups: (i) total hysterectomy, that is, laparoscopic assisted vaginal hysterectomy (TOT, N = 32); or (ii) subtotal hysterectomy, that is, supracervical laparoscopic hysterectomy (SUB, N = 31). Both groups were premenopausal and underwent hysterectomy without concurrent oophorectomy. Two premenopausal control groups: (i) minor gynecological surgery (SURG-CON, N = 30); and (ii) healthy nonsurgical controls (NORM-CON, N = 40), were also tested. All surgical groups were assessed 2-3 weeks before surgery and then 6-7 months afterward; the nonsurgical control group was assessed at the time of recruitment and 6-7 months later.
                Assessments included semistructured interviews, standardized questionnaires, and standardized gynecological examinations.
                For the TOT group, sexual drive, arousal, and sexual behavior significantly improved postoperatively. For the SUB group, sexual behavior and overall sexual functioning significantly improved. For both TOT and SUB groups, unprovoked pain in the abdomen and pain in the abdomen during gynecological examinations was significantly reduced. For both TOT and SUB groups, overall psychological functioning did not significantly change postoperatively. Although between 3% and 16% of women undergoing hysterectomy reported adverse changes in psychosocial well-being after surgery, similar percentages of women in the control groups reported such effects.
                Hysterectomy resulted in a consistent reduction in abdominal pain, some improvement in sexual functioning, but no change in overall psychological functioning. There was no evidence supporting the idea that subtotal hysterectomy produced more favorable psychosocial outcomes than total hysterectomy nor was there any evidence that either type of hysterectomy resulted in adverse effects. To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases.
                Randomised, controlled, unblinded trial with central, computer-generated randomisation.
                Danish trial performed in 11 departments of gynaecology.
                Women referred for benign uterine diseases were randomised to total abdominal hysterectomy (n = 158) or subtotal abdominal hysterectomy (n = 161). One-year follow up questionnaires had a response rate of 87%.
                Patients were followed by strict data collection procedures, including postal questionnaires. The results after one year of follow up were analysed by intention-to-treat analyses.
                (1) Primary: urinary incontinence and (2) secondary: post-operative complications, quality of life (SF-36), constipation, prolapse of the vaginal vault/cervical stump, satisfaction with sexual life, pelvic pain and vaginal bleeding.
                A significantly (P = 0.043) smaller proportion of women had urinary incontinence one year after total abdominal hysterectomy compared with subtotal abdominal hysterectomy [9% vs 18% (OR 2.08, 95% CI 1.01-4.29)]. The lower proportion of incontinent women in the total abdominal hysterectomy group was a result of a higher proportion of symptom relief (total abdominal hysterectomy: 20/140, subtotal abdominal hysterectomy: 14/136) as well as a lower proportion of women with new symptoms (total abdominal hysterectomy: 3/140, subtotal abdominal hysterectomy: 10/137). Twenty-seven women (20%) from the subtotal abdominal hysterectomy group had vaginal bleeding and two of them had to have their cervix removed. No other clinically important differences were found between the two hysterectomy methods.
                A smaller proportion of women suffered from urinary incontinence after total abdominal hysterectomy than after subtotal abdominal hysterectomy one year post-operatively. The impact of different surgical procedures on women's satisfaction after hysterectomy is a topical issue. The aim of this study was to investigate the impact of sub-total and total hysterectomy on women's satisfaction, evaluated with questionnaire assessment of sexual activity, body image, and health status.
                A prospective, randomized, non-blind study was conducted. In the study period of 3 years, 105 women were enrolled and completed the questionnaires [EuroQol (EQ-5D), body image scale (BIS), sexual activity questionnaire] 2 weeks before and 1 year after surgery.
                Both total and sub-total hysterectomy resulted with improvements in the women's sexual satisfaction (1 year after surgery), but no statistically significant differences were reached between the two groups. A highly significant difference (P < 0.001) in the perception of the body image between total and sub-total hysterectomy, at 1 year after surgery, was underlined. The health-related quality of life resulted significantly better in the "sub-total hysterectomy" group 1 year after surgery (P < 0.05).
                Considering these results, why should a total hysterectomy be performed, if the women's satisfaction seems to be higher using the sub-total technique? In our opinion, the woman undergoing hysterectomy for benign conditions must be counseled regarding the differences between the two techniques and, when possible, a choice must be offered to the woman. To compare surgical complications and clinical outcomes after total versus supracervical abdominal hysterectomy for control of abnormal uterine bleeding, symptomatic uterine leiomyomata, or both.
                We conducted a randomized intervention trial in four US clinical centers among 135 patients who had abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding refractory to hormonal treatment, or both. Patients were randomly assigned to receive a total or supracervical hysterectomy performed using the surgeon's customary technique. Using an intention-to-treat approach, we compared surgical complications and clinical outcomes for 2 years after randomization.
                Sixty-eight participants were assigned to supracervical hysterectomy (SCH) and 67 to total abdominal hysterectomy (TAH). Hysterectomy by either technique led to statistically significant reductions in most symptoms, including pelvic pain or pressure, back pain, urinary incontinence, and voiding dysfunction. Patients randomly assigned to (SCH) tended to have more hospital readmissions than those randomized to TAH, but this difference was not statistically significant. There were no statistically significant differences in the rate of complications, degree of symptom improvement, or activity limitation. Participants weighing more than 100 kg at study entry were twice as likely to be readmitted to the hospital during the 2-year follow-up period (relative risk [RR] 2.18, 95% confidence interval [CI] 1.06, 4.48, P=.034).
                We found no statistically significant differences between (SCH) and TAH in surgical complications and clinical outcomes during 2 years of follow-up. To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse.
                In a two-center prospective, double-blind randomized trial, 36 women with dysfunctional uterine bleeding, uterine fibroids or pelvic pain scheduled for hysterectomy were randomized to abdominal or vaginal hysterectomy. The primary outcome measure was the duration of hospital stay. Secondary outcome measures included analgesic requirements and return to normal health and function.
                There were no significant differences in peri-operative patient or surgical characteristics. Vaginal hysterectomy was associated with a reduction in hospital stay compared to abdominal hysterectomy (median stay 3 days vs. 5 days, p = 0.01). In addition, patients undergoing vaginal hysterectomy had reduced analgesic requirements (mean 75.4 mg vs. 131.4 mg morphine equivalent, p = 0.002), shorter need for intravenous hydration (mean 25.3 h vs. 32.7 h, p = 0.05), and faster return of bowel action (median 3 days vs. 4 days, p = 0.002). They also returned to normal domestic activities (mean 4.6 weeks vs. 8.5 weeks, p = 0.01) and work (mean 7.0 weeks vs. 13.9 weeks, p = 0.005), and completed their recovery (mean 7.9 weeks vs. 16.9 weeks, p = 0.008) more quickly.
                Vaginal hysterectomy was associated with significant benefits in terms of reduced hospital stay and improved patient recovery. Vaginal hysterectomy should be the route of choice not only for women with genital tract prolapse but also those without. To evaluate changes in sexual health and psychological well-being one year after subtotal and total hysterectomies.
                Prospective randomized controlled trial.
                One hundred and thirty-two premenopausal patients scheduled for hysterectomy without planned oophorectomy for benign disorders and without a history of cervical dysplasia or symptomatic prolapse were randomized to total (n = 66) or subtotal hysterectomy (n = 66). The McCoy Female Sexuality Questionnaire was used to evaluate changes in sexual health and the Psychological General Well-Being index was used to evaluate changes in psychological well-being. Differences in outcome before and one year after the hysterectomy were calculated for each individual, and changes compared between the groups.
                Women who had subtotal hysterectomy (SH) reported a significantly greater positive change in frequency of orgasm and sexual pleasure as compared with women who had total hysterectomy (TH) (mean values +/- standard deviation (SD), orgasm: SH: 0.4 +/- 1.1; TH: -0.2 +/- 0.9, p = 0.012, sexual enjoyment: SH 0.3 +/- 1.5; TH: -0.3 +/- 1.3, p = 0.039). There was a significantly greater general health gain for the women who underwent subtotal hysterectomy as compared with total hysterectomy (mean values +/- SD SH: 1.2 +/- 2.3; TH: 0.3 +/- 1.6, p = 0.03). The total score did not show a difference.
                Women undergoing subtotal hysterectomy experience a greater positive change in the frequency of orgasm and extent of sexual pleasure after surgery than women undergoing total hysterectomy, but the results must be interpreted with caution. To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function.
                Randomised trial.
                Three teaching hospitals in The Netherlands.
                Eighty-two patients undergoing surgical correction of uterine prolapse stages II-IV.
                Participating patients completed the urogenital distress inventory (UDI), before and at six weeks, six months and one year after surgery, to measure discomfort of prolapse and micturition symptoms. Domain scores of the UDI (ranging from 0 to 100, higher scores indicating more discomfort) were compared between groups at all time points. Findings at pelvic examination, number of doctor visits within the first year after surgery because of pelvic floor symptoms and performed or planned surgery of recurrent genital prolapse were also compared.
                Domain scores of the UDI at one year after surgery.
                At one year after surgery, scores on the discomfort/pain domain (mean difference 7.1, 95% confidence interval [CI] 1.1-13.2), overactive bladder domain (mean difference 8.7, 95% CI 0.5-16.9) and obstructive micturition domain (mean difference 10.3, 95% CI 0.6-20.1) of the UDI were significantly higher in the abdominal group than in the vaginal group. Findings at pelvic examination were similar in both groups. Doctor visits because of pelvic floor symptoms were more frequent in the abdominal group than in the vaginal group. Re-operation was performed or planned in 9 of the 41 patients who underwent abdominal surgery and in 1 of the 41 patients who underwent vaginal surgery (odds ratio [OR] = 11.2, 95% CI 1.4-90.0).
                Our findings suggest that vaginal hysterectomy with anterior and/or posterior colporraphy is preferable to abdominal sacro-colpopexy with preservation of the uterus as surgical correction in patients with uterine prolapse stages II-IV.
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. Women are more likely to experience ongoing cyclical bleeding up to a year after surgery with subtotal hysterectomy compared to total hysterectomy.