Laparoscopic Supracervical Hysterectomy Performed With and Without Excision of the Endocervix: A Randomized Controlled Trial

Total or Subtotal Hysterectomy for the Treatment of Endometriosis: A Review

OBJECTIVE

The purpose of the review was to evaluate and compare outcomes after total or subtotal hysterectomy in women with endometriosis or adenomyosis.

METHODS

We searched four electronic databases: Medline (PubMed), Scopus, Embase, and Web of Science (WoS). The first aim of the study was to compare outcomes after total and subtotal hysterectomy in women with endometriosis, and the second aim was to compare the two procedures in women with adenomyosis. Publications that reported short- and long-term outcomes after total and subtotal hysterectomy were included in the review. The search was not subject to any limitation in terms of time or method.

RESULTS

After screening 4948 records, we included 35 studies published from 1988 to 2021; the studies were based on various methodologies. With regard to the first aim of the review, we found 32 eligible studies and divided these into the following four categories: postoperative short- and long-term outcomes, recurrence of endometriosis, quality of life and sexual function, and patient satisfaction after total or subtotal hysterectomy in women with endometriosis. Five investigations were deemed eligible for the second aim of the review. No differences were seen in terms of postoperative short- and long-term outcomes after subtotal or total hysterectomy in women with endometriosis or adenomyosis.

CONCLUSIONS

Preservation or removal of the cervix in women with endometriosis or adenomyosis appears to have no effect on short- or long-term outcomes, recurrence of endometriosis, quality of life and sexual function, or patient satisfaction. Nevertheless, we lack randomized blinded controlled trials on these aspects. Such trials will be needed to enhance our comprehension of both surgical approaches.

The influence of persistent bleeding after supracervical hysterectomy on depressive and anxious symptoms: a prospective bicenter study

PURPOSE

Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet.

METHODS

311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups.

RESULTS

11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method.

CONCLUSION

Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting.

Intraoperative cervical treatment does not affect the prevalence of vaginal bleeding 1 year postoperatively after subtotal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery

INTRODUCTION

The objectives were to establish the prevalence of persistent vaginal bleeding following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of persistent vaginal bleeding, and to evaluate the impact of persistent vaginal bleeding on the patient-reported opinion concerning result of surgery and medical condition.

MATERIAL AND METHODS

Retrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre- and perioperative forms. Data concerning occurrence of persistent vaginal bleeding, rating of medical condition and contentment with result of surgery were collected from the 1-year inquiry form. Statistical analyses were performed with multivariable logistic regression models. The results are presented as adjusted odd ratios and 95% confidence intervals.

RESULTS

Persistent vaginal bleeding occurred in 18.6%. Intraoperative cervical treatment did not affect the frequency of persistent vaginal bleeding (adjusted odds ratio 1.48; 95% confidence interval 0.93-2.37). More than 90% were satisfied with the result of the hysterectomy, but women with persistent vaginal bleeding were less content compared with those without persistent vaginal bleeding (adjusted odds ratio 0.42; 95% confidence interval 0.26-0.67). The self-perception of the medical condition did not differ between the women with and without persistent vaginal bleeding (adjusted odds ratio 1.16; 95% confidence interval 0.33-4.12).

CONCLUSIONS

Nearly two in ten women may expect persistent vaginal bleeding following subtotal hysterectomy, and cervical treatment intraoperatively did not affect this. More than 90% were satisfied with the result but women with persistent vaginal bleeding were less content. Preoperative information on this risk of persistent vaginal bleeding may be important when choosing hysterectomy technique.

Assessing adequacy of cervical core specimens from extirpated uteri: implications for laparoscopic supracervical hysterectomy with transcervical coring

STUDY OBJECTIVE

To describe the histopathologic adequacy of cervical specimens after ex vivo excision of the cervical canal with cervical coring.

DESIGN

Descriptive study (Canadian Task Force classification III).

SETTING

Community medical center with university affiliation.

INTERVENTION

Endocervical coring.

MEASUREMENTS AND MAIN RESULTS

Eleven cervical core samples from hysterectomy specimens were evaluated. Cervical coring was performed using classic intrafascial supracervical hysterectomy instruments: 15 mm for 6 specimens and 20 mm for 5 specimens. Mean patient age was 49 years, and median (range) parity was 2 (0-3). Three patients (27.3%) were postmenopausal. In most patients (72.7%) leiomyomas and abnormal uterine bleeding was the indication for hysterectomy, and 3 patients (23.3%) had uterovaginal prolapse. The most common cervical pathologic diagnosis was chronic cystic cervicitis (72.7%). Histopathologic presence of the entire cervical transformation zone was present in all 11 cervical core samples. Endocervical glands were absent in the radial margins of all samples. Endometrial glands were absent in the radial margins in 7 samples (63.6%). There was no statistically significant difference in age, parity, cervical remnant, and cervical core dimensions between both core sizes (p > .05).

CONCLUSION

Cervical coring to remove the endocervical canal during hysterectomy resulted in adequate removal of endocervical glands and endometrial glands in most cases, using either the 15-mm or 20-mm classic intrafascial supracervical hysterectomy instrument.