Total versus subtotal hysterectomy: a survey of current views and practice among British gynaecologists

Subtotal hysterectomy and myomectomy - vaginally

Vaginal subtotal (or supracervical) hysterectomy and vaginal myomectomy are elegant procedures rarely carried out by the average gynaecologist. Both techniques, however, are easily learned, and in view of the proven advantages of vaginal surgery over abdominal or laparoscopic approaches, they are worthy of a wider application. Subtotal hysterectomy may be preferred to excision of the entire uterus in certain circumstances, and may be carried out vaginally. Vaginal myomectomy allows for a more thorough myomectomy and stronger uterine repair than a laparoscopic procedure, as well as avoiding abdominal wounds. It may represent the optimal approach where fibroids are favourably sited. We first set out the case for subtotal hysterectomy and then describe the development of vaginal subtotal hysterectomy and vaginal myomectomy. We discuss the evidence supporting their use and indications, and then describe techniques for both vaginal procedures.

Danish gynecologists' opinion about hysterectomy on benign indication: results of a survey

AIMS

To survey Danish gynecologists' recommendations concerning hysterectomy and its method for benign diseases.

METHODS

A questionnaire of seven clinical cases was sent to all gynecologists in Denmark (n = 450). The gynecologists were asked to recommend one of 14 possible treatments as the most appropriate for each case. In cases of hysterectomy the gynecologists were asked to rate the appropriateness of oophorectomy. Questions about age, employment, geographic area, sex of the gynecologist and preference of the hysterectomy method for themselves/their wives were included. RESULTS. THE RESPONSE RATE WAS: 73%. For women aged > or = 50 years meno-metrorrhagia and symptomatic fibroids seemed to be important for hysterectomy recommendations, and for those aged < 50 years asymptomatic fibroids and unexplained pelvic pain seemed important for recommendation of other treatments. Employment, gender and geographic area influenced the recommendation of hysterectomy, and employment and geographic area only for the recommended method. Most of the gynecologists recommended the abdominal route and preferred the subtotal method. The gynecologists agreed on the recommendation concerning oophorectomy in cases of women aged under 46 years and over 55 years. Disagreement was found in cases of perimenopausal women. The gynecologists' preferences for hysterectomy methods did not differ from their recommendations for the cases.

CONCLUSIONS

Agreement regarding the recommendation of hysterectomy was found in cases of postmenopausal metrorrhagia, while disagreement was found in cases of asymptomatic leiomyomas and unexplained pelvic pain. The gynecologists preferred the abdominal route and the subtotal hysterectomy method. Certain attributes of the gynecologists were found to be important to the recommendation of hysterectomy and its method.