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Supracervical hysterectomy not superior to total hysterectomy


Supracervical hysterectomy, a surgical technique that removes the uterus while leaving the cervix intact, does not have clear benefits over total hysterectomy in women with non-cancerous disease and should not be recommended as a superior technique.
Current research does not show significant improvements in postsurgical outcomes for supracervical hysterectomy when compared with hysterectomies that remove both the uterus and the cervix.
Women who choose the supracervical procedure are also at an increased risk for future problems with the retained cervix and may require additional surgery.

Hysterectomy is the second most common major surgery among reproductive-aged women, after cesarean delivery.
Hysterectomy is most often done to treat uterine fibroids or abnormal uterine bleeding. It is also indicated for women with certain gynecologic cancers.

Techniques such as laparascopic vaginal and supracervical hysterectomy are often used as an alternative to total abdominal hysterectomy.
" There has been renewed interest in supracervical hysterectomy as a way to reduce operative complications and reduce the effects of hysterectomy on urinary and sexual function. Unfortunately, these possible benefits are not supported by recent evidence, " says Denise J. Jamieson, chair of ACOG's Committee on Gynecologic Practice.

Research shows that the type of hysterectomy did not drastically affect urinary incontinence, urinary frequency, or bladder emptying, though one Danish study found that women with supracervical hysterectomy had higher rates of urinary incontinence than women who had total hysterectomy. Additionally, women gave similar postoperative ratings for measures of sexual function—such as frequency of sex, frequency and quality of orgasm, sexual desire, and body image whether they received supracervical or total abdominal hysterectomy. " Since laparoscopic hysterectomy techniques have not been carefully evaluated in randomized trials, it is unclear how preserving the cervix with laparoscopic techniques might compare in terms of risks and benefits," Jamieson adds.

Women with known or suspected gynecologic cancer, current or recent cervical dysplasia, or endometrial hyperplasia are not candidates for the supracervical technique because of the risk of future cervical cancer. Women should be carefully screened to exclude cervical and uterine cancer or cancer precursors before supracervical hysterectomy is performed.

Source: ACOG, 2007

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