Total versus subtotal hysterectomy : Risks and Benefits
Abstract
Introduction
Hysterectomy is one of the most common major gynaecological operations, and the vast majority of this procedure is performed for benign disease. This operation disrupts the intimate anatomical relationship between the uterus, bowel, bladder and vagina, and inevitably the local nerve supply. It is, therefore, conceivable that hysterectomy may alter the function of these organs. The procedure may be total, when both the body of the uterus and the cervix are removed, or subtotal, when the cervix is conserved. In the UK, subtotal hysterectomy is an unpopular procedure, accounting for only 1.47% of the hysterectomics in 1994-1995.(1) This is apparently largely due o a perceived risk of cervical stump carcinoma. However, there are a number of compelling reasons why gynaecologist might review his/her views: the incidence of cervical cancer is falling due to more effective screening; the increased risk of ureteric and bladder damage associated with total, but minimised by subtotal, hysterectomy might persuade some to consider whether the former operation is always necessary; and, finally, the conflicting report from Scandinavia in the early and late 1980, where the issue was whether one or the other operation conferred benefit in terms of urinary, bowel and sexual function, have brought the whole controversy into the public domain.
