When it comes to treating certain gynecological conditions like fibroids, adenomyosis, abnormal uterine bleeding not responding to conservative treatment, hysterectomy remains a common surgical intervention. However, there are different approaches to this procedure, each with its own benefits and considerations. In this blog post, we will delve into the key distinctions between total hysterectomy and supracervical hysterectomy, highlighting their pros and cons to help you make a more informed decision.
A total hysterectomy involves the removal of both the uterus and the cervix. It is often the preferred choice for certain conditions, such as cancerous or precancerous conditions, extensive endometriosis, multiple fibroids and cases involving abnormal bleeding.
Supracervical hysterectomy, also known as partial hysterectomy, involves removing the uterus while preserving the cervix. This technique has gained popularity in recent years due to its potential advantages in terms of quicker recovery and better sexual function.
Total vs. Supracervical Hysterectomy—What Does the Evidence Say?”
The Journal of Sexual Medicine, 2023, 20, 447–466
Hysterectomy and sexual function: a systematic review and meta-analysis:
Conclusion: Subtotal and total hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route.
The American Journal of Obstetrics and Gynecology, Volume 212, Issue 6, June 2015, Pages 758.e1-758.e54
Subtotal versus total abdominal hysterectomy: randomized clinical trial with 14-year questionnaire follow-up
Conclusion: Subtotal abdominal hysterectomy was not superior to total abdominal hysterectomy on any outcomes. More women seem to have subjective urinary incontinence 14 years after subtotal abdominal hysterectomy.
The Journal of Sexual Medicine, Volume 3, Issue 3, May 2006, Pages 483–491
The Psychosocial Outcomes of Total and Subtotal Hysterectomy: A Randomized Controlled Trial
Conclusions: 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.
Total or Supracervical Hysterectomy Research Group, Obstet Gynecol. 2003;102:453–462.7 Level I evidence
A randomized comparison of total or supracervical hysterectomy: Surgical complications and clinical outcomes.
CONCLUSION: We found no statistically significant differences between supracervical hysterectomy and total abdominal hysterectomy in surgical complications and clinical outcomes during 2 years of follow-up.
OBG Manag. 2004 September;16(9):32-45
Subtotal vs total hysterectomy: Does the evidence support saving the cervix?
Total hysterectomy and supracervical hysterectomy are two distinct surgical approaches, each with their own advantages and considerations. The choice between the two depends on several factors, such as the patients medical condition, age, previous surgeries, and personal preferences.
Based on the available literature and medical evidence, we conclude that supracervical hysterectomy is an alternative to total laparoscopic hysterectomy, offering a lower incidence of bladder injury, particularly in cases with previous cesarean sections. It also allows for earlier resumption of sexual activity. However, cervical preservation carries a small risk of bleeding, pelvic pain, and malignant transformation, which may require further intervention.
On the other hand, total laparoscopic hysterectomy has a lower incidence of reoperation and eliminates complications associated with the cervical stump. However, it is associated with an increased risk of urinary tract injury, particularly in the hands of inexperienced surgeons. The decision to perform either procedure depends on the surgeon’s expertise and the preferences of both the surgeon and the patient.
It is crucial to have a thorough discussion with your healthcare provider to evaluate the most appropriate option for your specific circumstances. Remember, making an informed decision is essential for your overall well-being and future health.
Dr. Alphy S Puthiyidom
Head of the Department Obstetrics & Gynecology
Advanced Gynecological Laparoscopic Surgeon
& Pelvic Reconstructive Surgeon
MEDICLINIC WELCARE HOSPITAL
Al Garhoud, Dubai
MEDICLINIC PARKVIEW HOSPITAL
Umm Sequim, Al Barsha South 3, Dubai