Removing the Cervix During a Hysterectomy May Be Redundant

Cervix removal during hysterectomy may not be necessary, according to the results of a follow-up survey of a randomized trial.

Researchers at the Mayday University Hospital (Croydon, United Kingdom), the University of Sussex (Brighton, UK), and St George's University of London (United Kingdom) compared the long-term outcomes of a randomized, double blind, multi-center trial in 279 women who underwent total abdominal hysterectomy (TAH) or subtotal abdominal hysterectomy (sub-TAH). Participants were invited to complete questionnaires regarding quality of life and pelvic organ function. Of the 181 women (65% of participants) who completed the study, 90 had undergone TAH and 91 underwent sub-TAH; mean follow-up was 9 years (range, 7 - 11 years).

The study results showed that quality of life, mental health, and pelvic organ function were not significantly different between the TAH and sub-TAH groups. Although urinary and bowel function did not change significantly over time, there were significant decreases in both groups in a variety of sexual function parameters, pain, and role limitations, which were attributed to emotional problems. The researchers also found that sub-TAH was technically easier and associated with quicker recovery, but that 7% of women who underwent sub-TAH experienced cyclical vaginal discharge or bleeding. The study was published in the December 2008 issue of Obstetrics & Gynecology.

"There were no long-term differences in outcomes between TAH and sub-TAH,” said lead author Ranee Thakar, M.D., of the department of obstetrics and gynecology at Mayday University Hospital. "The lack of a detrimental effect on bowel and urinary function seen at 12 months was maintained. The deterioration in sexual function is likely to be due to the climacteric.”

"Despite the proliferation in recent years of effective, less invasive, and cheaper surgical and nonsurgical alternatives to treat menorrhagia, hysterectomy remains the most common major gynecological operation performed in the United States and in the United Kingdom,” added the authors. "This is because research has shown that it is a definitive cure for a wide range of gynecological disorders with a low perioperative morbidity, high satisfaction rate, and improved quality of life.”

Related Links:
Mayday University Hospital
University of Sussex
St. George's University of London