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Wednesday, 12 June 2013

Hysterectomy rates, types of hysterectomy

Hysterectomy rates, types of hysterectomy

Hysterectomy, in the literal sense of the word, it means just removing the uterus. However, other organs such as the ovaries, fallopian tubes and cervix are removed frequently as part of the surgery.

• Radical hysterectomy-removal of the entire uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph, ovaries and fallopian tubes are also removed in this situation generally.

• Total hysterectomy: Complete removal of the uterus and cervix, with or without oophorectomy.

• subtotal hysterectomy-removal of the uterus, leaving the cervix in situ.

Subtotal hysterectomy (supracervical) originally proposed with the expectation that it can improve sexual function after hysterectomy, it has been postulated that removing the cervix causes excessive neurologic and anatomic disruption, which leads to a shortening vaginal prolapse vaginal vault and vaginal vault granulations. These theoretical advantages were not confirmed in practice, but other advantages over hysterectomy emerged. The main disadvantage is that the risk of cervical cancer is not removed and women may continue cyclical bleeding (but substantially less than before surgery). These issues were addressed in a systematic review compared supracervical hysterectomy for benign gynecological conditions, which reported the following results:

• There was no difference in rates of incontinence, constipation, sexual function measures or relief of symptoms before surgery.

• Duration of surgery and the amount of blood lost during surgery was significantly reduced during supracervical hysterectomy compared to total hysterectomy, but no difference in the rates of transfusion after the operation.

• febrile morbidity was less likely and ongoing cyclic vaginal bleeding one year after surgery was more likely after supracervical hysterectomy.
• There were no differences in the rates of other complications, recovery from surgery, or readmission rates.

A short-term, randomized trials have shown that cervical preservation or removal does not affect the rate of subsequent pelvic organ prolapse.

Supracervical hysterectomy does not eliminate the possibility of cervical cancer since the cervix itself is left intact and may be contraindicated in women at increased risk of this cancer, are still needed regular Pap tests to monitor cervical dysplasia or cancer.

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