Long-Term Outcomes Following Laparoscopic Supracervical Hysterectomy

Abstract

It is unclear whether the risk of persistent vaginal bleeding and pelvic pain following surgery is increased following laparoscopic supracervical hysterectomy (LSH) compared to total laparoscopic hysterectomy (TLH). In Norwegian women who underwent LSH, this retrospective study evaluated the occurrence of vaginal bleeding and pelvic pain, the toleration of residual symptoms, and overall satisfaction with the procedure through the use of a postal questionnaire during 2004 and 2005. Of a total of 315 consecutive patients contacted 12 to 36 months after surgery, 240 (78%) responded. Menstrual bleeding continued in 24% (57 women) but was considered minimal in 90% of the women; on a 10-point visual analogue scale (VAS), the mean bothersome score was 1.1 (SD 2.0). When only regular bleeding was included in the analysis, the percentage decreased from 24% to 8%. Women with a less experienced surgeon were more likely to report continued vaginal bleeding (P < 0.02). Of the 178 women (74%) with menstrual pain before LSH, up to 3 years after surgery, 89 women (38%) reported continued menstrual/cyclical pain. However, the pain was considerably less intense; the mean VAS-10 score before and after surgery was 6.8 (SD 2.05) and 3.5 (SD 2.16), respectively (P < 0.01). Significantly higher levels of residual menstrual/cyclical pain after surgery occurred among women reporting endometriosis as a reason for the hysterectomy compared with women who did not (P < 0.001). A total of 90% of the women were very satisfied (70%) or satisfied (20%) with the hysterectomy. These findings show a high level of patient satisfaction with LSH despite the relatively common occurrence of residual menstrual bleeding and pain.