Subtotal Abdominal Hysterectomy Research Articles

Hysterectomy on benign indication in Denmark 1988–1998

The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication. Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data on the female population distribution were obtained from the Danish National Population Register. During the last 11 years the incidence rate of hysterectomy performed for benign diseases has been stable. However, the rate of women treated surgically for benign diseases of the uterus has increased by 14%. During the study period the number of total abdominal hysterectomies has decreased by 38%, the number of subtotal abdominal hysterectomies has increased by 458%, the number of vaginal hysterectomies has increased by 107% and two new methods of surgical treatment for benign diseases of the uterus have been introduced. Abdominal hysterectomy still accounts for 80% of the total number of hysterectomies performed in Denmark in 1998. The age distribution for all hysterectomies has changed, from a maximum of 36-45 years in 1988 to 46-55 years in 1998. The age maximum for abdominal hysterectomy corresponds to that of all hysterectomies. For vaginal hysterectomy the age maximum is 56 years or older, while it is 36-45 years for laparoscopic hysterectomy. The incidence rate of hysterectomy was stable during the study period and the age distribution for all hysterectomies has changed. The study showed a change in the choice of surgical methods, although no evidence supports this practice.

Subtotal abdominal hysterectomy: a surgical advance or a backward step?

OBJECTIVE To review the short and medium term outcomes of subtotal abdominal hysterectomy. We also describe the management of cervical stump complications by vaginal trachelectomy or large loop excision of the transformation zone. Retrospective analysis. Warwick General Hospital, Warwickshire, UK. One hundred and fifty women underwent subtotal abdominal hysterectomy between 1993 and 1999. Five women had vaginal trachelectomy and another five had large loop excision of the transformation zone for complications relating to the cervical stump. The prevalence of intra-operative and early post-operative complications was 4% and 7.3%, respectively. Twenty women (13.3%) had late complications, of whom 17 (11%) presented with symptoms directly related to the stump (two had also genuine stress incontinence). Three presented with genuine stress incontinence alone. The commonest problem was regular menstruation, which occurred in 12 women (8%). Ten of these women underwent vaginal trachelectomy or large loop excision of the transformation zone. None had intra-operative or post-operative complications. The high prevalences of cervical stump problems should be taken into account before a change in surgical procedure from total to subtotal hysterectomy is recommended. Further prospective studies with prolonged follow up are needed to evaluate the risks and benefits of retaining the cervix at hysterectomy. Total hysterectomy, preferably by the vaginal route, remains the procedure of choice for most women. Should a problem develop, vaginal trachelectomy or large loop excision of the transformation zone by an experienced surgeon are the best options for these women.

Primitive neuroectodermal tumors of the uterus: A report of four cases

Four cases of primitive neuroectodermal tumor (PNET) of the uterine corpus are reported, bringing the total number of reported PNETs in this site to seven. The four women were in their seventh decade of life and presented with abnormal vaginal bleeding and, in two cases, an enlarged uterus. The patients underwent total or subtotal abdominal hysterectomy and bilateral salpingo-oophorectomy and, in one patient, pelvic lymphadenectomy. Three patients received postoperative radiation therapy, chemotherapy, or both. Gross examination revealed fleshy polypoid masses filling the endometrial cavity and, in two cases, deeply invading the myometrium. Histologic, immunohistochemical, and, in two cases, ultrastructural examination revealed typical PNETs that exhibited variable degrees of neural, glial, ependymal, and medulloepithelial differentiation. Two PNETs were admixed with other neoplasms: in one case a grade I endometrial adenocarcinoma and in the other a low-grade endometrial stromal sarcoma. The prognosis of the tumors was related to their stage: two patients with stage I tumor were alive with no evidence of disease at 5 and 6 years, whereas two patients with stage III or IV tumor died of tumor at 6 and 12 months. Although it has been suggested that uterine PNETs may be derived from displaced germ cells or implanted fetal tissues, evidence provided by this study, including the advanced ages of the patients and an admixture with neoplasms of unquestioned müllerian origin, suggests a müllerian origin for these tumors in at least some cases.

Intravenous leiomyomatosis with massive ascites

A case of intravenous leiomyomatosis with massive ascites is reported. This is the first such recorded case. The patient was treated with a subtotal abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathological examination established a vessel wall origin. There is no evidence of recurrence up to 20 months after initial treatment.

Prolapse of the vagina following abdominal hysterectomy

Sixteen cases of vaginal prolapse following subtotal abdominal hysterectomy were studied. Prolapse of the cervical stump occurred within from less than one year of 16 years following the hysterectomy. No cases were observed following total abdominal or vaginal hysterectomy.The treatment in 14 cases consisted of: a vaginal plastic procedure in 8 cases; colpocleisis in 4 cases; and 2 cases were treated by wearing a pessary.A study of the anatomy and mechanics of uterine and vaginal support and also clinical observation demonstrate that removal of the cervix with the fundus of the uterus does not predispose to prolapse of the vagina.When uterine descensus is present at the time of hysterectomy, vaginal removal of the uterus and repair of the hernial defect will prevent subsequent prolapse of the vagina.

Total versus subtotal abdominal hysterectomy in benign uterine disease

Total versus subtotal abdominal hysterectomy in benign uterine disease

Total versus subtotal abdominal hysterectomy in benign uterine disease

Total versus subtotal abdominal hysterectomy in benign uterine disease

Total Versus Subtotal Abdominal Hysterectomy: Dr. James C. Masson, Rochester, Minn., read a paper on. (For original article see October, 1927, issue, page 486.)

Total Versus Subtotal Abdominal Hysterectomy: Dr. James C. Masson, Rochester, Minn., read a paper on. (For original article see October, 1927, issue, page 486.)