NEW YORK (Reuters Health) – Long-term follow-up after laparoscopic supracervical hysterectomy shows that while many women continue to experience vaginal bleeding and pelvic pain, these symptoms are not as severe as before the surgery, and most patients are satisfied with the outcome.
Dr. M. Lieng at Ulleval University Hospital in Oslo, Norway and colleagues mailed questionnaires to 315 women who underwent the procedure during 2004 and 2005. The investigators report in the December issue of BJOG: An International Journal of Obstetrics and Gynaecology that 240 women (78%) responded.
Up to 3 years after surgery, 24% still had vaginal bleeding, although the mean "bothersome score" was 1.1 on a 10-point scale. This proportion of patients with postoperative bleeding is high compared to proportions in other studies of this procedure, the authors say, but they point out that unlike the others, their statistic includes regular menstrual bleeding, irregular bleeding, and bleeding with intercourse.
Women whose surgeons were less experienced were more likely to report vaginal bleeding after surgery.
Approximately 74% of the women reported experiencing pain before surgery, with a mean score of 6.8 on a 10-point scale. While all women reported less pain after surgery, "38% continued to experience menstrual pain, although this was significantly less intense with a mean score of 3.5," the investigators report.
Higher postoperative pain intensities were reported by women whose hysterectomies were done for endometriosis.
Fifty percent of the women did not realize they might have persistent bleeding after their surgery. Still, 20% were satisfied and 70% were very satisfied with their result.
An editorial by Dr. R. Garry of Guisborough, Yorkshire, UK compares postoperative courses after open total hysterectomy, laparoscopic total hysterectomy, and laparoscopic supracervical hysterectomy and concludes, "The advantages of the subtotal approach to hysterectomy appear confined to the perioperative period."
"There appear to be no long-term benefits associated with retention of the cervix," Dr. Garry writes, "and there are some important negative consequences." One is that regular cervical screening is required, "and there are risks of continued vaginal bleeding and postoperative pain, particularly if the procedure is associated with endometriosis."
Dr. Garry adds that these disadvantages are not offset by improvements in sexual, bowel or bladder function with the cervix-sparing procedure and concludes, "There remain many unanswered questions regarding the optimum method of performing hysterectomy, but recent data have dispelled some of the myths and clarified the indications for the different approaches."
Reference:
BJOG 2008;115:1597-1601,1605-1610.
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