Total abdominal hysterectomy: a randomized study comparing two techniques.
BACKGROUND
Abdominal hysterectomy is the most frequent operation performed by gynecologists. The most commonly used techniques are intrafascial, extrafascial and supracervical hysterectomy; in our department we mainly use the first method. A variant of this technique, because during the operation we use only an Allis clamp, simplifies the operation and maintains certain anatomical relationships between neighbouring pelvic structures.


METHODS
To compare two different surgical techniques between 1/1/1991 and 31/12/95, 262 women were randomized pre-operatively: 133 by the intrafascial technique of Richardson and 129 by the variant hysterectomy technique. The difference between the two techniques (Richardson versus variant hysterectomy technique), as performed in our department, was investigated regarding the clamping of uterine vessels, the resection of uterosacral and cardinal ligament. The two-tailed student test was used for continuous data and chi2 analysis for discrete data.


RESULTS
Less blood loss occurred in the variant than in the Richardson group (P<0.01) and no intrasurgical complications occurred as compared to one case of ureter lesion in the Richardson group. There were no differences in the number of days of hospitalization. No particular post-surgical complications occurred in the follow-up period, which has now elapsed. After 36 months of follow-up the variant group showed a reduced incidence (not significant) of vaginal vault prolapse. The patients who underwent the variant hysterectomy technique reported better compliance with regard to sexual intercourse and urinary function than the Richardson group.


CONCLUSIONS
We conclude that the variant hysterectomy technique is as valid as the Richardson technique, giving the surgeon the possibility of maintaining certain anatomical relationships between neighbouring pelvic structures. It also has minor delayed complications.
De Leo
V
V
Department of Obstetrics and Gynecology, University of Siena, Policlinico Le Scotte, Italy. deleo@unisi.it
De Palma
P
P
Ditto
A
A
Bifernino
V
V
Molinari
B
B
la Marca
A
A
Morgante
G
G
D000328:Adult; D003250:Constriction; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D014594:Uterine Neoplasms / Q000601:surgery; D014599:Uterus / Q000098:blood supply