A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes.
OBJECTIVE
To compare surgical complications and clinical outcomes after total versus supracervical abdominal hysterectomy for control of abnormal uterine bleeding, symptomatic uterine leiomyomata, or both.


METHODS
We conducted a randomized intervention trial in four US clinical centers among 135 patients who had abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding refractory to hormonal treatment, or both. Patients were randomly assigned to receive a total or supracervical hysterectomy performed using the surgeon's customary technique. Using an intention-to-treat approach, we compared surgical complications and clinical outcomes for 2 years after randomization.


RESULTS
Sixty-eight participants were assigned to supracervical hysterectomy (SCH) and 67 to total abdominal hysterectomy (TAH). Hysterectomy by either technique led to statistically significant reductions in most symptoms, including pelvic pain or pressure, back pain, urinary incontinence, and voiding dysfunction. Patients randomly assigned to (SCH) tended to have more hospital readmissions than those randomized to TAH, but this difference was not statistically significant. There were no statistically significant differences in the rate of complications, degree of symptom improvement, or activity limitation. Participants weighing more than 100 kg at study entry were twice as likely to be readmitted to the hospital during the 2-year follow-up period (relative risk [RR] 2.18, 95% confidence interval [CI] 1.06, 4.48, P=.034).


CONCLUSIONS
We found no statistically significant differences between (SCH) and TAH in surgical complications and clinical outcomes during 2 years of follow-up.
Learman
Lee A
LA
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94110, USA. learmanl@obgyn.ucsf.edu
Summitt
Robert L
RL
Varner
R Edward
RE
McNeeley
S Gene
SG
Goodman-Gruen
Deborah
D
Richter
Holly E
HE
Lin
Feng
F
Showstack
Jonathan
J
Ireland
Christine C
CC
Vittinghoff
Eric
E
Hulley
Stephen B
SB
Washington
A Eugene
AE
D000368:Aged; D002584:Cervix Uteri / Q000601:surgery*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods; D015994:Incidence; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000503:physiopathology; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*