title: [Hysterectomy for benign pathology: Guidelines for clinical practice].
abstract: OBJECTIVE
  The objective of the study was to provide guidelines for clinical practice from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning hysterectomy for benign pathology.
  
  
  METHODS
  Each recommendation for practice was allocated a grade which depends on the level of evidence (guidelines for clinical practice method).
  
  
  RESULTS
  Hysterectomy should be performed by a high volume surgeon (>10 procedures of hysterectomy per year) (grade C). Rectal enema stimulant laxatives are not recommended prior to hysterectomy (grade C). It is recommended to carry out vaginal disinfection using povidone iodine solution prior to an hysterectomy (grade B). Antibioprophylaxis is recommended during a hysterectomy, regardless of the surgical route (grade B). The vaginal or the laparoscopic routes are recommended for hysterectomy for benign pathology (grade B), even if the uterus is large and/or the patient is obese (grade C). The choice between these two surgical approaches depends on others parameters, such as the surgeon's experience, the mode of anesthesia and organizational constraints (operative duration and medico economic factors). Hysterectomy by vaginal route is not contraindicated in nulliparous women (grade C) or in women with previous c-section (grade C). No specific technique to achieve hemostasis is recommended with a view to avoid urinary tract injuries (grade C). In the absence of ovarian pathology and personal or family history of breast/ovarian carcinoma, it is recommended to conserve ovaries in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended in order to diminish the risk of per- or postoperative complications (grade B).
  
  
  CONCLUSIONS
  The application of these recommendations should minimize risks associated with hysterectomy.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France. Electronic address: xavier.deffieux@aphp.fr.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Service de gynécologie-obstétrique, hôpital Privé Marne-Chantereine, 77177 Brou-sur-Chantereine, France.
authors.forename: B
authors.initials: B
authors.lastname: de Rochambeau
authors.affiliation: Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, CHU Lyon Est, université Claude-Bernard Lyon 1, 69000 Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Chêne
authors.affiliation: Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France.
authors.forename: T
authors.initials: T
authors.lastname: Gauthier
authors.affiliation: Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France.
authors.forename: S
authors.initials: S
authors.lastname: Huet
authors.affiliation: Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, CHU Lyon Est, université Claude-Bernard Lyon 1, 69000 Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Lamblin
authors.affiliation: Service de gynécologie-obstétrique, hôpital la Conception, AP-HM, 13005 Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Agostini
authors.affiliation: Service de gynécologie-obstétrique, hôpital la Conception, AP-HM, 13005 Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Marcelli
authors.affiliation: Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 69495 Pierre-Bénite cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Golfier
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000592:standards; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000592:standards / Q000706:statistics & numerical data; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D011300:Preoperative Care / Q000592:standards; D016482:Urinalysis / Q000592:standards; D014591:Uterine Diseases / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D014621:Vagina / Q000382:microbiology
keywords: Bowel injury; Complication; Hemorrhage; Hysterectomy; Hystérectomie; Hémorragie; Morcellation; Morcellement; Plaie digestive; Plaie urinaire; Subtotal; Subtotale; Transfusion; Urinary injury