title: Hysterectomy for Benign Uterine Disease.
abstract: BACKGROUND
  Hysterectomy is the second most common operation in obstetrics and gynecology after Cesarean section. Until now, there has not been any German clinical guideline with recommendations concerning the indications for hysterectomy for benign uterine conditions, in consideration of the available uterus-preserving alternative treatments.
  
  
  METHODS
  We systematically searched the Medline database in 2013, in 2014, and in December 2015, focusing on aggregate evidence, and assessed the retrieved literature. The guideline recommendations were developed by a consensus process with structured independent moderation.
  
  
  RESULTS
  30 systematic reviews and 8 randomized controlled trials were analyzed. Among the study patients treated with either hysterectomy (by any technique) or an organ-preserving alternative, at least 75-94% were satisfied with their treatment. Vaginal hysterectomy was associated with lower complication rates, shorter procedure duration, and more rapid recovery than abdominal hysterectomy and is therefore the preferred technique. If vaginal hysterectomy is not possible, a laparoscopic approach should be considered. Abdominal hysterectomy should be reserved for special indications. In 2012, the frequency of abdominal hysterectomy in Germany, Austria, and Switzerland was lower than elsewhere in the world, at 15.7% , 28.0% , and 23.9% , respectively. Uterus-preserving techniques were associated with higher reintervention rates compared to hysterectomy (11-36% vs 4-10% ).
  
  
  CONCLUSIONS
  The main objective is to reduce the frequency of abdominal hysterectomy. Patients should be counseled and made aware of uterus-sparing alternatives to hysterectomy so that they are able to make informed decisions.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland University Medical Center, Germany, Department of Obstetrics and Gynecology, Tübingen University Hospital, Germany, Cantonal Hospital, Frauenfeld, Switzerland, Evangelisches Krankenhaus, Köln-Weyertal, Germany, Department of Obstetrics and Gynecology, Medical University of Graz, Austria, AWMF Institute of Medical Knowledge Management, c/o Philipps University Marburg, Germany.
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Neis
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zubke
authors.forename: Mathias
authors.initials: M
authors.lastname: Fehr
authors.forename: Thomas
authors.initials: T
authors.lastname: Römer
authors.forename: Karl
authors.initials: K
authors.lastname: Tamussino
authors.forename: Monika
authors.initials: M
authors.lastname: Nothacker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006176:Gynecology / Q000592:standards*; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000592:standards*; D008875:Middle Aged; D009774:Obstetrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000175:diagnosis* / Q000601:surgery*; D055815:Young Adult