title: Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology.
abstract: OBJECTIVE
  The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease.
  
  
  METHODS
  Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines).
  
  
  RESULTS
  Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (gradeC). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (gradeC). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (gradeC) or in women with previous cesarean section (gradeC). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (gradeC). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- 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 (APHP), 92140 Clamart, France. Electronic address: xavier.deffieux@aphp.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital Privé Marne Chantereine, 77177 Brou-sur-Chantereine, France.
authors.forename: Bertrand de
authors.initials: Bd
authors.lastname: Rochambeau
authors.affiliation: CHU Lyon Est, hôpital femme mère enfant, département de gynécologie-obstétrique, université Claude-Bernard Lyon 1, 69000 Lyon, France.
authors.forename: Gautier
authors.initials: G
authors.lastname: Chene
authors.affiliation: Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Gauthier
authors.affiliation: Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France.
authors.forename: Samantha
authors.initials: S
authors.lastname: Huet
authors.affiliation: CHU Lyon Est, hôpital femme mère enfant, département de gynécologie-obstétrique, université Claude-Bernard Lyon 1, 69000 Lyon, France.
authors.forename: Géry
authors.initials: G
authors.lastname: Lamblin
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital la Conception (APHM), 13005 Marseille, France.
authors.forename: Aubert
authors.initials: A
authors.lastname: Agostini
authors.affiliation: Service de Gynécologie Obstétrique, Hôpital la Conception (APHM), 13005 Marseille, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Marcelli
authors.affiliation: Service de gynécologie-obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France.
authors.forename: François
authors.initials: F
authors.lastname: Golfier
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D014591:Uterine Diseases / Q000601:surgery*
keywords: Bowel injury; Complication; Hemorrhage; Hysterectomy; Morcellation; Urinary tract injury