title: Cervical amputation versus vaginal hysterectomy: a population-based register study.
abstract: OBJECTIVE
  Surgical management of uterine prolapse varies greatly and recently uterus-preserving techniques have been gaining popularity. The aim of this study was to compare patient-reported outcomes after cervical amputation versus vaginal hysterectomy, with or without concomitant anterior colporrhaphy, in women suffering from pelvic organ prolapse.
  
  
  METHODS
  We carried out a population-based longitudinal cohort study with data from the Swedish National Quality Register for Gynecological Surgery. Between 2006 and 2013, a total of 3,174 patients with uterine prolapse were identified, who had undergone primary surgery with either cervical amputation or vaginal hysterectomy, with or without concomitant anterior colporrhaphy. Pre- and postoperative prolapse-related symptoms and patient satisfaction were assessed, in addition to complications and adverse events. Between-group comparisons were performed using univariate and multivariate logistic regression.
  
  
  RESULTS
  There were no differences between the two groups in neither symptom relief nor patient satisfaction. In both groups a total of 81 % of the women reported the absence of vaginal bulging 1 year after surgery and a total of 89 % were satisfied with the result of the operation. The vaginal hysterectomy group had a higher rate of severe complications than the cervical amputation group, 1.9 % vs 0.2 % (p < 0.001). The vaginal hysterectomy group also had a longer duration of surgery and greater perioperative blood loss, in addition to longer hospitalization.
  
  
  CONCLUSIONS
  Cervical amputation seems to perform equally well in comparison to vaginal hysterectomy in the treatment of uterine prolapse, but with less morbidity and a lower rate of severe complications.
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden. ida.bergman@sodersjukhuset.se.
authors.forename: Ida
authors.identifier: http://orcid.org/0000-0002-5515-5953
authors.initials: I
authors.lastname: Bergman
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden.
authors.forename: Marie Westergren
authors.initials: MW
authors.lastname: Söderberg
authors.affiliation: Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Kjaeldgaard
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden.
authors.forename: Marion
authors.initials: M
authors.lastname: Ek
mesh_terms: D000368:Aged; D002584:Cervix Uteri; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D008137:Longitudinal Studies; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D012042:Registries; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D000069339:Trachelectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology; D014596:Uterine Prolapse / Q000145:classification / Q000601:surgery*
keywords: Anterior colporrhaphy; Cervical amputation; Pelvic organ prolapse; Recurrence; Uterine prolapse; Vaginal hysterectomy