Total abdominal hysterectomy

Abstract

Hysterectomy is the most frequently performed major gynecologic operation in both the USA and the UK. It remains the only definitive cure for dysfunctional uterine bleeding and, compared to the myriad of alternative treatments now available, hysterectomy rates highest in satisfaction scores. Recent research has shown that it improves quality of life, an important consideration, since the vast majority of these procedures are performed for benign disease rather than to save lives. The vast majority of hysterectomies are performed by the abdominal route, despite strong research evidence showing that the vaginal route is superior in many respects, including recovery rates and complications. The laparoscopic approach is confined to centers with the requisite expertise, and the place of this approach remains to be fully evaluated. Uterine fibroids are the most common indication for hysterectomy. The longstanding debate on total vs subtotal hysterectomy has been resolved by recent large trials showing no major advantage for one operation over the other. Overall mortality rates are 0.5-2 per 1000, and rates of visceral damage are 0.5-2%. Complications are most common in women treated for uterine fibroids, and overall rates of complications decrease with increasing age of the woman. Although trends show that hysterectomy rates may be falling, such a fall as a result of conservative alternatives (endometrial ablative techniques, the Mirena IUS, and uterine artery embolization for fibroids) has not been as dramatic as might have been anticipated, and therefore abdominal hysterectomy is likely to remain the pre-eminent gynecologic operation for the foreseeable future. Hysterectomy rates vary widely between regions, and within the same geographical area, and the reasons for this are yet to be adequately researched.