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Total Versus Subtotal Hysterectomy: Systematic Review and Meta-analysis of Intraoperative Outcomes and Postoperative Short-term Events.

Abstract：

PURPOSE:The benefits and disadvantages of cervical extraction during hysterectomy are unclear in the literature. We intended to compare total (TH) with subtotal or supracervical (SH) hysterectomy regarding intraoperative and postoperative outcomes (quality of life, sexual function, pain and cyclical bleeding). METHODS:A systematic literature search for randomized controlled trials was conducted on MEDLINE, LILACS, Cochrane CENTRAL, SCOPUS, EMBASE, Clinicaltrials.gov databases, and conference abstracts (AAGL, AUGS, ICS) from 1970 to November 2017. Two reviewers independently searched, selected and then combined the articles. Meta-analyses were conducted using a random-effect model. The risk of bias was evaluated using the Cochrane's Collaboration tool. FINDINGS:Eleven studies were included involving 1523 patients. The analyses showed that the events operative time (mean difference: 12.88 minutes, 95%CI [7.45, 18.30] p < 0.000001), hospital stay (MD .44 days, 95%CI [0.11, 0.77] p = 0.0008), and intraoperative blood loss (MD 81.06 ml, 95%CI [9.16, 152.97] p = 0.03) favored SH over TH, although the rate of blood transfusion did not differ between the groups. Conversely, TH group had less cyclical vaginal bleeding over SH (1.2% versus 14.1%; RR .14 95%CI [0.05, 0.43] p = 0.0006) during one-year follow up. Persistent pain and sexual satisfaction rates, and quality of life scores were similar in both total and subtotal hysterectomy groups up to 12 months follow up. IMPLICATIONS:Overall perioperative outcomes favored the preservation of the cervix during hysterectomy but women that had SH are more susceptible to present cyclical vaginal bleeding mimicking menstruation. Those factors should be taken into account along with patient's needs and expectations prior to selecting the procedure.

journal_name

Clin Ther

journal_title

Clinical therapeutics

authors

Aleixo GF,Fonseca MCM,Bortolini MAT,Brito LGO,Castro RA

doi

10.1016/j.clinthera.2019.02.006

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

768-789

issue

eissn

0149-2918

issn

1879-114X

pii

S0149-2918(19)30066-9

journal_volume

pub_type

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Total Versus Subtotal Hysterectomy: Systematic Review and Meta-analysis of Intraoperative Outcomes and Postoperative Short-term Events.