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Total vs subtotal hysterectomy for benign gynaecological conditions

A total hysterectomy is one which removes the uterus and the cervix. A subtotal hysterectomy leaves the cervix intact. You can find out more about the various types of hysterectomy here: How is a Hysterectomy Performed?

Researchers in New Zealand have been using previous research such as the Cochrane database of controlled trials around Menstrual Disorders and Sub-fertility to determine if this previous research can show whether a total or subtotal hysterectomy has a better outcome for what are known as benign gynaecological conditions such as fibroids.

They found that there was no evidence of a difference in the rates of multiple outcomes that assessed urinary, bowel or sexual function between total or subtotal hysterectomy, either in the short term (up to two years post-surgery) or long term (nine years post-surgery).

The length of the operation (difference of 11 min) and amount of blood lost during surgery (difference of 57 ml) were significantly reduced during subtotal hysterectomy when compared with total hysterectomy; but they concluded that these differences were unlikely to constitute a clinical benefit and there was no evidence of a difference in the odds of blood transfusion.

They also found that fever after the operation and what is known as urinary retention were less likely  and that ongoing cyclical vaginal bleeding up to two years after surgery was more likely after a sub-total hysterectomy compared with a total hysterectomy.

However, there was no evidence of a difference in the rates of other complications, recovery from surgery, alleviation of pre-surgery symptoms or readmission rates between sub-total hysterectomy and a total hysterectomy whether they were carried out through the abdominal or laparoscopic route.

Their conclusion was that the review of the current research doesn’t confirm the perception that many surgeons and patients have that a subtotal hysterectomy offers improved outcomes for sexual, urinary or bowel function when compared with total abdominal hysterectomy.

In fact, women are more likely to experience ongoing cyclical bleeding up to a year after surgery with subtotal hysterectomy compared to total hysterectomy.

(http://www.ncbi.nlm.nih.gov/pubmed/22513925?dopt=Abstract)

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Linda Parkinson-Hardman

Transformational coach and founder of the Hysterectomy Association. Professionally I'm an information scientist who specialises in the adoption and engagement of digital technologies. I am a writer and author of nine books to date, and I've edited a further seven; phew what a lot for a Thursday afternoon :-)

This Post Has 7 Comments
  1. I have very large fibroids and my doctor advise a subtotal hysterectomy versed a total hysterectomy is this the best option,what are the chances of developing cancer from fibroids,also if I chose a subtotal hysterectomy what are the chance of developing cervical cancer.

  2. It depends on many different factors: why you’re having the surgery, the type of surgery, what your health is like, the support system at home – there is no ‘magic date’ for recovery unfortunately.

  3. My wife had a subtotal hysterectomy a few days ago necessitated by abnormal vaginal bleeding after a c s.will she still receive her periods?

  4. I have had a subtotal hysterectomy in November 2012. What are the chances of me conceiving at this point..

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