Supracervical Hysterectomy Not Superior to Total Hysterectomy
October 31, 2007
Washington, DC -- Supracervical hysterectomy, a surgical technique that removes the uterus while leaving the cervix intact, does not have clear benefits over total hysterectomy in women with non-cancerous disease and should not be recommended as a superior technique, according to a new Committee Opinion released today by The American College of Obstetricians and Gynecologists (ACOG). Current research does not show significant improvements in postsurgical outcomes for supracervical hysterectomy when compared with hysterectomies that remove both the uterus and the cervix. Women who choose the supracervical procedure are also at an increased risk for future problems with the retained cervix and may require additional surgery.
Hysterectomy is the second most common major surgery among reproductive-aged women, after cesarean delivery. According to the National Center for Health Statistics, there were approximately 617,000 hysterectomies performed in 2004. Hysterectomy is most often done to treat uterine fibroids or abnormal uterine bleeding. It is also indicated for women with certain gynecologic cancers.
Techniques such as laparascopic vaginal and supracervical hysterectomy are often used as an alternative to total abdominal hysterectomy. In its new Committee Opinion, ACOG reviewed available research comparing supracervical, total abdominal, and laparascopic vaginal hysterectomies. "There has been renewed interest in supracervical hysterectomy as a way to reduce operative complications and reduce the effects of hysterectomy on urinary and sexual function. Unfortunately, these possible benefits are not supported by recent evidence," says Denise J. Jamieson, MD, chair of ACOG's Committee on Gynecologic Practice.
Research shows that the type of hysterectomy did not drastically affect urinary incontinence, urinary frequency, or bladder emptying, though one Danish study found that women with supracervical hysterectomy had higher rates of urinary incontinence than women who had total hysterectomy. Additionally, women gave similar postoperative ratings for measures of sexual function—such as frequency of sex, frequency and quality of orgasm, sexual desire, and body image whether they received supracervical or total abdominal hysterectomy. "Since laparoscopic hysterectomy techniques have not been carefully evaluated in randomized trials, it is unclear how preserving the cervix with laparoscopic techniques might compare in terms of risks and benefits," Dr. Jamieson adds.
Women with known or suspected gynecologic cancer, current or recent cervical dysplasia, or endometrial hyperplasia are not candidates for the supracervical technique because of the risk of future cervical cancer. Women should be carefully screened to exclude cervical and uterine cancer or cancer precursors before supracervical hysterectomy is performed. A recent normal Pap test is required, and testing for high-risk human papillomavirus (HPV) may be considered.
Committee Opinion #388, "Supracervical Hysterectomy," is published in the November 2007 issue of Obstetrics & Gynecology.
The American College of Obstetricians and Gynecologists is the national medical organization representing over 51,000 members who provide health care for women.