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A Randomized Comparison of Total or Supracervical Hysterectomy: Surgical Complications and Clinical Outcomes

From the Departments of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology and Biostatistics, and Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California; University of Tennessee, Memphis, Tennessee; Wayne State University, Detroit, Michigan; University of California, San Diego, La Jolla, California; University of Alabama, Birmingham, Alabama

Address reprint requests to: Lee A. Learman, MD, PhD, Department of Obstetrics and Gynecology — Room 6D-9, San Francisco General Hospital, 1001 Potrero Street, San Francisco, CA 94110; E-mail: learmanl{at}obgyn.ucsf.edu.

OBJECTIVE: To compare surgical complications and clinical outcomes after total versus supracervical abdominal hysterectomy for control of abnormal uterine bleeding, symptomatic uterine leiomyomata, or both.

METHODS: We conducted a randomized intervention trial in four US clinical centers among 135 patients who had abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding refractory to hormonal treatment, or both. Patients were randomly assigned to receive a total or supracervical hysterectomy performed using the surgeon’s customary technique. Using an intention-to-treat approach, we compared surgical complications and clinical outcomes for 2 years after randomization.

RESULTS: Sixty-eight participants were assigned to supracervical hysterectomy (SCH) and 67 to total abdominal hysterectomy (TAH). Hysterectomy by either technique led to statistically significant reductions in most symptoms, including pelvic pain or pressure, back pain, urinary incontinence, and voiding dysfunction. Patients randomly assigned to (SCH) tended to have more hospital readmissions than those randomized to TAH, but this difference was not statistically significant. There were no statistically significant differences in the rate of complications, degree of symptom improvement, or activity limitation. Participants weighing more than 100 kg at study entry were twice as likely to be readmitted to the hospital during the 2-year follow-up period (relative risk [RR] 2.18, 95% confidence interval [CI] 1.06, 4.48, P = .034).

CONCLUSION: We found no statistically significant differences between (SCH) and TAH in surgical complications and clinical outcomes during 2 years of follow-up.

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