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Review
. 2016 Apr 8;113(14):242-9.
doi: 10.3238/arztebl.2016.0242.

Hysterectomy for Benign Uterine Disease

Klaus J Neis  1 , Wolfgang Zubke, Mathias Fehr, Thomas Römer, Karl Tamussino, Monika Nothacker
Affiliations
Review

Hysterectomy for Benign Uterine Disease

Klaus J Neis et al. Dtsch Arztebl Int. .

Abstract

Background: Hysterectomy is the second most common operation in obstetrics and gynecology after Cesarean section. Until now, there has not been any German clinical guideline with recommendations concerning the indications for hysterectomy for benign uterine conditions, in consideration of the available uterus-preserving alternative treatments.

Methods: We systematically searched the Medline database in 2013, in 2014, and in December 2015, focusing on aggregate evidence, and assessed the retrieved literature. The guideline recommendations were developed by a consensus process with structured independent moderation.

Results: 30 systematic reviews and 8 randomized controlled trials were analyzed. Among the study patients treated with either hysterectomy (by any technique) or an organ-preserving alternative, at least 75-94% were satisfied with their treatment. Vaginal hysterectomy was associated with lower complication rates, shorter procedure duration, and more rapid recovery than abdominal hysterectomy and is therefore the preferred technique. If vaginal hysterectomy is not possible, a laparoscopic approach should be considered. Abdominal hysterectomy should be reserved for special indications. In 2012, the frequency of abdominal hysterectomy in Germany, Austria, and Switzerland was lower than elsewhere in the world, at 15.7% , 28.0% , and 23.9% , respectively. Uterus-preserving techniques were associated with higher reintervention rates compared to hysterectomy (11-36% vs 4-10% ).

Conclusion: The main objective is to reduce the frequency of abdominal hysterectomy. Patients should be counseled and made aware of uterus-sparing alternatives to hysterectomy so that they are able to make informed decisions.

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Figures

Figure
Figure
Indications for hysterectomy
eFigure
eFigure
Method of the literature search Check whether the included studies are up-to-date as of 12/2015 by means of update search; 2 more recent Cochrane Reviews identified: (15) and (36). No new randomized controlled trial included; results unchanged n = number; Pat., patients; RCT, randomized controlled trial(s); SR, systematic review(s) *Publications in the following languages were included: German, English, French, Spanish
See this image and copyright information in PMC

Comment in

  • Unfortunately Without Patient Involvement.
    M Hr C. M Hr C. Dtsch Arztebl Int. 2016 Oct 14;113(41):688. doi: 10.3238/arztebl.2016.0688a. Dtsch Arztebl Int. 2016. PMID: 27839535 Free PMC article. No abstract available.
  • Confusing Information.
    Stang A. Stang A. Dtsch Arztebl Int. 2016 Oct 14;113(41):688-689. doi: 10.3238/arztebl.2016.0688b. Dtsch Arztebl Int. 2016. PMID: 27839536 Free PMC article. No abstract available.
  • Fibroid Ablation as an Option.
    Eisele RM. Eisele RM. Dtsch Arztebl Int. 2016 Oct 14;113(41):689. doi: 10.3238/arztebl.2016.0689a. Dtsch Arztebl Int. 2016. PMID: 27839537 Free PMC article. No abstract available.
  • Antihormonal Therapy.
    Wenderlein MJ. Wenderlein MJ. Dtsch Arztebl Int. 2016 Oct 14;113(41):689-690. doi: 10.3238/arztebl.2016.0689b. Dtsch Arztebl Int. 2016. PMID: 27839538 Free PMC article. No abstract available.

References

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    1. Cohen SL, Vitonis AF, Einarsson JI. Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy. JSLS. 2014;18(3 pii) - PMC - PubMed
    1. AQUA. Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Bundesauswertung zum Verfahrensjahr 2012 15/1, Gynäkologische Operationen. www.sqg.de/downloads/Bundesauswertungen/2012/bu_Gesamt_15N1-GYN-OP_2012.pdf. 2013 (last accessed on 11 February 2016)
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    1. Neis KJ, Ulrich K, Zeilmann W, Brandner P. Die laparoskopisch-assistierte vaginale Hysterektomie. Der Frauenarzt. 1993;34:1091–1096.