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

• Published in: Clinical therapeutics 2019-04, Vol.41 (4), p.768-789
• Main Authors: Aleixo, Gabriel Francisco, Fonseca, Marcelo C.M., Bortolini, Maria A.T., Brito, Luiz Gustavo O., Castro, Rodrigo A.
• Format: Article
• Language: English
• Subjects: Abdomen; Bias; Bleeding; Blood transfusion; Cervix; Clinical trials; Collaboration; Female; Hospitals; Humans; Hysterectomy; Intraoperative Complications; Intraoperative Period; Laparoscopy; Medical Subject Headings-MeSH; Menstruation; Meta-analysis; Mimicry; Morbidity; Pain; Postoperative Complications; Postoperative Period; Preservation; Quality of life; Questionnaires; Randomized Controlled Trials as Topic; review; sexual function; Short term; short-term events; subtotal; supracervical; Systematic review; total; Transfusion; Urogenital system; Vagina
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2019.02.006

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). 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. 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