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Hysterectomy
Aka: Hysterectomy, Transabdominal Hysterectomy, Laparoscopic Assisted Vaginal Hysterectomy, Vaginal Hysterectomy
- Epidemiology: United States
- Annual Incidence: 600,000
- Annual Hysterectomy Incidence is nearly twice that of appendectomy in the United States
- Surgically absent Uterus in 40% over age 60 years
- Most hysterectomies are for benign disease and are elective
- Indications
- Most common indications
- Uterine Leiomyoma or Uterine Fibroids (33%)
- Abnormal Uterine Bleeding
- Endometriosis
- Uterine Prolapse
- Cancerous and precancerous indications
- Endometrial Cancer (10%)
- Endometrial Hyperplasia (5%)
- Other indications
- Persistent Cervical Dysplasia
- Adenomyosis
- Peripartum bleeding
- Procedures
- Transabdominal Hysterectomy
- Lowest quality of life scores
- Highest hospitalization and postoperative costs
- Twice the risk of Postoperative Fever
- Significantly increased blood loss
- Prophylactic antibiotics are recommended
- Peipert (2004) Obstet Gynecol 103:86-91 [PubMed]
- Laparoscopic Assisted Vaginal Hysterectomy
- Same life quality as Vaginal Hysterectomy at 28 days
- Vaginal Hysterectomy
- Fastest return to normal activities
- Highest quality of life scores
- Lowest hospitalization and postoperative costs
- Adverse Effects (serious complication rate: 10%)
- Mortality: 6 per 10,000 operations
- Urinary Incontinence (increases risk by 40-80%)
- Does not adversely effect sexual function
- Sexual well-being improves after Hysterectomy
- Roovers (2003) BMJ 327:774-8 [PubMed]
- Precautions: Prophylactic Oophorectomy at time of Hysterectomy
- Benefits
- Ovarian Cancer significantly reduced
- Note Hysterectomy alone also reduces risk by 35%
- Breast Cancer risk is reduced by 50%
- Risks (if oophorectomy performed before age 45)
- Overall mortality increases
- Osteoporosis risk increases
- Cardiovascular disease risk increases
- Dementia risk increases
- References
- Parker (2005) Obstet Gynecol 106:219-26 [PubMed]
- Rocca (2006) Lancet Oncol 7:821-8 [PubMed]
- Rocca (2007) Neurology 69:1074-83 [PubMed]
- References
- Ryan (1999) Kistner's Gynecology, Mosby, p. 137-9
- Brown (2000) Lancet 356:535-9 [PubMed]
- van den Eeden (1998) Am J Obstet Gynecol 178:91-100 [PubMed]