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Risk Subtotal Hysterectomy
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An_248990 posted:
Trying to be sure I understand risk of leaving cervix in after hysterectomy. Having oophorectomy at same time. Have 14mm fibroid that is coming out with uterus. Two concerns with leaving cervix in: 1) Is it possible that uterine tissue remains (I understand they "cuff" the cervix) where a fibroid could grow again? I will be getting estrogen via patch. 2) What is the impact on the pelvic floor of removing cervix? What's the probability I'm risking bladder problems or prolapse?
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Jane Harrison Hohner, RN, RNP responded:
Dear An: MULTIPLE literature searches at the National Library of Medicine site did not yield any case reports of fibroids regrowing after a supercervical hysterectomy. Here is a partial citation which references your question:

JSLS. 2009 Apr-Jun;13(2):129-34.
Laparoscopic supracervical hysterectomy: a retrospective analysis of 1000 cases.
Bojahr B, Tchartchian G, Ohlinger R.
.......
RESULTS:

The main indication in 80.4% of cases was uterus myomatosis.

CONCLUSION:

An experienced surgeon can rapidly learn the technique of laparoscopic supracervical hysterectomy and can safely perform it. In patients with symptomatic uterine myomatosis, previous laparotomy and/or with a uterine weight of more than 500g, laparoscopic supracervical hysterectomy is a useful alternative to total hysterectomy. There are few complications if preservation of the cervix is not contraindicated.

Bottom line An_248990, a return of fibroids do not appear to be a significant risk based upon a review of the literature.

In terms of increased risk for prolapse or cystocele, the major risk factor is removal of the uterus. Here is the best citation I could find on this issue:

Dtsch Arztebl Int. 2010 May;107(20):353-9. Epub 2010 May 21.
Hysterectomy-a comparison of approaches.
M?ller A, Thiel FC, Renner SP, Winkler M, H?berle L, Beckmann MW.
Source

Frauenklinik, Universit?tsklinikum Erlangen. andreas.mueller@uk-erlangen.de <andreas.mueller@uk-erlangen.de>
Abstract
BACKGROUND:

The advantages and disadvantages of the various surgical techniques for hysterectomy are currently a topic of debate, with particular controversy over leaving the cervix in situ in the laparoscopic supracervical hysterectomy (LASH) procedure.
METHODS:

In a retrospective single-center study, medical history and clinical characteristics were compared in patients who had undergone hysterectomy for benign disease in the period 2002-2008 at the Department of Obstetrics and Gynecology, Erlangen University Hospital. Postoperative satisfaction and the frequency of secondary operations for prolapse or incontinence in women with surgery between 2002 and 2007 were surveyed by means of a questionnaire.
RESULTS:

The longest hospital stay was observed after abdominal hysterectomy (AH; 10 days), followed by vaginal hysterectomy (VH; 7.8 days) and laparoscopy-assisted vaginal hysterectomy (LAVH; 7.2 days). The shortest stays in hospital were seen after LASH (5.9 days) and total laparoscopic hysterectomy (TLH; 5.7 days). The shortest operating time was noted with VH (87 min) and the longest with LAVH (122 min). The lowest rates of blood loss were with LASH (1.38 g/dL) and TLH (1.51 g/dL). The highest rate of postoperative complications occurred after AH (8.9%). No differences were found in relation to postoperative satisfaction or surgery for prolapse or incontinence.
CONCLUSION:

No postoperative benefits were found for leaving the cervix in situ when performing LASH. However, this was not a controlled randomized study.

Hopefully, other women who have have had a supracervical hysterectomy will see your post and share their personal experiences. Ultimately your surgeon will be the best source of the most for sure answers since they know your current pelvic floor status. We all wish you the best-- how ever you decide to proceed.

Yours,
Jane
 
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sjb05151956 responded:
Some women think that keeping the cervix helps preserve sexual function. I don't have my cervix and lost a lot of sexual function but I evidently had uterine orgasms so not sure that leaving my cervix would have helped. But I've also lost almost all sensation in my genitals, clitoris, vagina and even my breasts since my hysterectomy. No libido either. There may be more nerves that are cut when the cervix is removed and nerves (and blood vessels) are critical to sensation.

It's actually the vagina that is cuffed so if you have a partner who's a bit longer than average, this could be an issue. I don't think this happens very often but I have read of cases where it did.

Hysterectomy increases the risk of pelvic organ prolapse. Someone posted here http://forums.webmd.com/3/gynecology-exchange/forum/27538 that her hysterectomy was in May 2011 and her cervix is falling. The vagina can fall too since the pelvic support structures have been cut. There are some other medically documented risks of hysterectomy and even more of oophorectomy. Peruse the medical journals or just look in PubMed for studies.


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