Cervix Removal Or Retaining During Hysterectomy – A Surgical Conundrum – Part I

Must the cervix be done away with as a regular practise of Hysterectomy in cases of benign disease? This surgical riddle has since long been a part of the incessant discussions in the field of gynaecology. The puzzlement is accentuated in the terms employed in that matter. A majority of gynaecologists utilize the expression ‘subtotal hysterectomy’ (STH) with inference of an unsatisfactory or unfinished procedure, while several others use the terminology ‘supracervical hysterectomy’ with its suggestions of being a better and enhanced technique.

The subtotal or supracervical hysterectomy approach has adeptly garnered phases of recognition with varying benefits and downsides being regularly brought to light by both supporters and challengers. Even the highly eminent gynaecological laparoscopists have staunchly vouched for STH in an effort to relieve the hitches of cervical removal at laparoscopy.

There are legible reasons for opting for cervix removal like the presence of cancer in the left over cervical base. There are grave perils of morbidity and deaths associated with cervical cancer developing in the retained cervix. This is the highly dreaded of most impediments of a retained cervix. Gynaecologists for a major part of the 20th century have been plagued by this major fear to remove the cervix. It was noted in a Brazil based series that close to 4% of a set of 363 cases amassed during the period of fifteen years had shown cancer developing in the cervical stump. It must be known that such rates mirrored the broad population rates in countries that fail to have adept cervical screening programs. No data is available regarding the risk of contracting cervical stump cancer in those women that were correctly diagnosed, but it is assumed to be negligibly low. Hence, the justification for cervical removal to avert cancer does not hold true in a populace wherein there are appropriate scanning procedures.

Following a STH, many women may still continue to experience cyclical or erratic vaginal blood loss. This was noticed in nearly 11.4% of such women who underwent the procedure, of whom 7% needed further surgery to reduce the symptoms.

When surgery was performed to treat endometriosis or pelvic pain, nearly one in four women would have enduring symptoms if STH is performed. This finding could reflect the early on experience with laparoscopic surgery with a prospect of improper removal of corpus.

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