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

There has been a rising trend of sway towards the subtotal or supracervical hysterectomy (STH) approach noticed especially in the certain European countries.

The cervix retaining or sparing approach is beyond doubt, deemed technically uncomplicated and safer surgery in comparison to the total abdominal hysterectomy (TAH). The reason being this approach averts the requirement to dissect through the vastly vascular para-vaginal cuff in close quarters to the ureter. The procedure is entirely an intra-peritoneal one and evades contact between the potentially contaminated vagina and abdominal cavity. There have been persistent suggestions that there direct outcomes of the approach are related with the clinical advantages.

A latest review has suggested that has been a greater inclination towards a cutback in surgical time, blood loss and post-operative febrile morbidity found in those women who underwent STH procedure. On the other hand, there were no marked disparities in grave morbidity rates or re-admissions subsequent to undergoing either STH or TAH procedures.

The other suggested reasoning towards retaining the cervix is better sexual, bowel and bladder function. Hysterectomy is known to disturb nerve plexuses and anatomical relations in the pelvic region. This has the likelihood to have an effect on the functioning of the pelvic organs comprising of the urinary bladder, bowel and the pelvic floor.

An assessment suggestive of the fact that the STH procedure improves sexual function garnered significant media awareness in the West. But, this assertion failed to brace the intransigence of larger and superior-conducted randomised tests. Also, noted was that there was no variation in bowel or bladder function following either STH or TAH procedure.

Finally, the conclusions drawn were that the benefits of the STH approach to hysterectomy are restricted to the peri-operative phase. Possible advantages like a swifter post-operative recuperation and enhanced short term quality of life, particularly with the laparoscopic STH, must be verified by adeptly sized randomised tests.

On the other hand, there are no long-term benefits of retaining the cervix and post hysterectomy cervical cancer examination on regular intervals is compulsory. The perils of vaginal blood loss and recurrent symptoms are not counteracted by enhancements in pelvic organ or pelvic floor function. In such scenarios, there seems to be the strong bearing for TAH remaining the default hysterectomy in certain third world or underdeveloped countries where opportunities for cervical screening are inadequate.

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