Total Versus Subtotal Hysterectomy for Benign Uterine Disease: Which Advantages

Abstract BACKGROUND: to evaluate the impact of total vs subtotal hysterectomy on vaginal bleeding and intestinal, sexual and bladder disfunction.METHODS: observational study conducted on women who underwent hysterectomy for benign uterine disease at S. Andrea university hospital in Rome between July 2013 and December 2017.We selected 236 women that underwent hysterectomy for benign disease to submit a validated questionnaire during the follow up evaluation at 12 months from the surgery. One hundred and sixty-two accepted to answer (84 subtotal hysterectomy, 78 total hysterectomy).RESULTS: Twenty-one percent (n=18) of subtotal hysterectomy (SAH) and eight percent (n=6) of total(TAH) showed vaginal bleeding (p=0,015). The difference was not statistically significant for pelvic pain,nausea, alvus changes and urinary incontinence.Thirteen percent (n=10) of women subjected to subtotal hysterectomy and twenty-nine percent (n=21) ofthe totals has declared to experience pain during sexual intercourse (p=0,0159). Thirty-one percent(n=22) of TAH noted a deterioration in the quality of sex intercourses (p=0.026).Concomitant bilateral salpingo-ovariectomy, compared to salpingectomy alone, resulted in an increase in sexual dysfunction for all the analyzed outcomes with a statistically significant difference in the group of total hysterectomies (perception of pain during intercourse [p=0,029], worse quality [p=0,015] and alteredvaginal length [p=0,003]).CONCLUSION: SAH is superior to TAH in terms of sexual function but is related to more vaginalbleeding. There are no differences between the groups regarding bowel and bladder function and thedevelopment of other symptoms after surgery. For these reasons the type of surgery should be decided bythe patient after accurate medical counselling, minimizing, the incidence of salpingo-ovariectomy associatedwith hysterectomy.