Surgery

Hysterectomy

Hysterectomy, Transabdominal Hysterectomy, Laparoscopic Assisted Vaginal Hysterectomy, Vaginal Hysterectomy

Annual Incidence: 600,000
1. 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

Transabdominal Hysterectomy
1. Lowest quality of life scores
2. Highest hospitalization and postoperative costs
3. Twice the risk of Postoperative Fever
4. Significantly increased blood loss
5. Prophylactic Antibiotics are recommended
6. Peipert (2004) Obstet Gynecol 103:86-91 [PubMed]
Laparoscopic Assisted Vaginal Hysterectomy
1. Same life quality as Vaginal Hysterectomy at 28 days
Vaginal Hysterectomy
1. Fastest return to normal activities
2. Highest quality of life scores
3. Lowest hospitalization and postoperative costs

Mortality: 6 per 10,000 operations
Urinary Incontinence (increases risk by 40-80%)
Does not adversely effect sexual function
1. Sexual well-being improves after Hysterectomy
2. Roovers (2003) BMJ 327:774-8 [PubMed]

Benefits
1. Ovarian Cancer significantly reduced
  1. Note Hysterectomy alone also reduces risk by 35%
2. Breast Cancer risk is reduced by 50%
Risks (if oophorectomy performed before age 45)
1. Overall mortality increases
2. Osteoporosis risk increases
3. Cardiovascular disease risk increases
4. Dementia risk increases
References