Total or subtotal hysterectomy for benign uterine diseases? A meta-analysis

Background. Total and subtotal abdominal hysterectomy for benign indications have been compared in randomized clinical trials and observational studies. A meta-analysis is performed to summarize the evidence. Methods. Thirty-four randomized clinical trials and observational studies comparing total and subtotal abdominal hysterectomy for benign indications were included. Endpoints were self-reported urinary incontinence, postoperative complications, operation time, quality of life, constipation, prolapse, sexual functioning, pelvic pain, and cervical stump problems after subtotal hysterectomy. Odds ratios and tests for heterogeneity and overall effect were calculated. Results. Urinary incontinence and prolapse showed a significant difference favoring the total hysterectomy. Some of the women having a subtotal hysterectomy had cervical stump problems (bleeding and abnormal smear). Operation time and peroperative bleeding are postoperative complications were significantly in favor of the subtotal hysterectomy. Lower urinary tract symptoms other than incontinence, quality of life, constipation, pelvic pain, and sexual life were not in favor of either of the hysterectomy methods. Conclusion. Less women suffered from urinary incontinence and prolapse and cervical stump problems after total than after subtotal hysterectomy. However, subtotal hysterectomy is faster to perform, has less peroperative bleeding, and seems to have less intra- and postoperative complications.