Persistence of Symptoms After Total vs Supracervical Hysterectomy in Women with Histopathological Diagnosis of Adenomyosis

Ajao MO, Mobolaji O. Ajao, Oliveira Brito LG, Luiz Gustavo Oliveira Brito, Luiz G Oliveira Brito, Karen C. Wang, Wang KC, Cox MKB, Mary K B Cox, Mary Cox, Elsemieke Meurs, Elsemieke A.I.M. Meurs, Emily R. Goggins, Goggins ER, Xiangmei Gu, Gu X, Allison F. Vitonis, Vitonis AF, Jon I. Einarsson, Einarsson JI, Sarah L. Cohen, Cohen SL
Journal of Minimally Invasive Gynecology · 2018 · vol. 26(5) , pp. 891–896 · doi:10.1016/j.jmig.2018.09.002 · PMID:30205164 · W2892361083
article OA: closed CC0 ⤵ 15 in-corpus citations
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This study compared symptom persistence between women undergoing total hysterectomy versus supracervical hysterectomy for adenomyosis.

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Abstract

Study objectiveTo compare symptom persistence in women with adenomyosis based on retention or removal of the cervix at the time of hysterectomy.DesignRetrospective cohort study and follow-up survey (Canadian Task Force classification xx).SettingTertiary care academic hospital in Boston, Massachusetts.PatientsWomen (n = 1580) who underwent laparoscopic hysterectomy for benign indications between 2008 and 2012 at Brigham and Women's Faulkner Hospital and Brigham and Women's Hospital.InterventionRetrospective chart review and follow-up survey.Measurements and main resultsAmong the 1580 women contacted, 762 (48%) responded to the postoperative symptom resolution survey. Of these 762 women, 623 agreed to participate in the study. Menopausal women or those who had undergone bilateral salpingo-oophorectomy were excluded. Adenomyosis was identified on histopathologic evaluation of the uterus in 171 of the remaining 443 women (39%). Compared with women without adenomyosis, those with adenomyosis were older on average (mean age, 46.6 ± 6.8 years vs 45.0 ± 5.5 years; p = .009) and more likely to report that abnormal bleeding and pain led to their hysterectomy (87.7% vs 79.8%; p = .03 and 64.9% vs 51.4%; p = .009, respectively). The rates of total and supracervical hysterectomies were similar in the 2 groups. Following surgery, women with adenomyosis were less likely than those without adenomyosis to report persistent pain (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.20-0.93; p = .03). Persistent bleeding was similar in the 2 groups (aOR, 0.97; 95% CI, 0.49-1.93; p = .94). Among women with adenomyosis, multivariable logistic regression showed no difference in persistence of symptoms with cervical removal or retention at the time of hysterectomy.ConclusionCompared with women without adenomyosis, those with histopathologically proven adenomyosis were less likely to report persistent pain following hysterectomy. Retention of the cervix does not appear to increase the risk of symptom persistence or postprocedure patient satisfaction.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Cervix Uteri Hysterectomy Hysterectomy Laparoscopy Laparoscopy Adenomyosis Adult Boston Cervix Uteri Female Humans Hysterectomy Laparoscopy Middle Aged Patient Satisfaction Retrospective Studies Surveys and Questionnaires Symptom Assessment Treatment Outcome

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