Removing the cervix at hysterectomy: an unnecessary intervention?

OBJECTIVE : To evaluate the long-term outcomes in women who underwent total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (sub-TAH). METHODS : Two hundred seventy-nine women between 7 and 11 years (mean 9 years) of follow-up who participated in a previously published randomized, double-blind, multicenter trial comparing TAH and sub-TAH were invited to complete questionnaires used in the previous study to assess quality of life and pelvic organ function. RESULTS : Sixty-five percent of the women (90 TAH and 91 sub-TAH) completed the study. There were no significant differences in quality of life, mental health, and pelvic organ function between TAH and sub-TAH. Urinary and bowel function variables did not change significantly over time, but significant decreases were found in a range of sexual function parameters, pain, and role limitations due to emotional problems in both the groups. CONCLUSION : There were no long-term differences in outcomes between TAH and sub-TAH. The lack of a detrimental effect on bowel and urinary function seen at 12 months was maintained. The deterioration in sexual function is likely to be due to the climacteric. CLINICAL TRIAL REGISTRATION : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00750035 LEVEL OF EVIDENCE : I.