Systematic review of the limited evidence for different surgical techniques at benign hysterectomy: A clinical guideline initiated by the Danish Health Authority

Sloth, Sigurd Beier; Schroll, Jeppe Bennekou; Settnes, Annette; Gimbel, Helga; Rudnicki, Martin; Topsoee, Märta Fink; Joergensen, Annemette; Nortvig, Helene; Moeller, Charlotte

doi:10.1016/j.ejogrb.2017.07.012

Cited by 19 publications

(23 citation statements)

References 41 publications

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“…25 In 2015 the Danish Health Authority recommended the use of contained morcellation in endobags. 20 Future data might answer whether the implementation of contained morcellation will influence the superiority of LH compared with VHnp in Denmark. 26…”

Section: Discussionmentioning

confidence: 99%

“…They funded the work for further evidence-based knowledge for national recommendations regarding hysterectomy. 20 The Danish Clinical Registers funded the database as well as the annual national audit meetings and reports. 15 We have no patients in the database.…”

Section: Methodsmentioning

confidence: 99%

“…15 In 2004 we established the hysterectomy database, prospectively registering patient-related factors and all postoperative complications with 100% follow-up in the National Patient Register (NPR). [19][20][21] The aim of this national population-based study was to compare the overall complications within 30 days of benign elective hysterectomy, according to the procedures used and calendar periods, controlled for patient-related confounding factors. A complete cohort of all benign hysterectomies, including more than 50 000 patients, allows for a comparison of complications of hysterectomy performed by local experts in daily practice.…”

Section: Introductionmentioning

confidence: 99%

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Complications after benign hysterectomy, according to procedure: a population‐based prospective cohort study from the Danish hysterectomy database, 2004–2015

Settnes

Moeller

Topsoee

et al. 2020

BJOG

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Objective To compare the risk of complications associated with benign hysterectomy according to surgical procedure. Design Register‐based prospective cohort study. Setting Danish Hysterectomy Database, 2004–2015. Population All Danish women with benign elective hysterectomy (n = 51 141). Methods Multivariate log‐binomial regression to compute relative risks (RRs) stratified by calendar period, and adjusted for age, height, weight, smoking habits, use of alcohol, comorbidity, indications, uterine weight and adhesions. Multiple imputation and ‘intention to treat’ analyses were performed. Main outcome measures Major (grades III–V) and minor (grades I–II) Clavien–Dindo modified complications within 30 days. Results Overall, major complications occurred in 3577 (7.0%) hysterectomies and minor complications occurred in 4788 (9.4%). The proportions of major and minor complications according to type of hysterectomy were: 10.3 and 9.6% for abdominal hysterectomy (AH); 4.1 and 12.1% for laparoscopic hysterectomy (LH); and 4.9 and 8.0% for vaginal hysterectomy (VH) for non‐prolapse, and 2.3 and 6.4% for prolapse. In multivariate analyses, compared with VH for non‐prolapse, the risk of major complications was higher for AH (RR 1.82, 95% CI 1.63–2.03) but lower for both LH (RR 0.78, 95% CI 0.68–0.90) and VH for prolapse (RR 0.55; 95% CI 0.41–0.75). For LH, the risk of major complications reduced from a RR of 0.96 (95% CI 0.75–1.22) in the time period 2004–2009 to an RR of 0.72 (95% CI 0.60–0.87) between 2010 and 2015. Conclusion Laparoscopic hysterectomy and VH for uterine prolapse are associated with fewer major complications, and AH is associated with more major complications, compared with VH performed in the absence of uterine prolapse. Tweetable abstract Laparoscopic hysterectomy has fewer major complications compared with vaginal hysterectomy, in the absence of uterine prolapse.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Complications after benign hysterectomy, according to procedure: a population‐based prospective cohort study from the Danish hysterectomy database, 2004–2015

Settnes

Moeller

Topsoee

et al. 2020

BJOG

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show abstract

“…This leads to the movement of the ureter out of the operative field, thereby protecting the ureter from possible injury. One recent study evaluating different guideline protocols proposed that the possibility of pelvic prolapse after hysterectomy may decrease by the suspension of the vaginal vault to the cardinal and uterosacral ligaments [ 22 ]. Another important surgical consideration is the prediction of the uterine anatomy based on the cervical position, which is an important consideration for several gynecological procedures.…”

Section: Reviewmentioning

confidence: 99%

Comprehensive Review of the Cardinal Ligament

Eid

Iwanaga

Oskouian

et al. 2018

Cureus

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The cardinal ligament is thought to be one of the important structures in providing support and stabilization for the pelvic organs e.g., the uterus. However, many discrepancies exist in the literature regarding terminology, anatomy, and histology. The cardinal ligament attaches the lateral side of the vagina and cervix to the lateral pelvic wall, which provides support to the vagina and cervix. Studies have shown variable findings in the collagen content and distribution in the cardinal ligaments of women with a prolapsed uterus. Uterine vessels and the branches of the inferior hypogastric plexus travel in the cardinal ligament, which is of great importance during pelvic surgeries. Cervical cancer may lead to metastatic spread to the lymph nodes juxtaposed to the cardinal ligaments. This review aims to highlight the clinical significance and surgical importance of the cardinal ligament with a comparison with previous studies.

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“…The question of whether to perform total or subtotal hysterectomy in benign cases is still controversial. Recently, the Danish Health Authority supported a national evaluation on the subject, with the purpose of establishing a clinical guideline. The literature was reviewed by a group of specialists who rated the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE).…”

mentioning

confidence: 99%