Total abdominal hysterectomy: a randomized study comparing two techniques

Background: Abdominal hysterectomy is the most frequent operation performed by gynecologists. The most commonly used techniques are intrafascial, extr afascial and supracervical hysterectomy; in our department we mainly use th e first method. A variant of this technique, because during the operation w e use only an Allis clamp, simplifies the operation and maintains certain a natomical relationships between neighbouring pelvic structures. Methods: To compare two different surgical techniques between 1/1/1991 and 31/12/95, 2 62 women were randomized pre-operatively: 133 by the intrafascial technique of Richardson and 129 by the variant hysterectomy technique. The differenc e between the two techniques (Richardson versus variant hysterectomy techni que), as performed in our department, was investigated regarding the clampi ng of uterine vessels, the resection of uterosacral and cardinal ligament. The two-tailed student test was used for continuous data and chi(2) analysi s for discrete data. Results: Less blood loss occurred in the variant than in the Richardson group (P<0.01) and no intrasurgical complications occurre d as compared to one case of ureter lesion in the Richardson group. There w ere no differences in the number of days of hospitalization. No particular post-surgical complications occurred in the follow-up period, which has now elapsed. After 36 months of follow-up the variant group showed a reduced i ncidence (not significant) of vaginal vault prolapse. The patients who unde rwent the variant hysterectomy technique reported better compliance with re gard to sexual intercourse and urinary function than the Richardson group. Conclusion: We conclude that the variant hysterectomy technique is as valid as the Richardson technique, giving the surgeon the possibility of maintai ning certain anatomical relationships between neighbouring pelvic structure s. It also has minor delayed complications. (C) 1999 Published by Elsevier Science Ireland Ltd. All rights reserved.