Supracervical versus total hysterectomy in women undergoing hysterectomy for benign gynaecological disease - a new danish recommendation

TY - ABST

T1 - Supracervical versus total hysterectomy in women undergoing hysterectomy for benign gynaecological disease - a new danish recommendation

AU - Sloth, Sigurd Beier

AU - Jørgensen, Annemette

AU - Schroll, Jeppe Bennekou

AU - Nortvig, Helene

AU - Møller, Charlotte

N1 - Conference code: 24

PY - 2015/10/8

Y1 - 2015/10/8

N2 - Background In May 2015 we published a national clinical guideline on hysterectomy for benign gynaecological conditions in cooperation with the Danish Health and Medicines Authority. One of nine investigated areas of interest was whether to perform total or supracervical hysterectomy in women undergoing hysterectomy for benign gynaecological disease. Methods A guideline panel of gynaecologists predefined critical and important outcomes for the assessment. The critical outcomes were defined as reoperation, urinary incontinence, sexual function, pelvic organ prolapse and cervical dysplasia. The important outcomes were defined as quality of life, cyclic vaginal bleeding, operating time, intraoperative bleeding and post-operative infections. A search specialist conducted a systematic literature search for publications from 2004 to 2014 in English, Danish, Norwegian and Swedish. In our first search we looked for existing guidelines in the Guidelines International Network, the National Institute for Health and Care Excellence, the National Guideline Clearinghouse, the Scottish Intercollegiate Guidelines Network, the Health Technology Assessment Database, the Cochrane Library, MEDLINE, EMBASE, CINAHL and Danish, Swedish and Norwegian national directorates of health and societies for gynaecology and obstetrics. In our second and third search we looked for systematic reviews and primary literature in MEDLINE and EMBASE. Two independent experts screened the search results. The guideline panel reviewed the literature. A methodologist performed a metaanalysis based on the available evidence. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results The literature search produced 269 hits for existing guidelines, 407 hits for systematic literature and 44 hits for primary literature. One systematic review (n = 1553) and one randomized controlled trial (RCT, n = 200) met the inclusion criteria. The quality of evidence for the critical outcomes was rated low to very low and for the important outcomes low to moderate. Evidence showed no differences in the critical outcomes. For the important outcomes evidence from 5 RCTs (n = 964) showed a higher risk of cyclic vaginal bleeding (RR 14.28 95% CI 5.51 to 36.98) after supracervical hysterectomy compared to total hysterectomy. Supracervical hysterectomy was associated with a shorter operating time and less intraoperative bleeding. Conclusions The overall quality of evidence was very low. The panel assesses that most women want to avoid cyclic vaginal bleeding after hysterectomy. Women with indications for hormone replacement therapy (HRT) that experience cyclic vaginal bleeding after supracervical hysterectomy should be treated with combined HRT. The panel assesses that the small differences in operating time and intraoperative bleeding are without clinical importance. Based on the available evidence, the balance between benefits and harms and patient values and preferences, the guideline panel gave a weak recommendation against supracervical hysterectomy in women undergoing hysterectomy for benign gynaecological disease.

AB - Background In May 2015 we published a national clinical guideline on hysterectomy for benign gynaecological conditions in cooperation with the Danish Health and Medicines Authority. One of nine investigated areas of interest was whether to perform total or supracervical hysterectomy in women undergoing hysterectomy for benign gynaecological disease. Methods A guideline panel of gynaecologists predefined critical and important outcomes for the assessment. The critical outcomes were defined as reoperation, urinary incontinence, sexual function, pelvic organ prolapse and cervical dysplasia. The important outcomes were defined as quality of life, cyclic vaginal bleeding, operating time, intraoperative bleeding and post-operative infections. A search specialist conducted a systematic literature search for publications from 2004 to 2014 in English, Danish, Norwegian and Swedish. In our first search we looked for existing guidelines in the Guidelines International Network, the National Institute for Health and Care Excellence, the National Guideline Clearinghouse, the Scottish Intercollegiate Guidelines Network, the Health Technology Assessment Database, the Cochrane Library, MEDLINE, EMBASE, CINAHL and Danish, Swedish and Norwegian national directorates of health and societies for gynaecology and obstetrics. In our second and third search we looked for systematic reviews and primary literature in MEDLINE and EMBASE. Two independent experts screened the search results. The guideline panel reviewed the literature. A methodologist performed a metaanalysis based on the available evidence. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results The literature search produced 269 hits for existing guidelines, 407 hits for systematic literature and 44 hits for primary literature. One systematic review (n = 1553) and one randomized controlled trial (RCT, n = 200) met the inclusion criteria. The quality of evidence for the critical outcomes was rated low to very low and for the important outcomes low to moderate. Evidence showed no differences in the critical outcomes. For the important outcomes evidence from 5 RCTs (n = 964) showed a higher risk of cyclic vaginal bleeding (RR 14.28 95% CI 5.51 to 36.98) after supracervical hysterectomy compared to total hysterectomy. Supracervical hysterectomy was associated with a shorter operating time and less intraoperative bleeding. Conclusions The overall quality of evidence was very low. The panel assesses that most women want to avoid cyclic vaginal bleeding after hysterectomy. Women with indications for hormone replacement therapy (HRT) that experience cyclic vaginal bleeding after supracervical hysterectomy should be treated with combined HRT. The panel assesses that the small differences in operating time and intraoperative bleeding are without clinical importance. Based on the available evidence, the balance between benefits and harms and patient values and preferences, the guideline panel gave a weak recommendation against supracervical hysterectomy in women undergoing hysterectomy for benign gynaecological disease.

U2 - 10.1007/s10397-015-0918-0

DO - 10.1007/s10397-015-0918-0

M3 - Konferenceabstrakt til konference

T2 - ESGE European society Gynecologic Endoscopy

Y2 - 6 October 2015 through 10 October 2015

ER -