Myth about Cervical Stump after Supracervical Hysterectomy
Tuesday - January 3, 2017 5:11 am
Many gynecologists favor to perform supracervical hysterectomy instead of total hysterectomy when performed for benign conditions. Arguments used in favor of such recommendation are that it entails less operating time, less blood loss and faster patient’s postoperative recovery. Other arguments are that preserving the cervix has positive impact on the sexual life of the patient as well as better support of the pelvic floor and urinary function.
These last arguments seem not to be supported by solid research evidence. There are in fact several problems that may arise related to preserving the cervical stump after performing a subtotal hysterectomy. These complications include cervical stump prolapse, chronic pelvic pain, the development of cervical or endometrial carcinoma, necrosis of the stump and cyclic recurrent vaginal bleeding.
In regards to cyclic bleeding, its incidence varies between different studies between 0% and 25%, the bleeding is due to the presence of an excessive amount of residual endometrium at the level of the cervical stump. Although electrocoagulation of the cervical canal is routinely done at the time of a supracervical hysterectomy, it has not been shown that this practice significantly reduces the incidence of persistent cyclical bleeding.
The recommended treatment for this condition is to perform a Trachelectomy, usually with a vaginal approach, but also it can also be performed abdominally or laparoscopically. The vaginal route is associated with a low complication rate, being urinary tract injuries the most common complication. Hysteroscopy can be useful both in locating and in treating the residual endometrial tissue. There are papers published on fulguration of the endometrial-endocervical tissue with bipolar electrode system Versapoint and Spring (Pontrelli et al, 2007) as well as with the use of a miniresector of 22FR and cutting loop (Alonso et al, 2012).
In both cases amenorrhea was immediately achieved from the time of the intervention. Hysteroscopy should be considered as a valid minimally invasive alternative for the treatment of continuous cyclic bleeding related to cervical stump after supracervical hysterectomy.