Long term outcome following laparoscopic supracervical hysterectomy

Objectives To assess the long term outcome of laparoscopic supracervical hysterectomy.

Design Retrospective study.

Setting Minimal Access Surgical Unit, Department of Gynaecology, Royal Surrey County Hospital, Surrey.

Methods Analysis of patient case records.

Population Seventy consecutive women who had a laparoscopic supracervical hysterectomy.

Outcome measures Symptoms related to the cervical stump and the need for further surgery.

Results The mean time of patient follow up was 66 months (range 52–84). The mean time from initial procedure to second treatment was 14 months (range 3–53). Seventeen women (24.3%) reported symptoms related to the cervical stump, and all required further surgery. The cervical stump was removed in 16 (22.8%). One patient had laparoscopic adhesiolysis only and two had a laparotomy and trachelectomy because the bowel was adherent to the cervical stump. Nine had a laparoscopically assisted cervical trachelectomy as the sole procedure. Five had laser treatment to endometriotic deposits, and laparoscopically assisted cervical trachelectomy. Histological analysis showed normal cervical tissue in six (35.3%). Endometriosis was detected in four cervical stumps (23.5 %), residual endometrium in another four (23.5 %) cases, and chronic cervicitis, mild CIN and a mucocoele in a further three patients. Of the 17 women who reported cervical stump symptoms, 14 (82.3%) had been treated for endometriosis in the past, compared with 17/53 (32%) who did not have symptoms (P<0.0002, χ² test).

Conclusions Symptoms related to the cervical stump requiring further surgery frequently occur following a laparoscopic supracervical hysterectomy.