Abdominal hysterectomy for benign indications: evidence-based guidance for surgical decisions

Abstract

The purpose of this review is to provide evidence-based guidance for surgical decisions during abdominal hysterectomy performed for benign indications. Using combinations of terms "abdominal," "hysterectomy," and "randomized clinical trials (RCT)," we performed Ovid, PubMed, and Cochrane searches for publications between 1988 and 2008. After reviewing over 3,000 abstracts, 19 RCT were identified. There are no grade A recommendations. The only grade B suggestion is use of a bipolar vessel sealing device (LigaSure) for vascular pedicles rather than sutures. Routine closure of peritoneum should be avoided. Evidence behind 71 % (15/21) of surgical steps is insufficient (grade I). Despite its common performance, there are no grade A recommendations that can be made for the technical aspects of abdominal hysterectomy. Since almost 70 % of the surgical steps during abdominal hysterectomy lack randomized clinical trials, adequately designed studies are needed to decrease perioperative morbidity.

A comparison of closed and open vaginal vault closure during abdominal hysterectomy

“…5 An open vaginal vault may provide drainage and potentially prevents infective morbidity. 7 In our institution, the technique of abdominal hysterectomy was the same except for vaginal vault closure, closed by suturing the anterior and posterior edges or leaving a tract of about 1.5 cm open in the center. Extra-peritoneal drainage without a drain was the purpose of the open method.…”