Total versus subtotal hysterectomy for benign gynaecological conditions

Anne Lethaby; Asima Mukhopadhyay; Raj Naik

doi:10.1002/14651858.CD004993.pub3

Histerectomía total versus subtotal para enfermedades ginecológicas benignas

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Referencias

Referencias de los estudios incluidos en esta revisión

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estudios a la espera de valoración
otras referencias

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Referencias de los estudios excluidos de esta revisión

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Einarsson JT, Suzuki Y, Vellinga T, Jonsdottir GM, Yoshida H, Walsh B. Prospective comparison of postoperative quality of life following total laparoscopic hysterectomy versus laparoscopic supracervical hysterectomy. Gynecological Surgery (Conference abstract ‐ 19th Annual Congress of the European Society for Gynaecological Endoscopy) 2010;7, supplement 1:S72.

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Referencias de los estudios en espera de evaluación

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Asgari Z, Aiaty F, Samiei H. Total versus subtotal laparoscopic hysterectomy: a comparative study in Arash Hospital. Tehran University Medical Journal 2009;67(6):393‐8.

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Referencias adicionales

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Asnafi 2010

Methods	Randomisation method: Not reported No. of centres: 1 Design: Parallel group Blinding: Not reported but unlikely No. randomised: 150 No. analysed: 150 Power calculation: Yes (150 overall to detect a 20% difference between the groups with 80% power, alpha level of 0.95 and confidence level of 95%) Intention‐to‐treat analysis: Yes, except for sexual functioning/dyspareunia ‐ analyses performed only in women who were sexually active or complained of dyspareunia Source of funding: Babol Medical University, Iran
Participants	Inclusion: Women >35 years; premenopausal; offered abdominal hysterectomy for symptomatic uterine fibroids with confirmation of the lesion or abnormal uterine bleeding without any response to hormone therapy of at least 3 months trial. Exclusion: Age >50 years at screening; positive pregnancy test; genital tract carcinoma; body weight >100kg; diabetes mellitus; candidates for vaginal hysterectomy determined by a gynecologist; unlikely to remain geographically accessible for follow up. Age: 43 and 46 years (mean in each treatment group) Source: From Department of Gynecology in a teaching hospital associated with Babol Medical University in Iran
Interventions	(1) subtotal abdominal hysterectomy (2) total abdominal hysterectomy Follow up: 6 months after surgery
Outcomes	Fever; anaemia; duration of hospitalisation, changes in sexual function
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Stated as "randomly assigned"
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding (performance bias and detection bias) All outcomes	High risk	Lack of blinding could have affected outcomes such as sexual functioning and pain
Incomplete outcome data (attrition bias) All outcomes	Low risk	No reported dropouts
Selective reporting (reporting bias)	Low risk	All prespecified outcomes reported
Other bias	Unclear risk	Sexual functioning assessed only in subgroups of women ‐ unclear if these subgroups groups were comparable at baseline. Short follow up for assessment of sexual functioning

Ellstrom 2010

Methods	Randomisation method: Method not described, other than allocation from sealed opaque envelopes No. of centres: 1 Design: Parallel group Blinding: No No. randomised: 132 No. analysed: 104 Exclusions from analysis: Subtotal: declined surgery or operated elsewhere (n=2); salphingoophorectomy (n=2); lost to follow up (n=10) Total: declined surgery or operated elsewhere (n=5); malignancy diagnosed perioperatively (n=1); lost to follow up (n=10) Protocol violations: Subtotal: Change of method due to surgical complications (n=2) Total: n=0 Power calculation: Yes (50‐70 patients per treatment arm required, no other details reported) Intention to treat analysis: Stated as yes, but not true ITT analysis as lost to follow up not included Source of funding: Swedish Medical Research Council (B95‐17X‐11237‐01A) and the Goteborg Medical Society Fund
Participants	Inclusion: Pre‐menopausal patients scheduled for hysterectomy for benign disorders Exclusion: Previous cervical dysplasia; planned oophorectomy; previous symptomatic prolapse Age: 45 years (mean) Source: Patients requiring hysterectomy for benign disorders at the Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
Interventions	(1) subtotal hysterectomy (2) total hysterectomy For both treatment groups, abdominal hysterectomy was recommended when the diameter of the uterus was >11cm, otherwise vaginal or laparoscopic surgery was planned but the final decision was made by the surgeon. Follow up: 12 months after surgery
Outcomes	Changes in sexual health (measured by the McCoy Female Sexuality Questionnaire) and changes in psychological wellbeing (measured by the Psychological General Well‐being index)
Notes	Lack of power
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Randomised in a ratio of 1:1" but method not described
Allocation concealment (selection bias)	Low risk	Sealed opaque envelopes; performed by a study nurse
Blinding (performance bias and detection bias) All outcomes	High risk	Blinding of participants was originally planned but proved impossible. Knowledge of treatment could have affected patients' perceptions of sexual function and health
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	>20% attrition in each group
Selective reporting (reporting bias)	Low risk	All prespecified outcomes reported
Other bias	Unclear risk	No adjustments made for multiple outcomes

Flory 2006

Methods	Randomisation method: Computer generated block randomisation No. of centres: 1 Design: Parallel group Blinding: No No. randomised: 80 No. analysed: 63 Dropout at the end of follow up: 9/40 in subtotal group (2 after randomisation; 2 moved/wrong phone; 3 not interested; 4 other reasons); 8/40 in total group (1 after randomisation; 3 moved/wrong phone; 2 not interested; 3 other reasons) Power calculation: Yes (32 per treatment arm for moderate effect size (difference of 0.5 SD) gave 80% power, with alpha=0.05) Intention‐to‐treat analysis: No Source of funding: Canadian Foundation for Womens Health Institute of Health Research
Participants	Inclusion: 18‐55 years old; pre‐menopausal; fluent in French language Exclusion: Prior oophorectomy; prior uterine prolapse; prior chemotherapy; prior neoplasia in the uterus/cervix Age: 44 years (mean) Source: From surgeons/gynaecologists and local media announcement, study undertaken at Department of Obstetrics and Gynecology, University of Montreal
Interventions	(1) subtotal laparoscopic hysterectomy (2) total laparoscopic assisted vaginal hysterectomy Follow up: 6 ‐ 7 months after surgery
Outcomes	Sexual drive; sexual arousal; orgasm; sexual behaviour; overall sexual functioning; pain (Likert scale and MPQ); depression and other psychological symptoms (BDI and BSI); body image (SSS and BES); psychosocial functioning
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated block randomisation
Allocation concealment (selection bias)	Low risk	Treatment assignment concealed in consecutively numbered sealed envelopes, opened by surgeons at the time of surgery
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	>20% dropout but balanced between groups
Selective reporting (reporting bias)	Low risk	All prespecified outcomes reported
Other bias	Unclear risk	Groups not balanced at baseline (87% of women in subtotal group and 66% of women in total group had fibroids)

Gimbel 2003

Methods	Randomisation method: Restricted, computer generated block randomisation No of centres: 11 Design: parallel group Blinding: No No. randomised: 319 No. analysed: 277 Dropout at end of follow up: 15% in subtotal group; 11% in total group Power calculation: yes Intention to treat analysis: Authors claimed both 'regular' ITT and per protocol analysis but 13% of randomised participants excluded from analysis Source of funding: Numerous trial groups/organisations and hospitals
Participants	Inclusion: Women who are scheduled for hysterectomy for benign disease Exclusion: Laparoscopic/vaginal hysterectomy; dysplasia (cervical); uterine prolapse; malignant disease; diabetes; participation in other research projects; unable to read/write Danish; former urological operation; cervix problems; psychological problems; poor mental function; neurological disease; chronic alcoholism. Age: 47 years (mean) Source: Departments of Obstetrics and Gynaecology in Denmark
Interventions	(1) subtotal hysterectomy (2) total abdominal hysterectomy Follow up 1 year
Outcomes	Primary: Perceived urinary incontinence Secondary: Quality of life (SF36); constipation; prolapse; satisfaction with sexual life; pelvic pain; vaginal bleeding; postoperative complications; dyspareunia
Notes	A later publication compared the effects of interventions on sexual function (Zobbe 2003) and another later publication (Gimbel 2005) compared the effects of the interventions on a more detailed specification or urinary symptoms (stress, urge and mixed incontinence and incomplete bladder emptying)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated randomisation procedure
Allocation concealment (selection bias)	Low risk	Central allocation
Blinding (performance bias and detection bias) All outcomes	High risk	Authors acknowledged the "lack of blinding"
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	>10% lost to follow up ‐ no reasons given
Selective reporting (reporting bias)	Low risk	All prespecified outcomes reported
Other bias	Low risk	Multiple sources of funding including Organon but unlikely bias because of independent data monitoring. No baseline imbalance between groups.

Gorlero 2008

Methods	Randomisation method: computer generated numbers Number of centres: 1 Design: parallel group No. randomised: 117 No. analysed: 105 Dropout at end of follow up: 12/117 (10.3%) ‐ reasons not given Power calculation: no Intention to treat analysis: no Source of funding: not stated
Participants	Inclusion: Women requiring an abdominal hysterectomy for a benign indication Exclusion: 2nd or 3rd degree uterine prolapse; age >75 years; malignancy; BMI>29; previous pelvic surgery; endometriosis or history of chronic pelvic pain; abnormal cervical smears; psychiatric disorders Age: subtotal hyst (mean 46 years); total hyst (mean 49 years) Source: Department of San Martino Hospital and University of Genoa in Genoa, Italy (Jan 2003 to December 2005)
Interventions	(1) subtotal hysterectomy (2) total hysterectomy Follow up: 1 year
Outcomes	Primary: Womens' satisfaction (evaluated by answers to a questionnaire on sexual activity, body image and health status) Secondary: Occurrence of surgical complications; postoperative recovery
Notes	Study measures 'satisfaction' by women's responses to questions on sexual activity, body image and quality of life
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated numbers
Allocation concealment (selection bias)	Low risk	Sealed opaque envelopes opened immediately before surgical incision
Blinding (performance bias and detection bias) All outcomes	High risk	Stated as not blinded
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No reasons given for incomplete data and no information on distribution between groups
Selective reporting (reporting bias)	Low risk	All prespecified outcomes reported
Other bias	Low risk	Groups comparable at baseline and no other potential bias identified

Learman 2003

Methods	Randomisation method: Computer generated random numbers sequence in blocks with sealed numbered opaque envelopes Number of centres: 4 Design: parallel group No randomised: 135 No analysed: 135 Drop out at end of follow up: 10% for subtotal hyst and 4% for total hyst Power calculation: yes Intention to treat analysis: Yes (for some outcomes) Source of funding: AHRQ Stratified by clinical centre
Participants	Inclusion: Pre‐menopausal women with symptomatic fibroids who have decided to undergo abdominal hysterectomy OR pre‐menopausal women who have abnormal bleeding and a minimum 3 month trial of hormonal management who want hysterectomy; if >/= 45 yrs, FSH </= 30 mIU/mL and negative biopsy within 6 months for hyperplasia/cancer Exclusion: Age >50 years; positive pregnancy test; desire for future childbearing; genital tract cancer (known or suspected); cervical dysplasia or carcinoma in situ; complex or atypical endometrial hyperplasia; candidate for vaginal hysterectomy; not geographically accessible for 4 yrs. Age: 41.8 (mean) Source: University gynaecological clinics affiliated with 4 universities in USA
Interventions	(1) subtotal hysterectomy (2) total abdominal hysterectomy Follow up: 2 yrs
Outcomes	Primary: Surgical complications and clinical outcomes: reduction in symptoms; hospital readmissions; rate of complications; degree of symptom improvement; activity limitation Secondary: Sexual function and health related quality of life
Notes	A later publication compared the effects of the interventions on sexual function and quality of life
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated random number sequence, stratified by centre, in blocks
Allocation concealment (selection bias)	Low risk	Sealed numbered opaque envelopes
Blinding (performance bias and detection bias) All outcomes	High risk	Unblinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	Loss to follow up but reasons clearly specified
Selective reporting (reporting bias)	Low risk	All pre‐specified outcomes reported
Other bias	Low risk	No baseline imbalance, funding by AHRQ

Morelli 2007

Methods	Randomisation method: Computer generated No. of centres: 1 Design: Parallel group No. randomised: 141 No. analysed: 129 (primary outcome at 24 months); 141 for surgical outcomes Dropout at end of follow up: Subtotal group: 8/71 (11.3%) ‐ 1 death, 7 lost to follow up. Total group: 4/70 (5.7%) ‐ 1 death, 3 lost to follow up Power calculation: Not reported Intention to treat analysis: No for primary outcomes but surgical outcomes were ITT. Source of funding: Not reported
Participants	Inclusion: Age >30 years; pre‐menopausal; abnormal uterine bleeding with previous hormonal treatment for at least 3 months and diagnosis confirmed by echo or hysteroscopy OR symptomatic uterine leiomyomas (bleeding, compression etc) with diagnosis confirmed by echo or hysteroscopy OR patients >45 years with FSH ≤30 mIU/ml and negative endometrial biopsy for hyperplasia or carcinoma. Exclusion: Pregnancy; age >50 years; planned pregnancy; diagnosed or suspected genital cancer; dysplasia; endometrial hyperplasia; candidate for vaginal hysterectomy Age: Mean 42 years Source: Not reported ‐ all patients identified through a vaginal screening program in Catanzaro, Italy
Interventions	(1) subtotal laparoscopic hysterectomy (2) total laparoscopic hysterectomy (both using standard surgery procedures) Follow up: 24 months after surgery
Outcomes	Surgical outcomes: operation time, blood loss, other operative complications; readmission to hospital during follow up; irregular bleeding; pelvic pain; pelvic compression; lumbar pain; urinary urgency; sensation of incomplete emptying of bladder; stress incontinence
Notes	Publication translated from Italian into English by Lorenzo Moja of the Italian Cochrane Centre
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Not reported but unlikely
Incomplete outcome data (attrition bias) All outcomes	Low risk	Reasons clearly specified for dropouts before the conclusion of the trial at 24 months
Selective reporting (reporting bias)	Low risk	All prespecified outcomes reported
Other bias	Low risk	Groups balanced at baseline. No other possible bias identified.

Persson 2010

Methods	Randomisation method: Random numbers table with block randomisation according to centre No. of centres: 8 Design: Parallel group No. randomised: 200 No. analysed: 178 Dropout at end of follow up: Subtotal group: 5/104 withdrew consent prior to surgery, 4/104 withdrew consent during study period and 1/104 missing diary. Total group: 3/96 withdrew consent prior to surgery, 2/96 intraoperative finding of cancer, 1/96 converted to subtotal hysterectomy, 1/96 protocol violation, 5/96 withdrew consent during study period, 1/96 missing diary Power calculation: Yes: difference in PGWB score of 8 points Intention to treat analysis: Stated as intention to treat but 10% of subtotal and 13% of total group not included in the analyses Source of funding: Medical Research Council of south‐east Sweden and County Council of Ostergotland and Linkoping University
Participants	Inclusion: Planned hysterectomy for benign gynaecological condition, proficiency in Swedish, preservation of at least one ovary Exclusion: Malignancy in genital organs, previous or present cervical dysplasia, rapidly growing fibroids where malignancy could not be ruled out, preoperative treatment with GnRH analogues, post‐menopausal women without hormone replacement therapy, severe psychiatric disorders Age: Mean 46 years Source: Patients identified from seven hospitals and one private gynaecological clinic in Sweden ‐ admitted for hysterectomy because of benign gynaecological conditions
Interventions	(1) subtotal abdominal hysterectomy (2) total abdominal hysterectomy (both techniques according to surgeon discretion) Follow up: 12 months after surgery
Outcomes	Primary: General psychological wellbeing Secondary: Post‐operative complications (including stress incontinence), surgical and clinical outcomes during surgery
Notes	Two publications
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random numbers table with block randomisation according to centre
Allocation concealment (selection bias)	Low risk	"Opaque envelopes numbered sequentially in accordance with random table, opened consecutively"
Blinding (performance bias and detection bias) All outcomes	High risk	"Women informed about their assignment prior to surgery"
Incomplete outcome data (attrition bias) All outcomes	Low risk	"Missing outcome data balanced in numbers across intervention groups with similar reasons for missing data across groups"
Selective reporting (reporting bias)	Low risk	All prespecified outcomes reported
Other bias	Low risk	Comparison groups balanced at baseline. No pharmaceutical funding.

Thakar 2002

Methods	Randomisation method: Computer generated numbers and sealed opaque envelopes opened after surgical incision made. No of centres: 2 Design: parallel group Blinding: double (participants and investigator for 1 year of trial) No randomised: 279 No analysed: 279 (only for peri‐operative outcomes) Dropout at end of follow up: 8% in subtotal group; 14% in total group Power calculation for sample size: yes Intention to treat analysis: yes for some outcomes, but some data not available for analysis of primary outcomes Source of funding: Responsive Funding Program, Research and Development; NHS Executive; London.
Participants	Inclusion: Women offered abdominal hysterectomy for a benign indication Exclusion: >60 years; suspected carcinoma; body weight >100 kg; previous pelvic surgery; known endometriosis; abnormal cervical smears; symptomatic uterine prolapse; symptomatic urinary incontinence Age: 43‐44 (mean) Source: 2 London hospitals in the UK (Jan 1996 to Apr 2000)
Interventions	(1) subtotal hysterectomy (2) total abdominal hysterectomy Follow up: 1 yr
Outcomes	Primary: Bowel, bladder and sexual function Secondary: Postoperative complications; intra‐operative outcomes and complications; readmission rate; changes in psychological outcomes and health status/quality of life
Notes	A later publication (Thakar 2004) compared the effects of the interventions on health status/quality of life and psychological outcomes and another later publication (Thakar 2005) compared the effects of the interventions on longer follow up (7 to 11 years after surgery).
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated numbers
Allocation concealment (selection bias)	Low risk	Sealed opaque envelopes only opened after surgical incision
Blinding (performance bias and detection bias) All outcomes	Low risk	Participants and investigators blinded for 1 year
Incomplete outcome data (attrition bias) All outcomes	Low risk	Clear explanations given for missing data but analysis at 9 years undertaken on 65% of original study group
Selective reporting (reporting bias)	Low risk	All pre‐specified outcomes reported
Other bias	Low risk	No baseline imbalance, funding by research program

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos
estudios a la espera de clasificación

Study	Reason for exclusion
Einarsson 2010	Not RCT ‐ does not mention randomisation to groups
Gimbel 2007	Meta‐analysis, not RCT
Kives 2010	Guideline on subtotal hysterectomy, not RCT
Lalos 1986	Did not measure one or more of the primary outcomes for the review
Lyons 1993	Not randomised
Robert 2008	Meta‐analysis, not RCT
Showstack 2004	Resource use for total and supracervical hysterectomy was compared. These outcomes are not relevant to the review

Characteristics of studies awaiting assessment [ordered by study ID]

Ir a:

estudios incluidos
estudios excluidos

Asgari 2009

Methods	RCT
Participants	Patients who were candidates for hysterectomy with benign disease with no contraindications for laparoscopic surgery; recruited from Arash Hospital from March 2007 to April 2009. N=45; 20 for subtotal and 25 for total hysterectomy
Interventions	(1) subtotal laparoscopic hysterectomy; (2) total laparoscopic hysterectomy
Outcomes	Duration of surgery, blood transfusion, length of hospital stay, post‐operative pain, time to return to normal activities, sexual function, dyspareunia, cyclic bleeding, cervical prolapse, intra and post‐operative complications
Notes	Awaiting translation

Ghanbari 2007

Methods	Single blinded RCT
Participants	N=50; 25 randomised to subtotal abdominal hysterectomy and 25 randomised to total abdominal hysterectomy
Interventions	(1) subtotal abdominal hysterectomy; (2) total abdominal hysterectomy
Outcomes	Duration of surgery, volume of bleeding, duration of hospital stay, operative complications, dyspareunia, sexual satisfaction, ongoing bleeding
Notes	Awaiting translation

Data and analyses

Open in table viewer

Comparison 1. Subtotal hysterectomy versus total hysterectomy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Prevalence of stress urinary incontinence within 2 years post surgery Show forest plot	5	955	Odds Ratio (M‐H, Fixed, 95% CI)	1.45 [0.85, 2.47]
Open in figure viewer Analysis 1.1 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 1 Prevalence of stress urinary incontinence within 2 years post surgery.
1.1 Abdominal surgery	4	826	Odds Ratio (M‐H, Fixed, 95% CI)	1.55 [0.86, 2.78]
1.2 Laparoscopic surgery	1	129	Odds Ratio (M‐H, Fixed, 95% CI)	1.05 [0.29, 3.82]
2 Prevalence of stress urinary incontinence >2 years post surgery Show forest plot	1	178	Odds Ratio (M‐H, Fixed, 95% CI)	1.15 [0.63, 2.08]
Open in figure viewer Analysis 1.2 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 2 Prevalence of stress urinary incontinence >2 years post surgery.
2.1 Abdominal surgery	1	178	Odds Ratio (M‐H, Fixed, 95% CI)	1.15 [0.63, 2.08]
2.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Prevalence of incomplete bladder emptying within 2 years post surgery Show forest plot	4	768	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.59, 1.47]
Open in figure viewer Analysis 1.3 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 3 Prevalence of incomplete bladder emptying within 2 years post surgery.
3.1 Abdominal surgery	3	639	Odds Ratio (M‐H, Fixed, 95% CI)	0.89 [0.55, 1.45]
3.2 Laparoscopic surgery	1	129	Odds Ratio (M‐H, Fixed, 95% CI)	1.28 [0.37, 4.44]
4 Prevalence of incomplete bladder emptying >2 years post surgery Show forest plot	1	173	Odds Ratio (M‐H, Fixed, 95% CI)	0.69 [0.37, 1.29]
Open in figure viewer Analysis 1.4 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 4 Prevalence of incomplete bladder emptying >2 years post surgery.
4.1 Abdominal surgery	1	173	Odds Ratio (M‐H, Fixed, 95% CI)	0.69 [0.37, 1.29]
4.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Prevalence of urinary urgency within 2 years post surgery Show forest plot	2	254	Odds Ratio (M‐H, Fixed, 95% CI)	1.05 [0.47, 2.37]
Open in figure viewer Analysis 1.5 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 5 Prevalence of urinary urgency within 2 years post surgery.
5.1 Abdominal surgery	1	125	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.25, 2.99]
5.2 Laparoscopic surgery	1	129	Odds Ratio (M‐H, Fixed, 95% CI)	1.23 [0.42, 3.61]
6 Prevalence of urinary urgency >2 years post surgery Show forest plot	1	174	Odds Ratio (M‐H, Fixed, 95% CI)	1.26 [0.68, 2.32]
Open in figure viewer Analysis 1.6 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 6 Prevalence of urinary urgency >2 years post surgery.
6.1 Abdominal surgery	1	174	Odds Ratio (M‐H, Fixed, 95% CI)	1.26 [0.68, 2.32]
6.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Prevalence of constipation within 2 years post surgery Show forest plot	2	555	Odds Ratio (M‐H, Fixed, 95% CI)	0.80 [0.49, 1.31]
Open in figure viewer Analysis 1.7 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 7 Prevalence of constipation within 2 years post surgery.
7.1 Abdominal surgery	2	555	Odds Ratio (M‐H, Fixed, 95% CI)	0.80 [0.49, 1.31]
7.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Prevalence of constipation >2 years post surgery Show forest plot	1	165	Odds Ratio (M‐H, Fixed, 95% CI)	1.52 [0.67, 3.45]
Open in figure viewer Analysis 1.8 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 8 Prevalence of constipation >2 years post surgery.
8.1 Abdominal surgery	1	165	Odds Ratio (M‐H, Fixed, 95% CI)	1.52 [0.67, 3.45]
8.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Prevalence of incontinence of stools within 2 years post surgery Show forest plot	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]
Open in figure viewer Analysis 1.9 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 9 Prevalence of incontinence of stools within 2 years post surgery.
9.1 Abdominal surgery	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]
9.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Prevalence of incontinence of stools >2 years post surgery Show forest plot	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]
Open in figure viewer Analysis 1.10 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 10 Prevalence of incontinence of stools >2 years post surgery.
10.1 Abdominal surgery	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]
10.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Satisfaction with sex within 2 years post surgery Show forest plot	2	454	Odds Ratio (M‐H, Fixed, 95% CI)	1.04 [0.68, 1.59]
Open in figure viewer Analysis 1.11 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 11 Satisfaction with sex within 2 years post surgery.
11.1 Abdominal surgery	2	454	Odds Ratio (M‐H, Fixed, 95% CI)	1.04 [0.68, 1.59]
11.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Satisfaction with sex >2 years post surgery Show forest plot	1	131	Odds Ratio (M‐H, Fixed, 95% CI)	0.95 [0.13, 6.98]
Open in figure viewer Analysis 1.12 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 12 Satisfaction with sex >2 years post surgery.
12.1 Abdominal hysterectomy	1	131	Odds Ratio (M‐H, Fixed, 95% CI)	0.95 [0.13, 6.98]
12.2 Laparoscopic hysterectomy	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Satisfaction with sex (cont) within 2 years post surgery Show forest plot	2	192	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.15 [‐0.43, 0.13]
Open in figure viewer Analysis 1.13 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 13 Satisfaction with sex (cont) within 2 years post surgery.
13.1 Abdominal surgery	1	129	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.39, 0.30]
13.2 Laparoscopic surgery	1	63	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.37 [‐0.87, 0.13]
14 Satisfaction with sex (cont) >2 years post surgery	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.1 Abdominal surgery	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.2 Laparoscopic surgery	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Prevalence of pain during sex within 2 years post surgery Show forest plot	2	452	Odds Ratio (M‐H, Fixed, 95% CI)	0.87 [0.46, 1.67]
Open in figure viewer Analysis 1.15 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 15 Prevalence of pain during sex within 2 years post surgery.
15.1 Abdominal surgery	2	452	Odds Ratio (M‐H, Fixed, 95% CI)	0.87 [0.46, 1.67]
15.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Prevalence of pain during sex >2 years post surgery Show forest plot	1	133	Odds Ratio (M‐H, Fixed, 95% CI)	0.56 [0.25, 1.23]
Open in figure viewer Analysis 1.16 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 16 Prevalence of pain during sex >2 years post surgery.
16.1 Abdominal surgery	1	133	Odds Ratio (M‐H, Fixed, 95% CI)	0.56 [0.25, 1.23]
16.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Quality of life within 2 years post abdominal surgery (high better) Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.17 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 17 Quality of life within 2 years post abdominal surgery (high better).
17.1 General (abdominal)	3	478	Mean Difference (IV, Fixed, 95% CI)	0.35 [‐0.27, 0.97]
17.2 Physical domain (abdominal)	3	652	Mean Difference (IV, Fixed, 95% CI)	‐0.52 [‐2.18, 1.14]
17.3 Mental domain (abdominal)	4	831	Mean Difference (IV, Fixed, 95% CI)	‐0.61 [‐2.05, 0.82]
18 Quality of life within 2 years post abdominal surgery (low better) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.18 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 18 Quality of life within 2 years post abdominal surgery (low better).
18.1 General (abdominal)	1	179	Mean Difference (IV, Fixed, 95% CI)	‐1.0 [‐4.92, 2.92]
18.2 Anxiety (abdominal)	1	179	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐2.68, 3.08]
18.3 Depression (abdominal and laparoscopic)	2	242	Mean Difference (IV, Fixed, 95% CI)	‐0.27 [‐1.55, 1.00]
18.4 Psychological domain (laparoscopic)	1	63	Mean Difference (IV, Fixed, 95% CI)	‐2.0 [‐15.66, 11.66]
19 Operating time (mins) Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.19 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 19 Operating time (mins).
19.1 Abdominal surgery	4	694	Mean Difference (IV, Fixed, 95% CI)	‐11.26 [‐15.07, ‐7.45]
19.2 Laparoscopic surgery	1	141	Mean Difference (IV, Fixed, 95% CI)	‐5.0 [‐14.80, 4.80]
20 Length of hospital stay (days) Show forest plot	6		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.20 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 20 Length of hospital stay (days).
20.1 Abdominal surgery	5	844	Mean Difference (IV, Fixed, 95% CI)	‐0.17 [‐0.39, 0.04]
20.2 Laparoscopic surgery	1	141	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐0.62, 0.22]
21 Return to normal activities (weeks) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.21 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 21 Return to normal activities (weeks).
21.1 Abdominal surgery	2	310	Mean Difference (IV, Fixed, 95% CI)	‐0.14 [‐0.53, 0.25]
21.2 Laparoscopic surgery	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Requirement for blood transfusion Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.22 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 22 Requirement for blood transfusion.
22.1 Abdominal surgery	4	694	Odds Ratio (M‐H, Fixed, 95% CI)	1.24 [0.61, 2.54]
22.2 Laparoscopic surgery	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	1.25 [0.32, 4.86]
23 Blood loss during surgery (mls) Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.23 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 23 Blood loss during surgery (mls).
23.1 Abdominal surgery	3	589	Mean Difference (IV, Fixed, 95% CI)	‐56.63 [‐99.58, ‐13.68]
23.2 Laparoscopic surgery	1	141	Mean Difference (IV, Fixed, 95% CI)	‐36.0 [‐145.35, 73.35]
24 Short term complications (predischarge) Show forest plot	6		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.24 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 24 Short term complications (predischarge).
24.1 Surgical injury	3	549	Odds Ratio (M‐H, Fixed, 95% CI)	0.28 [0.06, 1.36]
24.2 Pelvic haematoma/abscess	3	660	Odds Ratio (M‐H, Fixed, 95% CI)	0.41 [0.13, 1.32]
24.3 Vaginal bleeding	3	660	Odds Ratio (M‐H, Fixed, 95% CI)	0.74 [0.29, 1.91]
24.4 Wound infection	3	733	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.38, 1.95]
24.5 Pyrexia (fever)	5	933	Odds Ratio (M‐H, Fixed, 95% CI)	0.48 [0.31, 0.75]
24.6 Urinary retention	5	933	Odds Ratio (M‐H, Fixed, 95% CI)	0.23 [0.06, 0.81]
24.7 Bowel obstruction/ileus	4	731	Odds Ratio (M‐H, Fixed, 95% CI)	0.59 [0.24, 1.46]
25 Intermediate term complications (after discharge and within 2 years post surgery) Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.25 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 25 Intermediate term complications (after discharge and within 2 years post surgery).
25.1 Ongoing cyclical bleeding	5	964	Odds Ratio (M‐H, Fixed, 95% CI)	15.97 [6.14, 41.56]
25.2 Persistent pain	5	963	Odds Ratio (M‐H, Fixed, 95% CI)	0.90 [0.58, 1.38]
25.3 Removal of cervical stump	2	457	Odds Ratio (M‐H, Fixed, 95% CI)	5.14 [0.60, 44.35]
25.4 Pelvic prolapse	4	839	Odds Ratio (M‐H, Fixed, 95% CI)	2.74 [0.80, 9.34]
25.5 Gynaecological cancer	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Long term complications (>2 years post surgery) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.26 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 26 Long term complications (>2 years post surgery).
26.1 Fistula	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.2 Pelvic prolapse	1	127	Odds Ratio (M‐H, Fixed, 95% CI)	0.84 [0.41, 1.70]
26.3 Gynaecological cancer	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Alleviation of pre‐surgery symptoms Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.27 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 27 Alleviation of pre‐surgery symptoms.
27.1 Back pain	2	266	Odds Ratio (M‐H, Fixed, 95% CI)	1.33 [0.78, 2.27]
27.2 Pelvic pressure	2	266	Odds Ratio (M‐H, Fixed, 95% CI)	0.69 [0.28, 1.68]
27.3 Menstrual abnormalities	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	3.00 [0.12, 74.90]
27.4 Pelvic pain	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.31, 2.38]
28 Readmission rate (related to surgery) Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.28 Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 28 Readmission rate (related to surgery).
28.1 Abdominal surgery	4	869	Odds Ratio (M‐H, Fixed, 95% CI)	1.10 [0.63, 1.91]
28.2 Laparoscopic surgery	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	1.96 [0.68, 5.62]

Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 1 Prevalence of stress urinary incontinence within 2 years post surgery.

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Analysis 1.2

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 2 Prevalence of stress urinary incontinence >2 years post surgery.

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Analysis 1.3

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 3 Prevalence of incomplete bladder emptying within 2 years post surgery.

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Analysis 1.4

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 4 Prevalence of incomplete bladder emptying >2 years post surgery.

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Analysis 1.5

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 5 Prevalence of urinary urgency within 2 years post surgery.

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Analysis 1.6

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 6 Prevalence of urinary urgency >2 years post surgery.

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Analysis 1.7

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 7 Prevalence of constipation within 2 years post surgery.

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Analysis 1.8

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 8 Prevalence of constipation >2 years post surgery.

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Analysis 1.9

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 9 Prevalence of incontinence of stools within 2 years post surgery.

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Analysis 1.10

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 10 Prevalence of incontinence of stools >2 years post surgery.

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Analysis 1.11

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 11 Satisfaction with sex within 2 years post surgery.

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Analysis 1.12

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 12 Satisfaction with sex >2 years post surgery.

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Analysis 1.13

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 13 Satisfaction with sex (cont) within 2 years post surgery.

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Analysis 1.15

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 15 Prevalence of pain during sex within 2 years post surgery.

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Analysis 1.16

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 16 Prevalence of pain during sex >2 years post surgery.

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Analysis 1.17

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 17 Quality of life within 2 years post abdominal surgery (high better).

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Analysis 1.18

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 18 Quality of life within 2 years post abdominal surgery (low better).

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Analysis 1.19

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 19 Operating time (mins).

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Analysis 1.20

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 20 Length of hospital stay (days).

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Analysis 1.21

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 21 Return to normal activities (weeks).

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Analysis 1.22

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 22 Requirement for blood transfusion.

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Analysis 1.23

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 23 Blood loss during surgery (mls).

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Analysis 1.24

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 24 Short term complications (predischarge).

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Analysis 1.25

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 25 Intermediate term complications (after discharge and within 2 years post surgery).

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Analysis 1.26

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 26 Long term complications (>2 years post surgery).

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Analysis 1.27

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 27 Alleviation of pre‐surgery symptoms.

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Analysis 1.28

Comparison 1 Subtotal hysterectomy versus total hysterectomy, Outcome 28 Readmission rate (related to surgery).

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Subtotal hysterectomy compared with total hysterectomy for benign gynaecological conditions
Patient or population: Women requiring hysterectomy for benign conditions Settings: Hospital Intervention: Subtotal hysterectomy Comparison: Total hysterectomy
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	[control]	[experimental]
Prevalence of stress urinary incontinence within 2 years post surgery [follow‐up]	Low risk population		OR 1.45 (0.85 to 2.47)	955	⊕⊕⊕⊝ moderate	Stress incontinence was measured in most trials by questionnaire, but in Thakar it was more objectively determined by the use of twin‐channel subtracted cystometrography
	52 per 1000	73 per 1000
	Medium risk population
	[value] per 1000	[value] per 1000 ([value] to [value])
	High risk population
	[value] per 1000	[value] per 1000 ([value] to [value])
Prevalence of constipation within 2 years post surgery [follow‐up]	Low risk population		OR 0.80 (0.49 to 1.31)	555	⊕⊕⊝⊝ low	Evaluated by questionnaire. Inconsistency between trials.
	[value] per 1000	[value] per 1000 ([value] to [value])
	Medium risk population
	150 per 1000	126 per 1000 ([value] to [value])
	High risk population
	[value] per 1000	[value] per 1000 ([value] to [value])
Satisfaction with sex within 2 years post surgery [follow‐up]	Low risk population		OR 1.04 (0.68 to 1.59)	454	⊕⊕⊝⊝ low	Evaluated by questionnaire. Inconsistency between trials may have resulted from different questions on sexual satisfaction being asked.
	[value] per 1000	[value] per 1000 ([value] to [value])
	Medium risk population
	[value] per 1000	[value] per 1000 ([value] to [value])
	High risk population
	725 per 1000	736 per 1000 ([value] to [value])
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio; [other abbreviations, eg. OR, etc]
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

Ir a la tabla de la revisión

Comparison 1. Subtotal hysterectomy versus total hysterectomy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Prevalence of stress urinary incontinence within 2 years post surgery Show forest plot	5	955	Odds Ratio (M‐H, Fixed, 95% CI)	1.45 [0.85, 2.47]

1.1 Abdominal surgery	4	826	Odds Ratio (M‐H, Fixed, 95% CI)	1.55 [0.86, 2.78]
1.2 Laparoscopic surgery	1	129	Odds Ratio (M‐H, Fixed, 95% CI)	1.05 [0.29, 3.82]
2 Prevalence of stress urinary incontinence >2 years post surgery Show forest plot	1	178	Odds Ratio (M‐H, Fixed, 95% CI)	1.15 [0.63, 2.08]

2.1 Abdominal surgery	1	178	Odds Ratio (M‐H, Fixed, 95% CI)	1.15 [0.63, 2.08]
2.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Prevalence of incomplete bladder emptying within 2 years post surgery Show forest plot	4	768	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.59, 1.47]

3.1 Abdominal surgery	3	639	Odds Ratio (M‐H, Fixed, 95% CI)	0.89 [0.55, 1.45]
3.2 Laparoscopic surgery	1	129	Odds Ratio (M‐H, Fixed, 95% CI)	1.28 [0.37, 4.44]
4 Prevalence of incomplete bladder emptying >2 years post surgery Show forest plot	1	173	Odds Ratio (M‐H, Fixed, 95% CI)	0.69 [0.37, 1.29]

4.1 Abdominal surgery	1	173	Odds Ratio (M‐H, Fixed, 95% CI)	0.69 [0.37, 1.29]
4.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Prevalence of urinary urgency within 2 years post surgery Show forest plot	2	254	Odds Ratio (M‐H, Fixed, 95% CI)	1.05 [0.47, 2.37]

5.1 Abdominal surgery	1	125	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.25, 2.99]
5.2 Laparoscopic surgery	1	129	Odds Ratio (M‐H, Fixed, 95% CI)	1.23 [0.42, 3.61]
6 Prevalence of urinary urgency >2 years post surgery Show forest plot	1	174	Odds Ratio (M‐H, Fixed, 95% CI)	1.26 [0.68, 2.32]

6.1 Abdominal surgery	1	174	Odds Ratio (M‐H, Fixed, 95% CI)	1.26 [0.68, 2.32]
6.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Prevalence of constipation within 2 years post surgery Show forest plot	2	555	Odds Ratio (M‐H, Fixed, 95% CI)	0.80 [0.49, 1.31]

7.1 Abdominal surgery	2	555	Odds Ratio (M‐H, Fixed, 95% CI)	0.80 [0.49, 1.31]
7.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Prevalence of constipation >2 years post surgery Show forest plot	1	165	Odds Ratio (M‐H, Fixed, 95% CI)	1.52 [0.67, 3.45]

8.1 Abdominal surgery	1	165	Odds Ratio (M‐H, Fixed, 95% CI)	1.52 [0.67, 3.45]
8.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Prevalence of incontinence of stools within 2 years post surgery Show forest plot	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]

9.1 Abdominal surgery	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]
9.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Prevalence of incontinence of stools >2 years post surgery Show forest plot	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]

10.1 Abdominal surgery	1	166	Odds Ratio (M‐H, Fixed, 95% CI)	0.52 [0.05, 5.83]
10.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Satisfaction with sex within 2 years post surgery Show forest plot	2	454	Odds Ratio (M‐H, Fixed, 95% CI)	1.04 [0.68, 1.59]

11.1 Abdominal surgery	2	454	Odds Ratio (M‐H, Fixed, 95% CI)	1.04 [0.68, 1.59]
11.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Satisfaction with sex >2 years post surgery Show forest plot	1	131	Odds Ratio (M‐H, Fixed, 95% CI)	0.95 [0.13, 6.98]

12.1 Abdominal hysterectomy	1	131	Odds Ratio (M‐H, Fixed, 95% CI)	0.95 [0.13, 6.98]
12.2 Laparoscopic hysterectomy	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 Satisfaction with sex (cont) within 2 years post surgery Show forest plot	2	192	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.15 [‐0.43, 0.13]

13.1 Abdominal surgery	1	129	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.39, 0.30]
13.2 Laparoscopic surgery	1	63	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.37 [‐0.87, 0.13]
14 Satisfaction with sex (cont) >2 years post surgery	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.1 Abdominal surgery	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.2 Laparoscopic surgery	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Prevalence of pain during sex within 2 years post surgery Show forest plot	2	452	Odds Ratio (M‐H, Fixed, 95% CI)	0.87 [0.46, 1.67]

15.1 Abdominal surgery	2	452	Odds Ratio (M‐H, Fixed, 95% CI)	0.87 [0.46, 1.67]
15.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
16 Prevalence of pain during sex >2 years post surgery Show forest plot	1	133	Odds Ratio (M‐H, Fixed, 95% CI)	0.56 [0.25, 1.23]

16.1 Abdominal surgery	1	133	Odds Ratio (M‐H, Fixed, 95% CI)	0.56 [0.25, 1.23]
16.2 Laparoscopic surgery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
17 Quality of life within 2 years post abdominal surgery (high better) Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

17.1 General (abdominal)	3	478	Mean Difference (IV, Fixed, 95% CI)	0.35 [‐0.27, 0.97]
17.2 Physical domain (abdominal)	3	652	Mean Difference (IV, Fixed, 95% CI)	‐0.52 [‐2.18, 1.14]
17.3 Mental domain (abdominal)	4	831	Mean Difference (IV, Fixed, 95% CI)	‐0.61 [‐2.05, 0.82]
18 Quality of life within 2 years post abdominal surgery (low better) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.1 General (abdominal)	1	179	Mean Difference (IV, Fixed, 95% CI)	‐1.0 [‐4.92, 2.92]
18.2 Anxiety (abdominal)	1	179	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐2.68, 3.08]
18.3 Depression (abdominal and laparoscopic)	2	242	Mean Difference (IV, Fixed, 95% CI)	‐0.27 [‐1.55, 1.00]
18.4 Psychological domain (laparoscopic)	1	63	Mean Difference (IV, Fixed, 95% CI)	‐2.0 [‐15.66, 11.66]
19 Operating time (mins) Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

19.1 Abdominal surgery	4	694	Mean Difference (IV, Fixed, 95% CI)	‐11.26 [‐15.07, ‐7.45]
19.2 Laparoscopic surgery	1	141	Mean Difference (IV, Fixed, 95% CI)	‐5.0 [‐14.80, 4.80]
20 Length of hospital stay (days) Show forest plot	6		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

20.1 Abdominal surgery	5	844	Mean Difference (IV, Fixed, 95% CI)	‐0.17 [‐0.39, 0.04]
20.2 Laparoscopic surgery	1	141	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐0.62, 0.22]
21 Return to normal activities (weeks) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.1 Abdominal surgery	2	310	Mean Difference (IV, Fixed, 95% CI)	‐0.14 [‐0.53, 0.25]
21.2 Laparoscopic surgery	0	0	Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
22 Requirement for blood transfusion Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

22.1 Abdominal surgery	4	694	Odds Ratio (M‐H, Fixed, 95% CI)	1.24 [0.61, 2.54]
22.2 Laparoscopic surgery	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	1.25 [0.32, 4.86]
23 Blood loss during surgery (mls) Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

23.1 Abdominal surgery	3	589	Mean Difference (IV, Fixed, 95% CI)	‐56.63 [‐99.58, ‐13.68]
23.2 Laparoscopic surgery	1	141	Mean Difference (IV, Fixed, 95% CI)	‐36.0 [‐145.35, 73.35]
24 Short term complications (predischarge) Show forest plot	6		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

24.1 Surgical injury	3	549	Odds Ratio (M‐H, Fixed, 95% CI)	0.28 [0.06, 1.36]
24.2 Pelvic haematoma/abscess	3	660	Odds Ratio (M‐H, Fixed, 95% CI)	0.41 [0.13, 1.32]
24.3 Vaginal bleeding	3	660	Odds Ratio (M‐H, Fixed, 95% CI)	0.74 [0.29, 1.91]
24.4 Wound infection	3	733	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.38, 1.95]
24.5 Pyrexia (fever)	5	933	Odds Ratio (M‐H, Fixed, 95% CI)	0.48 [0.31, 0.75]
24.6 Urinary retention	5	933	Odds Ratio (M‐H, Fixed, 95% CI)	0.23 [0.06, 0.81]
24.7 Bowel obstruction/ileus	4	731	Odds Ratio (M‐H, Fixed, 95% CI)	0.59 [0.24, 1.46]
25 Intermediate term complications (after discharge and within 2 years post surgery) Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

25.1 Ongoing cyclical bleeding	5	964	Odds Ratio (M‐H, Fixed, 95% CI)	15.97 [6.14, 41.56]
25.2 Persistent pain	5	963	Odds Ratio (M‐H, Fixed, 95% CI)	0.90 [0.58, 1.38]
25.3 Removal of cervical stump	2	457	Odds Ratio (M‐H, Fixed, 95% CI)	5.14 [0.60, 44.35]
25.4 Pelvic prolapse	4	839	Odds Ratio (M‐H, Fixed, 95% CI)	2.74 [0.80, 9.34]
25.5 Gynaecological cancer	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
26 Long term complications (>2 years post surgery) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

26.1 Fistula	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
26.2 Pelvic prolapse	1	127	Odds Ratio (M‐H, Fixed, 95% CI)	0.84 [0.41, 1.70]
26.3 Gynaecological cancer	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
27 Alleviation of pre‐surgery symptoms Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

27.1 Back pain	2	266	Odds Ratio (M‐H, Fixed, 95% CI)	1.33 [0.78, 2.27]
27.2 Pelvic pressure	2	266	Odds Ratio (M‐H, Fixed, 95% CI)	0.69 [0.28, 1.68]
27.3 Menstrual abnormalities	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	3.00 [0.12, 74.90]
27.4 Pelvic pain	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.31, 2.38]
28 Readmission rate (related to surgery) Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

28.1 Abdominal surgery	4	869	Odds Ratio (M‐H, Fixed, 95% CI)	1.10 [0.63, 1.91]
28.2 Laparoscopic surgery	1	141	Odds Ratio (M‐H, Fixed, 95% CI)	1.96 [0.68, 5.62]

Comparison 1. Subtotal hysterectomy versus total hysterectomy

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Referencias

Referencias de los estudios incluidos en esta revisión

Asnafi 2010 {published data only}

Ellstrom 2010 {published data only}

Flory 2006 {published data only}

Gimbel 2003 {published data only}

Gorlero 2008 {published data only}

Learman 2003 {published data only}

Morelli 2007 {published data only}

Persson 2010 {published data only}

Thakar 2002 {published data only}

Referencias de los estudios excluidos de esta revisión

Einarsson 2010 {published data only}

Gimbel 2007 {published data only}

Kives 2010 {published data only}

Lalos 1986 {published data only}

Lyons 1993 {published data only}

Robert 2008 {published data only}

Showstack 2004 {published data only}

Referencias de los estudios en espera de evaluación

Asgari 2009 {published data only}

Ghanbari 2007 {published data only}

Referencias adicionales

Abrams 1983

ACOG 2007

Brown 2000

Culhed 1993

Eaker 1998

Esdaile 2006

Farquhar 2002

Gimbel 2001

Gimbel 2005

Helstrom 1994

Higgins 2003

Higgins 2011

Jacobson 2006

Kaser 1985

Kilkku 1981

Kilkku 1983

Kilkku 1983a

Kilkku 1985

Lethaby 2009

Lonnee‐Hoffmann 2006

Merrill 2008

Nathorst‐Boos 1992

Neumann 2004

Nezhat 1996

Nieboer 2006

Parys 1990

Roovers 2001

Roovers 2003

Roovers 2007

Roussis 2004

Saini 2002

Storm 1992

Sutton 1997

Thakar 2005

van Dam 1997

Zekam 2003

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Characteristics of studies awaiting assessment [ordered by study ID]

Data and analyses

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