Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC
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This guideline reviews the evidence relating to the potential benefits of the vaginal hysterectomy (VH) and supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) with respect to postoperative sexual function, urinary function, and peri- and postoperative complications. Laparoscopic options are not included in this guideline. ⋯ 1. Vaginal hysterectomy is generally considered the first choice of surgical approach for most benign indications for hysterectomy, as it is associated with lower rates of morbidity, fewer postoperative complications, and a faster recovery time than abdominal hysterectomy. (I-A). 2. Women contemplating a vaginal, laparoscopic, or abdominal hysterectomy for the management of benign uterine disease should be reassured that hysterectomy is usually associated with improved quality of life, including improved sexual function, whether or not the cervix is removed. (I-B). 3. Supracervical hysterectomy should not be recommended as a superior technique to total abdominal hysterectomy for the prevention of postoperative lower urinary tract symptoms. (I-B). 4. Although supracervical hysterectomy may be associated with less blood loss and a shorter surgical time, these parameters have not been found to be clinically significant, and supracervical hysterectomy should not be recommended as a superior technique to total abdominal hysterectomy for the prevention of peri- and postoperative complications. (I-B). 5. Women considering a supracervical hysterectomy should be counselled that they may continue experiencing cyclic vaginal bleeding following the surgery. (I-B). 6. Women must be advised that they require routine cytological screening following a supracervical hysterectomy. (II-B). 7. Women who require a hysterectomy and who have a current or significant history of abnormal cervical cytological results should be counselled on the advantages of vaginal hysterectomy or total abdominal hysterectomy over supracervical hysterectomy. (I-B).