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Related Experiment Video

Updated: Mar 29, 2026

Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
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Total Versus Sub-Total Hysterectomy: A Meta-Analysis of Randomized Controlled Trials.

Giulia Bonavina1, Gianluca Bonitta2, Elena Puzzi1

  • 1Department of Obstetrics and Gynecology (Drs Bonavina, Puzzi, and Bulfoni), IRCCS MultiMedica, Milan, Italy.

Journal of Minimally Invasive Gynecology
|March 27, 2026
PubMed
Summary

Total hysterectomy (TH) significantly reduces long-term abnormal bleeding and urinary incontinence compared to subtotal hysterectomy (SH). While SH offers minor short-term surgical advantages, TH demonstrates better long-term outcomes for women with benign gynecological conditions.

Keywords:
Abnormal uterine bleedingCervical cancerHysterectomySub-total hysterectomySupra-cervical hysterectomyTotal hysterectomy

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Area of Science:

  • Gynecology
  • Surgical Outcomes
  • Evidence-Based Medicine

Background:

  • Hysterectomy is a common procedure for benign gynecological conditions.
  • Total hysterectomy (TH) and subtotal hysterectomy (SH) are two surgical approaches.
  • Comparative data on long-term outcomes between TH and SH is crucial for clinical decision-making.

Purpose of the Study:

  • To compare the short- and long-term outcomes of total hysterectomy (TH) versus subtotal hysterectomy (SH).
  • To synthesize available evidence from randomized controlled trials (RCTs) on hysterectomy types for benign gynecological disease.

Main Methods:

  • A systematic review and meta-analysis of 14 RCTs involving 1,921 women undergoing TH or SH.
  • Databases searched included Pubmed, Embase, and ClinicalTrials.gov up to November 1, 2025.
  • Random effects meta-analysis was used to compute pooled effect estimates and confidence intervals, with heterogeneity assessed by the I² statistic.

Main Results:

  • Total hysterectomy (TH) significantly reduced abnormal/cyclic vaginal bleeding at 1 year (RR 0.15) and urinary incontinence (UI) beyond 1 year (RR 0.67).
  • Operative time, blood loss, and hospital stay were slightly higher with TH but considered clinically negligible.
  • No significant differences were observed in urinary, sexual, or bowel function, or quality of life between TH and SH in the long term.

Conclusions:

  • Total hysterectomy (TH) offers superior long-term benefits by reducing cyclical bleeding and urinary incontinence compared to subtotal hysterectomy (SH).
  • Subtotal hysterectomy (SH) provides only minor short-term surgical advantages.
  • Evidence suggests no long-term differences in other functional outcomes or quality of life between the two hysterectomy methods.