[How to avoid the complications associated with hysterectomy: Place of subtotal hysterectomy, prevention of venous thromboembolism risk and preoperative treatment: Guidelines].

OBJECTIVE

The National College of French gynecologists and obstetricians (CNGOF) decided to issue recommendations for clinical practice concerning the prevention of complications due to hysterectomy for benign disease.

METHODS

Review of the English and French literature until May 2015 about complications with hysterectomy for benign gynaecological disease, excluding cancer. The following topics are covered in this article: prevention of venous thromboembolism risk, preoperative treatment that reduce the frequency of laparotomic hysterectomy and real interest of subtotal hysterectomy.

RESULTS

For the prevention of venous thromboembolism risk we advise to follow the recommendations of the SFAR. In case of hysterectomy for benign indication for which a median laparotomy is envisaged, given the volume of the uterus, it is recommended to prescribe GnRH agonists and then reassess the surgical approach (grade B). We do not observe significative differences regarding the sexual quality of life for laparotomic subtotal hysterectomy versus laparotomic total hysterectomy (EL1). We do not observe significative differences regarding the sexual quality of life for laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy (EL1). Subtotal hysterectomy is not associated with a significant improvement in the sexual quality of life (EL1). Subtotal hysterectomy is not associated with a decreased prevalence of intraoperative Hemorrhagic or visceral complications (EL3) or to a reduction in transfusions (EL2). It is not recommended to perform subtotal hysterectomy to reduce the risk of complications per or postoperative (grade B).