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Trachelectomy following supracervical hysterectomy

INTRODUCTION

Trachelectomy to remove the cervical stump after prior supracervical hysterectomy is typically performed to manage cervical symptoms or disease that develops postoperatively. In a series of 70 consecutive women who underwent supracervical hysterectomy, 17 (24 percent) subsequently reported symptoms such as cyclical bleeding, pelvic pain, and dyspareunia [1]. Postoperative cyclical vaginal bleeding often results from residual endometrium and has been reported by 5 to 20 percent of patients randomized to supracervical hysterectomy in trials comparing subtotal versus total hysterectomy [2-4]. Pain and dyspareunia may be due to adhesions, cervical fibroid, or consequences of morcellation of the uterine body, which can result in painful myometrial implants and/or endometriosis [5].

This topic will review the indications for trachelectomy after supracervical hysterectomy, as well as techniques and possible complications. Radical trachelectomy performed as fertility sparing surgery in women with early stage cervical cancer is discussed separately. (See "Fertility sparing surgery for invasive cervical cancer".)

INDICATIONS

Trachelectomy is typically performed after prior supracervical hysterectomy to treat disease or symptoms referable to the cervical stump. It may also be performed in conjunction with other pelvic surgery (eg, oophorectomy, bowel resection). In the largest series of trachelectomy from a single institution (n = 310 cases from 1974 to 2003), the most common indications were [6]:

Prolapse (52 percent)

Pelvic mass (25 percent)

       

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Literature review current through: Mar 2014. | This topic last updated: Jan 13, 2014.
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References
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