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Most hysterectomies not worth it.

Women who have had hysterectomies for the removal of benign ovarian cysts experience five times the number of complications as women who have the same diagnosis but no hysterectomy, researchers reported in a recent Journal of Women's Health.

For more than a decade physicians have debated whether the benefits of hysterectomy--the second most common surgery performed in the United States (cesarean section is first)--outweigh the risks for certain gynecological problems.

The study details obvious risks of the surgery for removal of benign tumors while the benefits remain unproven, said one of the study's authors, Dr. Joseph Gambone, associate professor of obstetrics and gynecology at the University of California, Los Angeles School of Medicine.

"Our data show that women who have a benign ovarian or adjacent mass and a healthy uterus fare better without hysterectomy," Gambone said. "There can be significant problems when the uterus is removed electively, and the benefits have not been demonstrated in any definitive way."

There are specific reasons why a woman should undergo a hysterectomy, experts say. These include uterine cancer, abnormal growth of the uterine tissue (called endometrial hyperplasia), large fibroids that cause pressure or pain and uncontrollable bleeding.

But, said Dr. Joel Lench, a co-author of the study, "There is still not 100 percent agreement by everyone about what's necessary and what's unnecessary."

About 650,000 hysterectomies are performed annually in the United States; about 65,000 of these for benign cysts. Of these 65,000, says Gambone, the uterus is healthy in about 40,000 cases.

Although the practice has become less popular in the last 10 years of so, surgeons traditionally remove the uterus, ovaries and Fallopian tubes when removing a benign mass in order to prevent future problems with the uterus, such as cancer, bleeding or other cysts or fibroids. Typically, benign cysts and tumors do not increase a women's risk of developing cancer. experts say.

"That's the justification for removing the uterus: |The abdomen is open. the women is asleep, we're already here, let's take everything out.' That is the practice plan we are questioning?" he said. "Since the benefits are all theoretical--no one has ever measured them--we wanted to look at what are the risks."

The study compared 100 women who underwent hysterectomy for benign cysts to 100 women who had benign cysts removed but did not lose the uterus.

The women with hysterectomies, whose average age was 45, had five times the rate of complications (28 percent compared to 5 percent), including urinary tract and wound infections, thrombosis and fever with illness, the study showed.

Moreover, the average hysterectomy patient had more than double the blood loss, and three hysterectomy patients underwent transfusions compared to none in the other group. The hospital stay was more than double for hysterectomy patients (5.2 days compared to 2.6 days).

There was also one death in the hysterectomy group, although the study was too small to determine overall death rates. Typically, hysterectomy produces a death rate of about one in 500 to 1000.

With the added financial costs of hysterectomy, the surgery should not be recommended for benign cysts, Gambone said.
COPYRIGHT 1993 Association of Labor Assistants & Childbirth Educators
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Publication:Special Delivery
Date:Mar 22, 1993
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