Hysterectomy risks, benefits are questioned

December 08, 1992|By Los Angeles Times

Women who undergo 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 report in today's 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 the obvious risks of the surgery for the 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 (UCLA), School of Medicine.

"Our data show that women who have a benign ovarian or adjacent mass and a healthy uterus fare better without hysterectomy," Dr. 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 and medical director for the nurse-midwife program at the Naval Hospital of San Diego: "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 are for benign cysts. Of these 65,000, said Dr. Gambone, the uterus is healthy in about 40,000 cases.

Although the practice has become less popular in the last 10 years, surgeons traditionally remove the uterus, ovaries and Fallopian tubes when removing a benign mass to prevent future problems with the uterus, such as cancer, bleeding or other cysts or fibroids, Dr. Gambone said.

Typically, benign cysts and tumors do not increase a woman's risk of developing cancer, experts say.

"That's the justification for removing the uterus: 'The abdomen is open, the woman is asleep, we're already here, lets 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, conducted by UCLA, University of Iowa College of Medicine and San Diego Naval Hospital researchers, 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 shows.

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