embolization versus myomectomy versus hysterectomy which is best when

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A., Birnie, E., van der Kooij, S. M., Volkers, N. A., & Hehenkamp, W. J. K. (2016). It involves canalization of the femoral artery, which may be achieved on one or both sides at the same time. In addition to patient care, Dr. Lalezarian teaches and supervises medical students, residents, and fellows as a full-time teaching Professor in the Department of Radiology at UCLA. 1 Symptomatic fibroids usually present with vaginal bleeding, pain, and other symptoms, such as dyspareunia, urinary frequency or urgency, and . Scars: UFE vs Myomectomy vs Hysterectomy - Los Angeles Fibroid Center It would appear that after abdominal myomectomy, the recurrence rate varies from 5.711.1% (Fauconnier et al., 2000). An official website of the United States government. Bookshelf In the initial series, there have been few women treated who have desired pregnancy, so most information is anecdotal. Our own in Scotland, which is a randomized controlled trial of UAE against surgical treatment, which will assess all aspects of the gynaecological and social problem, as well as including a detailed cost analysis. However, if the fibroid protrudes into the uterine cavity, myomectomy can be achieved hysteroscopically. For Patients - Gynesonics An official website of the United States government. Cochrane Database Syst Rev. The best treatment for you will ultimately depend on your individual medical history and health condition. It can be well controlled using parenteral analgesia similar to that used after laparotomy, but is usually the reason why an in-patient stay is required. Allameh Z, Afzali S, Jafarpisheh M, Movahedi M, Mousavi Seresht L. Med J Islam Repub Iran. One clinical study that followed women for multiple years after treatment observed that women have about a 10% chance of dealing with recurrent fibroids within 2 years of their first treatment.. [6] Davis, M. R., Soliman, A. M., Castelli-Haley, J., Snabes, M. C., & Surrey, E. S. (2018). Both patient and GP also receive information as to what should be expected after the procedure with the phone number of an individual to contact at any time. [1] Gupta et al. Uterine fibroids are the most common tumour in the female reproductive system. Infection may be more prevalent in certain racial groups. Our physicians specialize in UFE and have helped countless women overcome fibroids without major surgery. The VALUE (Vaginal, Abdominal, Laparoscopic Uterine Excision) study of 37 000 hysterectomies carried out for benign indications and excluding post-partum hysterectomy, recorded 14 deaths in total, of which eight were in women aged 51 years (M.Maresh and K.McPherson, unpublished data). Anchan RM, Wojdyla D, Bortoletto P, Terry K, Disler E, Milne A, Gargiulo A, Petrozza J, Brook O, Srouji S, Morton CC, Greenberg J, Wegienka G, Stewart EA, Nicholson WK, Thomas L, Venable S, Laughlin-Tommaso S, Diamond MP, Maxwell GL, Marsh EE, Myers ER, Vines AI, Wise LA, Wallace K, Jacoby VL, Spies JB. Fibroid specialist Dr. Michael Lalezarian compares myomectomy vs hysterectomy vs UFE for the treatment of fibroids and discusses which option is best for you. Side effects describe unintended negative interactions between the treatment and the body. Long-term satisfaction is high even in those experiencing pre-operative or early post-operative complications. The success of myomectomy is less certain since no randomized trials against expectant management have ever been carried out. If youre still unsure of which treatment is best for you, another way to look at all of these decision points is to ask three critical questions: 1. There is a small chance that what was thought to be a fibroid could instead be a . Uterine artery embolization versus myomectomy to treat uterine fibroids None. The https:// ensures that you are connecting to the Long Term Health-Related Quality of Life and Symptom Severity Following Hysterectomy, Myomectomy, or Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids. 3 Effective: UFE is just as safe and equally effective. Fastest Recovery: Patients that have a UFE procedure have a much shorter recovery time than patients that undergo hysterectomy or myomectomy surgery. The relationship between fibroids and fertility was reviewed by Vercellini, with consideration of data from nine prospective studies (Vercellini et al., 1998). Five early miscarriages occurred and the seven other pregnancies were uneventful. This has been reported following administration of GnRH agonist and is probably associated with a rapid change in size of an intracavity of submucous fibroid. The risk/benefit equation is different in this group than when the operation is life saving, for example in the presence of malignant disease,. Medical treatment may be useful in specific instances and for the short-term, but does not lead to a cure. The da Vinci robotic myomectomy is another technique that offers precision and smaller incisions on open procedure. Many units within the UK's National Health Service are adhering to these guidelines, with patients being referred into centres whereby detailed audit can be performed. Hysterectomy is a more invasive surgery, so it has a longer recovery time. Hysterectomy is associated with a high level of satisfaction. The mean difference in the primary outcome at 4-year follow-up was 5.0, in favor of myomectomy: 95% CI: -1.4 to 11.5 (P = 0.13). On the other hand, UFE and myomectomy are uterus-sparing procedures, meaning that women still have a chance of getting pregnant afterward. These are listed in Table I. However, women who have conservation of their ovaries at the time of hysterectomy may also go through an earlier menopause (Siddle et al., 1987), possibly due to interference in the blood supply. Data from clinical studies suggest that major side effects and complications are more common in patients that undergo major surgery (hysterectomy or myomectomy) than in patients that undergo UFE. Management of Fibroids for Patients desiring Pregnancy: UAE (Uterine When stratified by route, minimally invasive hysterectomy had better HRQOL scores than minimally invasive myomectomy. Studies estimate this to be between 10 and 20/1000 operations (Bernstein et al., 1997). Hysterectomy permanently removes the uterus, so it is not an option for women who want to have children in the future. Uterine fibroids are the most common benign tumours in women of the reproductive age. 2015 Mar;37(3):277-285. doi: 10.1016/S1701-2163(15)30318-2. RANDHealth. 2015 Feb;37(2):157-178. doi: 10.1016/S1701-2163(15)30338-8. There was little difference in scores with abdominal approaches. Delivery prior to 37 weeks occurred in three instances and there was one case of toxaemia. 2020 Mar;113(3):618-626. doi: 10.1016/j.fertnstert.2019.10.028. The .gov means its official. The incidences of perioperative and postoperative complications from all initial procedures were similar for both groups: 29% in the myomectomy group vs. 24% in the UAE group. Fibroids can range in size from as small as a pinhead to larger than a melon. Hysterectomy is associated with a high rate of satisfaction and is likely to relieve menstrual problems in virtually all women. Uterine artery embolisation or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: a cost-utility analysis of the FEMME trial. (2014). Careers. Prolapse of the uterine fibroid through the cervix can be a distressing symptom for women after embolization (Abbara et al., 1999; Berkowitz et al., 1999). This means that an alternative treatment has to be extremely good in order to have a higher satisfaction rate than hysterectomy itself. Please enable it to take advantage of the complete set of features! This is more likely when the register is local and most of the participants carrying out this procedure are known. This can result in the formation of post-operative adhesions that may impair fertility further. eCollection 2022. UFE might be the better option in these cases. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. An incision-free, uterus . Many women are busy with work, family, and other obligations, and cannot afford to take an extended leave from their responsibilities to heal from a major surgery. Incisions into the uterus to remove fibroids can lead to adhesions bands of scar tissue that may develop after surgery. Fibroids: diagnosis and management | The BMJ When we consult with patients about their options, we tend to focus on these 7 decision points (these are also good points to discuss with your gynecologist): Invasiveness how much trauma is involved in the procedure? Disclaimer. Generally speaking a hysteroscopic approach requires no hospital stay and 1-4 days of recovery at home, a laparoscopic or robotic approach requires one night in the hospital and a 4 week recovery at home, and an abdominal approach requires a few days in the hospital and a recovery period of up to 6 weeks. Haemorrhage occurred in 2.1, 3.1 and 2.7% of abdominal, vaginal and laparoscopic hysterectomy respectively. PMC Would you like email updates of new search results? Classically, treatment has been surgical with hysterectomy the most common approach for women who have completed their fertility and myomectomy for those who wish to conceive. There are numerous unsubstantiated theories as to why fibroids cause symptoms and these have been extensively reviewed (Lumsden and Wallace, 1998). Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Hysterectomy is the only treatment option that cures fibroids and eliminates any chance of fibroid recurrence. The procedure is performed through a single puncture in the leg with no major incisions and no cutting, making it the least invasive option available for fibroids. - If youre planning to get pregnant in the future, hysterectomy is definitely not an option for you. Abdominal Myomectomy Versus Uterine Fibroid Embolization in the - AJR UAE impairs ovarian reserve and is associated with significant post-intervention endometrial abnormalities. Who are appropriate candidates for the various treatment options? A hysterectomy is a surgical procedure to remove the uterus. Dr. Lalezarian Explains Fibroid specialist Dr. Michael Lalezarian compares myomectomy vs hysterectomy vs UFE for the treatment of fibroids and discusses which option is best for you. Women who have uterine artery embolization require extremely careful and long-term follow-up as complications have been reported as long after the procedure as 4 months. MeSH If you are considering a myomectomy, you should talk to your doctor about the risks and benefits of the procedure. Carranza-Mamane B, Havelock J, Hemmings R; REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY COMMITTEE; SPECIAL CONTRIBUTOR. Please enable it to take advantage of the complete set of features! For obvious reasons, minimal recovery time is ideal. Department of Obstetrics and Gynaecology, Queen Mother's Hospital, Yorkhill, Glasgow G3 8SJ, UK. Scars: UFE vs Myomectomy vs Hysterectomy - California Fibroid Center Complications, on the other hand, describe things that can go wrong during a procedure that causes some degree of harm to the patient. Uterine artery embolisation (UAE) has been in use since 1991 as a "noninvasive . It is thought that >10 000 procedures have now been performed, although it is difficult to get an accurate figure. Anchan RM, Spies JB, Zhang S, Wojdyla D, Bortoletto P, Terry K, Disler E, Milne A, Gargiulo A, Petrozza J, Brook O, Srouji S, Morton CC, Greenberg J, Wegienka G, Stewart EA, Nicholson WK, Thomas L, Venable S, Laughlin-Tommaso S, Diamond MP, Maxwell GL, Marsh EE, Myers ER, Vines AI, Wise LA, Wallace K, Jacoby VL. UAE offers no significant procedural risk reduction over myomectomy. and Kitchener, H.C. (, Querleu, D., Cosson, M., Parmentier, D., Debodinance, P. and Crepin, G. (, Ravina, J.H., Herbreteau, D., Ciraru-Vigneron, N., Houdart, E., Aymar, A. and Merland, J.J. (, Ravina, J.H., Ciraru-Vigneron, N., Aymard, A., Le Dref, O. and Merland, J.J. (. The morbidity and mortality must be compared with surgical treatment, since no new intervention should be introduced that is less safe than this effective, acceptable treatment for menstrual problems. Because theres a lot of information to consider, we also put together this infographic to help you navigate the details. Before 2014 Oct 21;(10):CD004638. Also, it is as yet unknown whether the incidence of fibroid recurrence will be similar to that after myomectomy since there are no studies with sufficient long-term follow up. Myomectomy vs Hysterectomy vs UFE - Which is Best? The incidence of complications at hysterectomy is increased in the presence of uterine fibroids (data from VALUE study) (Maresh and McPherson, 2001). [5] de Bruijn, A. M., Ankum, W. M., Reekers, J. However, since the late 1980s, the new option of laparoscopic hysterectomy (Reich et al., 1989) has raised questions about the most suitable type of approach. Epub 2023 Jan 13. Occasionally, the bleeding can be sufficiently heavy as to require hysterectomy. Hysterectomy has been compared with endometrial ablation in the treatment of menstrual problems in several studies, which have suggested that as many as 95% of women will be satisfied (Pinion et al., 1994; O'Connor et al., 1997). He is regarded as an expert in uterine fibroid embolization. Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT Health Technol Assess. Results of different treatments are comparable. Dr. Michael Lalezarian is a practicing interventional radiologist with the Fibroid Specialists of University Vascular in Los Angeles, CA. Rana D, Wu O, Cheed V, Middleton LJ, Moss J, Lumsden MA, McKinnon W, Daniels J, Sirkeci F, Manyonda I, et al. Uterine artery embolisation versus myomectomy for - PubMed Prostaglandin synthetase inhibitors are effective in a proportion of women and GnRH agonists or danazol (agents that produce amenorrhoea), can be useful in some instances (Stovall et al., 1991; Maheux and Lemay, 1992; West et al., 1992; Davis and Schlaff, 1995). 2012 May 16;(5):CD005073. Myomectomy is surgery to remove uterine fibroids. National Library of Medicine Hysterectomy can be performed using different surgical approaches such as a vaginal hysterectomy, laparoscopy-assisted vaginal hysterectomy (LAVH), robotic-assisted laparoscopic hysterectomy, or abdominal hysterectomy (open surgery). Can lead to long-term physical and psychological effects such as incontinences, loss of sexual pleasure, and depression. Fertility after uterine artery embolization: A review. (, Fauconnier, A., Chapron, C., Babaki-Fard, K. and Dubuisson, J.B. (, Fedele, L., Parazzini, F., Luchine, L., Mezzopare, R., Iozzi, L. and Villa, L. (, Goldenberg, M., Bider, D., Sivan, E., Rabinovici, J., Sharabi, Z. and Seidman, D.S. Women who have a UFE or a myomectomy procedure may have an additional UFE or myomectomy procedure to address fibroid recurrence, or undergo a hysterectomy sometime later. HHS Vulnerability Disclosure, Help American Journal of Obstetrics and Gynecology, 215(6), 745.e1-745.e12. Prospective cohort study. When stratified across race/ethnicity and age, hysterectomy had higher HRQOL scores compared with myomectomy. For multiple myomas or a significantly enlarged uterus, this will be achieved, most often, by the abdominal route. Hyattsville, Maryland. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. FOIA 2023 Apr;32(4):423-433. doi: 10.1089/jwh.2022.0133. Vilos GA, Allaire C, Laberge PY, Leyland N; SPECIAL CONTRIBUTORS. Fibroids have been reported weighing more than 40 pounds. However, hysterectomy is a very successful operation with as many as 8590% of women being satisfied with the operation and reporting improved quality of life. Lowest Recurrence Rate: Hysterectomy eliminates any chance of fibroid regrowth or new fibroid formation. J. Intervent. Ability to Become Pregnant: There are several reports of healthy, successful pregnancies after UFE and myomectomy. 2014 Dec 26;(12):CD005073. Uterine fibroids are the commonest tumour affecting the female reproductive tract. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Myomectomy | Johns Hopkins Medicine The management of uterine fibroids in women with otherwise unexplained infertility. This blog post was written with research and editorial assistance from OnChart. Overall, the incidence of significant complications is low. 1 Box 1 lists the several risk factors for fibroids. It is unusual for symptoms to appear prior to the age of 30 years and these will usually disappear at the time of the menopause. The former will be considered further in this debate. 2019 Aug;134(2):261-269. doi: 10.1097/AOG.0000000000003354. 2023 Apr 20;13(4):e070830. Resource use, costs and health outcomes . Advertisement intended for healthcare professionals. Inevitably, sepsis is a major problem, although it is possible that this may be related to the site and size of the fibroids and also to the patient groups in question, although insufficient data are available to confirm this. Brechin, S., Farquharson, D.M., Hawthorn, R., Davis, J., Fisher, P., Philips, W. and Lumsden, M.A. Generally, invasiveness describes the level of trauma thats associated with a procedure. In the above infographic, we use green to highlight where a treatment provides an advantage over others, and red to show where a treatment provides some disadvantage compared to another treatment. Technology assessment: Number 34. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Unlike surgery, there is virtually no blood loss during the UFE procedure. In the case of hysterectomy, patients may have a follow-up to the procedure to correct persistent abdominal pain, hernia, or prolapse. Risk of Reintervention will I need another procedure for my fibroids in the future? The larger the size of the uterus, the greater the risk of significant blood loss and trauma to the surrounding structures. Subserosal fibroids can also be removed laparoscopically. Myomectomy preserves the uterus, so it is an option for women who want to have children in the future. J Womens Health (Larchmt). doi: 10.1136/bmjopen-2022-070830. Consequently, other modalities are being developed, one of which is uterine artery embolization. 2. Five-Year Lapsed: Review of Laparoscopic Myomectomy versus Open Myomectomy in Putrajaya Hospital. However, it is important that studies are carried out to investigate the incidence of uterine rupture and possible problems with placentation, although this has not been reported in women who have had embolization for other causes. With the exception of units serving a large Afro-American population, the number of myomectomies performed is small, which calls the overall success of the operation into question and explains why alternatives are being sought. However, it is associated with significant complications and requires further evaluation before being accepted as a useful alternative to surgical therapy in the management of women with uterine fibroids. [6] Davis, M. R., Soliman, A. M., Castelli-Haley, J., Snabes, M. C., & Surrey, E. S. (2018). Am J Obstet Gynecol. Accessible myomas can be resected with an operating endoscope through the cervix. Maria Vargas, M.D., a fellowship-trained Gyn/Ob at Johns Hopkins' Sibley Memorial Hospital . women >40 years, and their causality is unproven. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Bethesda, MD 20894, Web Policies One significant complication associated with the procedure is a post-embolization syndrome similar to that following myocardial infarction and possibly related to the release of cytokines and toxins from the ischaemic tissues. Patient(s): Intervention(s): The .gov means its official. If the uterus is not removed, as is the case with UFE or myomectomy, fibroids can regrow or entirely, If youve evaluated your options and you feel that major surgery isnt right for you, you can schedule a consultation with the, Dr. Michael Lalezarian is a practicing interventional radiologist with the Fibroid Specialists of University Vascular in Los Angeles, CA. In many instances they are asymptomatic, but in some women there does appear to be an association with heavy menstrual blood loss and, possibly, subfertility. As important as it is to understand the benefits of treatment, its equally important to understand the safety profile of it as well. Myomectomy vs Uterine Artery Embolization for Fibroids - Medscape Do you aspire to get pregnant in the future? This might suggest that the location, size and number are of importance, although data for the assertion are lacking. The prevalence of asymptomatic fibroids is unknown. Many women learn about their fibroids in the middle of their childbearing years and are concerned about the impact of fibroids and fibroid treatment on their ability to become pregnant. There is a small but significant mortality associated with hysterectomy. In fact, many women who face infertility choose a myomectomy to improve their chances of conceiving. UFE vs Others Lower Risks: UFE is less invasive. Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids Fertil Steril. Both procedures were equally effective in controlling pain. Prehysterectomy embolisation of uterine arteries for large uterine In most series, including our own, ovarian failure after UAE was found to occur most often in women in their late forties, when already nearing the menopause, with an overall incidence of 5%. Radiol., in press. A vast majority of those being treated have completed their families. Hysterectomy is the only treatment option that cures fibroids and eliminates any chance of fibroid recurrence. MR-1158 CIRREF. There is still insufficient data from UAE regarding recurrence, the incidence of premature menopause, the outcome of pregnancy and quality of life. RAND Health. There were no differences in baseline HRQOL. How often do women need additional procedures after conservative therapy for fibroids? Shortest Hospital Stay: UFE requires the shortest hospital stay, and in some cases, patients are able to return home on the day of the procedure. It is only then that the questions posed in Table I and in the title, can be answered. This is probably related to the development of intrauterine adhesions, a potential issue for those wishing to conserve fertility. Recovery Time how many weeks until I can return to my daily activities? 2015 Sep;26(9):1277-84. doi: 10.1007/s00192-015-2665-1. Federal government websites often end in .gov or .mil. MeSH After adjustment for baseline differences between groups, compared with myomectomy, patients' HRQOL (95% confidence interval [CI], 5.4, 17.2) and symptom severity (95% CI, -16.3, -8.8) were significantly improved with hysterectomy. Compare each treatment's invasiveness, recovery time, safety, pregnancy, and side effects in this detailed review. Over time, the treated fibroid shrinks and your symptoms will reduce or disappear. Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT. For women with submucous fibroids, hysteroscopic myomectomy maybe the most appropriate route. For benign indications, many countries have favoured either the abdominal (Harkki-Siren et al., 1997) or the vaginal approach (Querleu et al., 1994). (3) . By age 50 nearly 70% of white women and more than 80% of black women have had at least one fibroid. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Does additional treatment result in significantly increased morbidity compared with immediate definitive therapy? Trials. HHS Vulnerability Disclosure, Help Menorrhagia may be better controlled with embolization, and myomectomy may be a better option in patients with mass effect. and transmitted securely. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Category C1 is defined as, `Safety and/or efficacy not yet established; procedure requires a fully controlled evaluation and may be used only as part of systematic researchan observational study in which all interventions and their outcomes are systematically recorded'. Myomectomy vs. Fibroid Embolization: Which Treatment is Best for you? E-mail: Search for other works by this author on: European Society of Human Reproduction and Embryology, The risk of miscarriage following COVID-19 vaccination: a systematic review and meta-analysis, How common is natural conception in women who have had a livebirth via assisted reproductive technology? They may be single or multiple and their size varies from a few millimetres to 30 cm or more. Online ahead of print. In some instances the myoma can cause tubal occlusion and it is possible that there may be a foreign body reaction with endometrial inflammation, altered vascularity or altered contractility (Buttram and Reiter, 1981; Stewart, 2001). A recent study carried out in Glasgow suggests that it is associated with significant morbidity in 3% of cases and minor morbidity in 14%, the total cost of operation being 2400 ( Lumsden et al ., 2000 ). These alternatives include uterine artery embolization and myolysis. 1Department of Obstetrics and Gynaecology, University of Glasgow, UK. Many women have a myomectomy with the aim of improving fertility. In many instances they are asymptomatic, but in some women there does appear to be an association with heavy menstrual blood loss and, possibly, subfertility. Copyright 2023 European Society of Human Reproduction and Embryology. The https:// ensures that you are connecting to the There has been a further anecdotal report of a death, in Italy, of a woman who had pulmonary embolus after embolization. There have been reports in the literature of two deaths, one occurring from sepsis and a second, not related to the procedure, but due to ovarian cancer that might have been treated had the women in question had a hysterectomy (Vashisht et al., 1999; Armstrong and Caird, 2001). An update on uterine artery embolization for uterine leiomyomata and adenomyosis of the uterus. (2000) A Scottish audit of laparoscopically assisted vaginal hysterectomy. . [5] de Bruijn, A. M., Ankum, W. M., Reekers, J. Uterine Artery Embolization versus Myomectomy: Impact on - Springer Key questions that might be useful to consider when assessing surgical treatment for fibroids, Abbara, S., Spies, J., Scialli, A., Jha, R., Lage, J. et al. Our own study cited above would support these data. However, they can also discuss the other treatment options, including myolysis and endometrial ablation. Unable to load your collection due to an error, Unable to load your delegates due to an error. Fertility after uterine artery embolization: A review. Risk of Fibroid Recurrence will the fibroids come back? The normal myometrium rapidly develops a new blood supply from collateral circulations, whereas the fibroids do not. Out of all the surgical approaches, open surgery is a more invasive procedure, so it has a longer recovery time and is only used if necessary. The significance of this is less since these women do not wish to maintain their fertility. Uterine-Artery Embolization or Myomectomy for Uterine Fibroids Myomectomy appears to be an effective treatment for menstrual problems in many instances, although overall these studies have used subjective means of assessment with variable length and enthusiasm of follow-up (Derman et al., 1991). In those attending their gynaecology clinics, menstrual problems and pressure symptoms are common. Uterine Fibroids, Perceived Stress, and Menstrual Distress: a Key Role of Heavy Menstrual Bleeding. [2] de Bruijn, A. M., Ankum, W. M., Reekers, J. www.ahcpr.gov, Berkowitz, R., Hutchins, F. and Worthington-Kirsch, R. (, Bernstein, S., Fiske, M., McGlynn, E. and Gifford, D. (1997) Hysterectomy: a review of the literature on indications, effectiveness and risks. Abdominal hysterectomy is a major operation, involving a hospital in-patient stay of 35 days and a convalescence time of several weeks.