NEW YORK (Reuters Health) - One of the latest approaches to hysterectomy is to remove the uterus via a "keyhole" incision, leaving the cervix in place, and the results seem to be satisfactory to most women who undergo the procedure, a follow-up survey shows.

However, many women continue to experience vaginal bleeding and some degree of pelvic pain, although these symptoms are not as severe as before the surgery.

Dr. M. Lieng at Ulleval University Hospital in Oslo, Norway, and colleagues mailed questionnaires to 315 women who had a so-called supracervical laparoscopic hysterectomy to see how they were faring.

Up to three years after surgery, 24 percent still had vaginal bleeding, although the average "bothersome score" was just 1.1 on a 10-point scale, the investigators report in BJOG: An International Journal of Obstetrics and Gynaecology.

Approximately 74 percent of the women reported experiencing pain before surgery, with an average score of 6.8 on a 10-point scale. While all women reported less pain after surgery, "38 percent continued to experience menstrual pain, although this was significantly less intense with a mean score of 3.5," Lieng's group reports.

Fifty percent of the women did not realize they might have persistent bleeding after their surgery. Still, 20 percent were satisfied and 70 percent were very satisfied with their result.

However, Dr. R. Garry of Guisborough, Yorkshire, UK, sees little advantage to the procedure over conventional hysterectomy in the long run.

In an editorial, Garry writes: "There appear to be no long-term benefits associated with retention of the cervix and there are some important negative consequences."

One drawback is that regular cervical screening for cancer is still necessary, "and there are risks of continued vaginal bleeding and postoperative pain, particularly if the procedure is associated with endometriosis."

SOURCE: BJOG, December 2008.

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