SUB TOTAL

HYSTERECTOMY
Dr Saba Abbas
 A Q U I C K R E V I E W A B O U T W H AT S S U B
T O TA L H Y S T R E C T O M Y, I T S A L S O C A L L E D
lady xyz47 years old para 3 all svds presented with irregular per
vaginal bleeding despite having medical treatment. She had intra
mural fibroid of 5.7 into 5.5 cm in the fundal area. She had a small
cervical polyp of 1 into 2 cm. she was planned for myomectomy
and hysteroscopic removal of cervical polyp.as per patient’s wish
the plan was changed to total abdominal hysterectomy with
preservation of ovaries.
 PER OPERATIVE FINDINGS

Multiple fibroids ,Largest one on fundus, second was right lateral

and third was cervical fibroid in right wall
Pouch of Douglas was shallow

Posterior dissection of cervix was not possible due to close

proximity of rectum and long cervix.
 INDICATIONS

Dens adhesions due to previous pelvic surgeries

Disseminated endometriosis

Chronic PID

Normal looking cervix

Availability of cervical screening

 BENEFITS

Takes less time than total hysterectomy

Less per operative bleeding

Less intra op and per op complications

In TAH vaginal length is shortened.

Cervical stump prolapse is less common than vaginal vault

prolapse
 DRAWBACKS

Risk of developing cervical cancer

Require cervical screening

Patient continue to bleed cyclically

There is no proven difference in
sexual desire

Achievement of orgasm

No difference between bowel and bladder function