A Look Forward to the Past.

Probably the most classic operation in gynecology, other than dilatation and curettage, is the total abdominal hysterectomy with bilateral salpingo-oophorectomy.

It is important to realize, however, that the majority of these operations are done for benign uterine conditions such as fibroids, endometriosis, and various types of menstrual disorders that are refractory to medical or other simpler surgical procedures. Removing the cervix and the ovaries, therefore, may be overkill.

In the vast majority of total hysterectomies, the cervix need not be removed. The total hysterectomy was invented be- fore the Pap smear was devised. Cervical cancer was a much more lethal disease then. Since there was no way to screen for it and the diagnosis was dependent on biopsying any suspicious areas, it made perfect sense to remove the cervix, especially after the development of antibiotics allowed surgical entry into the vagina without fear of massive infection.

The majority of complications from total abdominal hysterectomy come from the removal of the cervix. By amputating the uterus after ligating the uterine vessels, the patient is spared considerable blood loss, danger of bladder and ureteral injuries, and infection. These complications can be virtually abolished by performing supracervical hysterectomies. In addition, the jury is still out on whether the cervix has a function in a woman's sexuality.

Regarding bilateral oophorectomy, many of us were trained that if a woman was over 40 her ovaries should ...