TITLE:
Vaginal Trachelectomy for Retained Cervical Stump after Supracervical Hysterectomy: Technical Tips and Outcomes
AUTHORS:
Mohamed Ayaty, Hisham Khalifa, Sherif M. S. Abohleka, Haitham Abdel Wahab
KEYWORDS:
Supracervical Hysterectomy, Cervical Stump, Vaginal Trachelectomy
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.7,
July
25,
2022
ABSTRACT: Background and
Objectives: The supracervical hysterectomy (SCH) has resulted
in a group of patients with a retained cervix at risk of persistent symptoms,
who may require a trachelectomy in the future. This study was to evaluate the
efficacy of vaginal trachelectomy (VT) after a previous SCH. Methods: This was a prospective study that includes 13 cases
with different ages and different complaints, sharing
the same primary operation supracervical hysterectomy.
They have different pathologies of the SCH specimen but they share the
same completion surgery. The surgical outcome was analyzed. Results: Thirteen patients underwent vaginal trachelectomy
for recurrent symptoms. The ages of patients were ranged from 37 years to 68
years (Mean ± SD, 56.4 ± 10.7). SCH was most commonly
performed for abnormal uterine bleeding AUB (7/13, 53.8%), pelvic
mass (5/1, 38.5%), and pelvic pain (1/13, 7.7%), the symptoms leading to vaginal trachelectomy
were the same as those leading to
supracervical hysterectomy. The median interval time from SCH to seeking
medical help for the persistence or recurrence of symptoms and to VT was
2 weeks (1 to 96 weeks). Concomitant procedures were laparoscopic removal of
both ovaries in 2 cases and pelvic lymphadenectomy in 1 case. The median length
of operation was 45 minutes. In all cases, symptoms leading to trachelectomy
resolved completely after surgery, and patients reported a significant
improvement. Conclusions: The cervix, left behind at subtotal
hysterectomy, requires removal, the vaginal route is probably the safest, and
least traumatic. Vaginal radical
trachelectomy appears to be feasible and safe for the treatment of
endometrial malignancy discovered after supracervical hysterectomy.