Abdominal hysterectomy for benign indications: evidence-based guidance for surgical decisions

The purpose of this review is to provide evidence-based guidance for surgical decisions during abdominal hysterectomy performed for benign indications. Using combinations of terms "abdominal," "hysterectomy," and "randomized clinical trials (RCT)," we performed Ovid, PubMed, and Cochrane searches for publications between 1988 and 2008. After reviewing over 3,000 abstracts, 19 RCT were identified. There are no grade A recommendations. The only grade B suggestion is use of a bipolar vessel sealing device (LigaSure) for vascular pedicles rather than sutures. Routine closure of peritoneum should be avoided. Evidence behind 71 % (15/21) of surgical steps is insufficient (grade I). Despite its common performance, there are no grade A recommendations that can be made for the technical aspects of abdominal hysterectomy. Since almost 70 % of the surgical steps during abdominal hysterectomy lack randomized clinical trials, adequately designed studies are needed to decrease perioperative morbidity.