Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology

Objective: The objective of the study was to draw up French College of ă Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on ă the best available evidence concerning hysterectomy for benign disease. ă Methods: Each recommendation for practice was allocated a grade, which ă depends on the level of evidence (clinical practice guidelines). ă Results: Hysterectomy should be performed by a high-volume surgeon (>10 ă hysterectomy procedures per year) (grade C). Stimulant laxatives taken ă as a rectal enema are not recommended prior to hysterectomy (grade C). ă It is recommended to carry out vaginal disinfection using ă povidone-iodine solution prior to hysterectomy (grade B). Antibiotic ă prophylaxis is recommended during hysterectomy, regardless of the ă surgical approach (grade B). The vaginal or laparoscopic approach is ă recommended for hysterectomy for benign disease (grade B), even if the ă uterus is large and/or the patient is obese (grade C). The choice ă between these two surgical approaches depends on other parameters, such ă as the surgeon's experience, the mode of anesthesia, and organizational ă constraints (duration of surgery and medical economic factors). Vaginal ă hysterectomy is not contraindicated in nulliparous women (grade C) or in ă women with previous cesarean section (grade C). No specific hemostatic ă technique is recommended with a view to avoiding urinary tract injury ă (grade C). In the absence of ovarian disease and a personal or family ă history of breast/ovarian carcinoma, the ovaries should be preserved in ă premenopausal women (grade B). Subtotal hysterectomy is not recommended ă with a view to reducing the risk of peri-or postoperative complications ă (grade B). ă Conclusion: The application of these recommendations should minimize ă risks associated with hysterectomy. (C) 2016 Elsevier Ireland Ltd. All ă rights reserved.