ABSTRACT
Before the Second World War, the universal approach to hysterectomy had been the subtotal procedure, because this was associated with a reduced risk of ureteric injury, haemorrhage, and in particular postoperative sepsis [1]. However, as operative gynaecology became safer, in part secondary to the introduction of antibiotics, surgical practice changed in favour of total hysterectomy. The impetus for this change was primarily to prevent cervical stump carcinoma because the recognition of preinvasive lesions by exfoliative cytology had not been developed [2]. Subtotal hysterectomy subsequently fell into disrepute. Even today, many surgical textbooks merely refer to subtotal hysterectomy. For instance, in Bonney’s Gynaecological Surgery published in 1986, it is stated that subtotal hysterectomy is: ‘. . . only mentioned to say that there is no indication for its presence in a modern surgical text. There is no evidence that the incidence of vaginal prolapse is higher after a total hysterectomy than a subtotal one, and no evidence of a reduction in the patient’s capacity for vaginal orgasm after removal of the cervix . . .’ [3].The recognized indications for the subtotal procedure have therefore been restricted to caesarean hysterectomy, obliteration of the cul-de-sac with adhesions, and cases where the cervix is grossly elongated. Not surprisingly, some regard the performance of the operation as evidence of a lack of skill on the part of the surgeon [4].
