Study Questions Worth of Some Hysterectomies : Health: Women with benign ovarian tumors are found to suffer fewer problems if only cysts are removed.

Women who undergo hysterectomies for removal of benign ovarian cysts experience five times the number of complications as women who have the cysts removed but no hysterectomy, Southern California and Iowa researchers reported today in the Journal of Women’s Health.

For more than a decade, physicians have debated whether the benefits of hysterectomy--the second most common surgery performed in the United States (Cesarean section is first)--outweigh the risks for certain gynecological problems.

Today’s study details obvious risks of hysterectomy for removal of benign tumors while the benefits remain unproven, said one of the study’s authors, Dr. Joseph Gambone, associate professor of obstetrics and gynecology at the UCLA School of Medicine.

“Our data show that women who have a benign ovarian or adjacent mass and a healthy uterus fare better without hysterectomy,” Gambone said. “There can be significant problems when the uterus is removed electively, and the benefits have not been demonstrated in any definitive way.”

There are specific reasons why a woman should undergo a hysterectomy, experts say. These include uterine cancer, abnormal growth of the uterine tissue (called endometrial hyperplasia), large fibroids that cause pressure or pain, and uncontrollable bleeding.

But, said Dr. Joel Lench, a co-author of the study and medical director for the nurse-midwife program at the Naval Hospital of San Diego: “There is still not 100% agreement by everyone about what’s necessary and what’s unnecessary.”

About 650,000 hysterectomies are performed annually in the United States, about 65,000 of them for benign cysts. Of these, Gambone said, the uterus is healthy in about 40,000 cases.

Although the practice has become less popular in the last 10 years or so, surgeons usually remove the uterus, ovaries and Fallopian tubes when removing a benign mass in order to prevent problems with the uterus, such as cancer, bleeding or other cysts or fibroids, Gambone said. Typically, benign cysts and tumors do not increase a woman’s risk of developing cancer, experts say.

“That’s the justification for removing the uterus: ‘The abdomen is open, the woman is asleep, we’re already here, let’s take everything out.’ That is the practice plan we are questioning,” Gambone said. “Since the benefits are all theoretical--no one has ever measured them--we wanted to look at what are the risks.”

The study, conducted by UCLA, University of Iowa College of Medicine and the Naval Hospital of San Diego researchers, compared 100 women who underwent hysterectomy for benign cysts to 100 women who had benign cysts removed but did not lose their uteri.

The women with hysterectomies, whose average age was 45, had more than five times the rate of complications (28% compared to 5%), including urinary tract and wound infections, thrombosis and fever with illness, the study showed.

Moreover, the average hysterectomy patient had more than double the blood loss, and three hysterectomy patients underwent transfusions compared to none in the other group. The hospital stay was double for hysterectomy patients (5.2 days compared to 2.6 days).

Although transfusions and infections are considered minor complications, “these complications do keep you in the hospital longer and add to the expense of the hospital stay,” Lench said. “And, in this day and age, there are more worries about blood transfusions.”

There was also one death in the hysterectomy group, although the study was too small to statistically determine overall death rates. Typically, hysterectomy produces a death rate of about one in 500 to 1,000.

“I’m absolutely certain that the (physicians), in retrospect, would not have done it,” Gambone said of the patient who died. “Clearly, it was the additional surgery that put the patient at risk.”

With the added financial costs of hysterectomy--which this study did not explore--the surgery should not be recommended for benign cysts, Gambone said.

“Removing everything is effective, but it may not be efficient because there are more complications and expense,” he said. “What we need to do more of in health care is look at what is the more effective and efficient way, because there are too many people having unnecessary surgery.”

According to Lench, studies that attempt to document the benefits of hysterectomy for various gynecological problems are harder because it would require years for the benefits to become clear, he said.

Although few physicians would argue with the recommendation to avoid hysterectomy for benign cysts, many are reluctant to break with tradition and what they have been taught, Gambone said.

“Much of medical practice is based not so much on science and what studies tell us we should be doing but what is taught to us by professors,” he said.

Women in the United States have about a 36% chance of having a hysterectomy by age 64, studies show. But, according to Dr. Mary Beard, an assistant clinical professor of obstetrics and gynecology at the University of Utah, more physicians are using new techniques, such as removing cysts through small incisions called laparoscopy, which will reduce hysterectomy rates.

“Because we are doing more laser surgery and laparoscopy, we don’t necessarily need to do hysterectomies,” she said.

Gambone and his colleagues also suggested, in a paper published in June, that a woman with an enlarged uterus but no other symptoms can “watch and wait” rather than undergo a hysterectomy.

The researchers will look next at two other controversial uses of hysterectomy: for abnormal bleeding and a prolapsed uterus, he said.