Table 3 Evidence-based recommendations for abdominal hysterectomy

Patient position

0

I

Low

Skin cleaning

0

I

Low

Vaginal preparation

3

1,899

C

Mod

Povidone-iodine vaginal antisepsis may reduce the overall infection morbidity after abdominal hysterectomy. Compliance with protocol (1,000 cc night before and day of surgery) may not be feasible.

Skin incision type

I

Low

Skin incision length (minilaparotomy)

0

I

Low

Subcutaneous incision

1

380

C

Mod

Incision of subcutaneous tissue by electrocautery or scalpel does not influence the rate of wound complications.

Fascial incision

0

I

Low

Rectus fascia dissection

0

I

Low

Opening peritoneum

0

I

Low

Retractors

0

I

Low

Ureter identification

0

I

Low

Vascular pedicles: suture ligature vs. bipolar vessel sealing device ligature

2

87

B

Mod

Compared to suture ligature, use of bipolar vessel sealing device (LigaSure) for vascular pedicles significantly decreases postoperative pain during first 3 postoperative days.

Total vs. supracervical hysterectomy

4

733

C

High

Compared to total, supracervical hysterectomy is associated with a significant decrease in the duration of surgery, intraoperative blood loss and fever. Postoperative cyclical bleeding up to a year is significantly more common with supracervical than total hysterectomy.

Vaginal cuff open vs. closed (sutures or staples)

4

612

C

Mod

With staples intraoperative time is significantly reduced. Granulation at 6 weeks is significantly less with staples than open.

Vaginal cuff closed suture vs. staples

1

60

C

Mod

No clinical advantage of closing the vaginal cuff with suture or staple.

Angle stitch

0

I

Low

Intraabdominal Irrigation

0

I

Low

Peritoneal closure

3

298

D

Mod

Not recommended because peritoneal closure provides no postoperative benefits while unnecessarily increasing surgical time and anesthesia exposure.

Techniques of fascial closure

0

C

Low

Subcutaneous tissue closure vs. nonclosure

1

60

I

Low

No significant difference in closure vs no closure but the trial design was poor.

Closure of skin with staples vs. subcuticular suture

0

I

Low

Total

19^a

4,129