Pär Persson

Psychological wellbeing after laparoscopic and abdominal hysterectomy- : a randomised controlled multicentre study

Objective  To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures.

Short‐term recovery after subtotal and total abdominal hysterectomy—a randomised clinical trial

Please cite this paper as: Persson P, Brynhildsen J, Kjølhede P on behalf of the Hysterectomy Multicentre Study Group in South‐East Sweden. Short‐term recovery after subtotal and total abdominal hysterectomy—a randomised clinical trial. BJOG 2010;117:469–478.

Attitudes to mode of hysterectomy – a survey-based study among Swedish gynecologists

Objective. To determine gynecologists’ attitudes to mode of hysterectomy on benign indication. Design. Cross‐sectional study. Setting. Sweden. Population. Members of the Swedish Society of Obstetrics and Gynecology. Methods. A postal questionnaire. Questions examined attitudes to mode of hysterectomy based on three clinical scenarios with different conditions of the uterus. Gynecologists were also asked to estimate how the distribution of the different modes of benign hysterectomy should be overall. The modes to choose were total abdominal, subtotal abdominal, laparoscopic or vaginal hysterectomy (VH). Analyses were performed with multiple logistic regression and multivariate analysis of covariance. Main outcome measures. Preferred mode of hysterectomy in the three scenarios and distribution of modes of hysterectomy. Results. VH was the most preferred method in general as well as when the uterus was of normal size, whereas subtotal and total abdominal hysterectomy were the most favored methods when the uterus was enlarged. VH was more often preferred by male compared to female gynecologists as a personal preference. The choice and distribution of mode varied significantly between place of work, seniority and in the quantity of yearly performed hysterectomies. The minimal invasive methods, vaginal and laparoscopic hysterectomy, were recommended in more than 50% of the overall suggested distribution. Conclusion. Personal choice of mode of hysterectomy does not seem to strictly follow evidence‐based recommendations, but varies significantly between gynecologists gender, type of clinical setting in which the gynecologist works, seniority and by how many hysterectomies the gynecologist does annually.

Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy.

OBJECTIVES To determine whether the day-by-day recovery of general wellbeing was faster in women undergoing laparoscopic hysterectomy than in total abdominal hysterectomy and to analyse the association between stress coping and sick-leave and the day-by-day recovery measured as general wellbeing. STUDY DESIGN A randomised multicentre trial conducted in five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study and 117 women completed the study. Fifty-five women were randomised to abdominal hysterectomy and 62 to laparoscopic hysterectomy. Day-by-day recovery of general wellbeing was measured by a visual analogue scale 1 week preoperatively, 35 days postoperatively, and during 1 week 6 months postoperatively. Stress-coping capability was measured preoperatively using a specific psychometric measurement. Sick-leave was granted with an initial period of 14 days and prolonged on patient demand with 7 days periods. Effects of operating method and stress-coping ability on the day-by-day recovery adjusted for postoperative complications and analgesics were analysed by means of analysis of variance for repeated measurements. RESULTS No significant difference was found in the day-by-day recovery of the general wellbeing between the operating methods. Stress-coping ability did significantly influence the day-by-day recovery of general wellbeing. Duration of sick-leave was associated with the occurrence of postoperative complications but not with stress-coping ability. CONCLUSIONS The day-by-day recovery of general wellbeing is not faster in laparoscopic hysterectomy than in abdominal hysterectomy. Women with high stress-coping abilities have a better outcome in general wellbeing than women with low stress-coping capacity. Identification of women with low stress-coping abilities and prevention of complications might be of benefit for improving postoperative wellbeing.

A 1‐year follow up of psychological wellbeing after subtotal and total hysterectomy—a randomised study

Please cite this paper as: Persson P, Brynhildsen J, Kjølhede P on behalf of the Hysterectomy Multicentre Study Group in South‐East Sweden. A 1‐year follow up of psychological wellbeing after subtotal and total hysterectomy—a randomised study. BJOG 2010;117:479–487.

A 1-year follow up of psychological wellbeing after subtotal and total hysterectomy-a randomised study: Hysterectomy and psychological wellbeing

Please cite this paper as: Persson P, Brynhildsen J, Kjølhede P on behalf of the Hysterectomy Multicentre Study Group in South‐East Sweden. A 1‐year follow up of psychological wellbeing after subtotal and total hysterectomy—a randomised study. BJOG 2010;117:479–487.

A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study

Please cite this paper as: Persson P, Brynhildsen J, Kjølhede P on behalf of the Hysterectomy Multicentre Study Group in South‐East Sweden. A 1‐year follow up of psychological wellbeing after subtotal and total hysterectomy—a randomised study. BJOG 2010;117:479–487.

Attitudes to Mode of Hysterectomy―A Survey-Based Study Among Swedish Gynecologists

Limited data are available on the attitudes of gynecologists regarding mode of hysterectomy for benign indications. This cross-sectional study used a postal questionnaire to assess attitudes of members of the Swedish Society of Obstetrics and Gynecology toward mode of benign hysterectomy. The choices of mode of hysterectomy were total abdominal hysterectomy, subtotal abdominal hysterectomy, laparoscopic or laparoscopically-assisted hysterectomy, and vaginal hysterectomy (VH). Participants were asked questions about their gender, seniority, place of work, and surgical experience, including years in the specialty and annual number of hysterectomies performed to determine whether differences in such factors influenced their choice of mode. The gynecologists were asked to choose between these modes for 3 scenarios with different benign clinical conditions. Scenario A was a normal to slightly enlarged uterus with no uterine descensus and no previous cervical dysplasia. Scenario B differed from the first scenario only in that there had been previous treatment of cervical dysplasia up to moderate degree (CIN II). In scenario C, there was an enlarged uterus (larger than gestational week 12―13) with no uterine descensus and no previous cervical dysplasia. The respondents were also asked to give their personal view of how the overall distribution should be for the different modes of benign hysterectomy. Multiple logistic regression and multivariate models of covariance were used for unadjusted and adjusted analyses. The participants chose VH in general or when the uterus was of normal size or slightly enlarged (scenarios A and B), and recommended abdominal hysterectomy and subtotal abdominal hysterectomy when the uterus was enlarged (scenario C). More male gynecologists than female gynecologists favored VH as a personal preference. There were significant variations in choice and suggested distribution of mode for place of work, seniority, and annual number of hysterectomies performed. More than 50% of the participants recommended the minimally-invasive methods of vaginal and laparoscopic hysterectomy as their overall personal choice for suggested distribution. These findings indicate that choice of mode of hysterectomy for benign conditions among gynecologists is significantly influenced by personal preference based on differences in gender, place of work, seniority, and annual number of hysterectomies, and does not appear to strictly follow evidence-based recommendations.