
==== Front
BMC Womens Health
BMC Womens Health
BMC Women's Health
1472-6874
BioMed Central London

3326
10.1186/s12905-024-03326-2
Case Report
Cervical stump leiomyomata after supracervical hysterectomy; a case report with review of literature
https://orcid.org/0000-0002-3422-3822
Shoukry Ahmed ahmedshoukry1989@outlook.com

Yousri Mahmoud
https://ror.org/00mzz1w90 grid.7155.6 0000 0001 2260 6941 Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
10 9 2024
10 9 2024
2024
24 50012 4 2024
21 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Background

Despite being a highly debated issue, subtotal or supracervical hysterectomy (SCH) is still considered a safe and effective treatment for women with benign gynecological lesions. Benign and malignant cervical diseases have been reported after SCH, with fibroids being the most frequently diagnosed lesions in the excised cervical stump. Recurrence of cervical disease after SCH usually presents with vaginal bleeding, pelvic mass, or abdominal pain; moreover, it may necessitate reoperation and resection of the cervical stump or trachelectomy. Trachelectomy is known to be a difficult surgical procedure that may be associated with significant intra- and post-operative morbidity.

Case presentation

We presented here a case of a 41-year-old nulliparous woman with a pelvic mass related to the cervical stump presented 2 years after subtotal hysterectomy, performed due to interactable abnormal uterine bleeding, which was attributed to a multiple fibroid uterus. Six years ago, she complained of pelvic pain, excessive vaginal discharge, and spotting. A transvaginal sonography and magnetic resonance imaging with contrast were performed, which revealed a 10.2 × 7.6 × 6.5 cm heterogeneous pelvic mass with irregular borders and marked vascularity on color Doppler. Surgical exploration and resection of the mass with cervical stump excision were performed. Histopathology confirmed the diagnosis of cervical stump multiple benign leiomyomata with no atypical features.

Conclusion

Recurrence or De novo development of leiomyomata and other cervical lesions might occur after supracervical or subtotal hysterectomy; thus, thorough pre-operative counseling for women requesting a SCH regarding the pros and cons of the procedure compared with total hysterectomy should be optimized. Meticulous follow-up, including the continuation of routine cervical cytological smears, is mandatory for patients with a retained cervix.

Keywords

Subtotal
Supracervical
Hysterectomy
Stump
Fibroids
Alexandria UniversityOpen access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcBackground

Hysterectomy is the most frequently performed surgical procedure for women with symptomatic uterine fibroids [1, 2].

Preservation of the cervix uteri during a hysterectomy is a highly debated issue. Some of the potential benefits of supracervical hysterectomy (SCH) that proponents often mention are reduced blood loss, a shorter hospital stay, fewer intraoperative risks, fewer urinary complications, and better pelvic support [3–5]. Although postoperative sexual function is presumed to be more satisfactory after SCH [6], it was not found to be superior to a total hysterectomy (TH) [7]. On the contrary, some problems have been often described with SCH, such as cyclic bleeding, pelvic pain, and a higher incidence of cervical disease [8]. Among the commonest clinical indications for surgical excision of the cervical stump following supracervical hysterectomy are pelvic masses and vaginal bleeding [9]. It has been observed that fibroids are the most common (in approximately 35%) pathology found in the excised cervical stump [10].

We report a case of large stump fibroids after a subtotal abdominal hysterectomy for multiple fibroid uterus.

Case report

Chief complaints

A 41-year-old nulliparous woman presented to the gynecology outpatient clinic of El-Shatby University Hospital, Alexandria, Egypt, with pelvic pain and excessive vaginal discharge with occasional vaginal spotting.

History of the current illness

The patient had chronic dull, aching pelvic pain with a heaviness sensation. She also described an increased amount of brownish vaginal discharge. Her symptoms started in 2018, and she reported that the condition became noticeably worse six months ago with frequent episodes of vaginal bleeding, so she sought gynecological consultation.

History of the past illness

She gave a history of four abdominal myomectomies for the excision of multiple fibroids while she was seeking fertility; the last myomectomy was performed in 2014. After that, she complained of intractable vaginal bleeding. A multiple fibroid uterus was diagnosed, so she underwent a supracervical abdominal hysterectomy with preservation of both ovaries in 2016. All previous surgeries were performed outside our hospital through midline vertical incisions.

Hysterectomy specimen examination revealed a 2500-gm uterus with multiple interstitial and subserous leiomyomata ranging from 2 to 9.5 cm. Histopathological examination confirmed the diagnosis of typical leiomyoma pathological features with no detected atypical or mitotic figures.

Medical, personal, and family history

She gave history of two failed IVF trials after her first and third myomectomy. Her medical history is irrelevant except for mild bronchial asthma controlled with periodic beta-agonist inhalers. She did not have a history of smoking or drinking alcohol. She did not undergo any pap smears either before or after the supracervical hysterectomy. She denies any follow-up visits to her gynecologist after the hysterectomy.

Physical examination

On examination, her abdomen was lax and non-tender, with no palpable masses. The previous midline incisions were noticed with no palpable hernias. A bimanual examination revealed a firm, non-tender pelvic mass that has limited mobility in conjugation with movement of the cervix. A speculum examination showed a normal-looking cervix with a well-estrogenized vagina.

Imaging examinations

A transvaginal ultrasound revealed a 10.2 × 7.6 × 6.5 cm pelvic mass with irregular borders and heterogeneous echotexture with no external shadowing. There were internal cystic areas resembling the picture of degenerated fibroid. The mass had marked vascularity on the color Doppler, especially in the peripheral regions. The mass was seen encroaching on the right adnexa, with the normal appearance of the left ovary.

The mass looks suspicious for malignancy, so confirmatory magnetic resonance imaging (MRI) with IV gadolinium contrast was performed, as demonstrated in Figs. 1 and 2. The heterogeneous T2 lobulated mixed solid and cystic lesion showed a mainly hypo-intense signal in the T2 and T1 weighted images, epicentered upon the cervical stump and engulfing the right adnexa.

The patient was counseled for exploratory laparotomy and resection of the mass with the cervix and both ovaries. A complete preoperative workup was performed, including a chest x-ray; all investigations were within normal range.

Fig. 1 Sagittal T2W image showing the remaining cervical stump with its endometrial lining (blue arrow) and a heterogeneous solid lesion (yellow star) above the cervix with its MRI signal matching with fibroid

Fig. 2 Sagittal T2W image showing heterogeneous lobulated mainly hypo-intense solid (blue arrows) lesion showing areas of cystic changes (small yellow arrows) consistent with degenerated cervical leiomyomata

Surgical details

An extended lower midline incision was performed to optimize the exposure of the entire abdominal cavity and the pelvis. Upon entry of the abdomen, a large pelvi-abdominal mass was found, which was entirely covered by densely adherent bowel loops posteriorly and an exceptionally adherent urinary bladder anteriorly.

The lateral approach, through opening the retroperitoneal avascular pelvic spaces, was used to properly identify the borders of the mass and to secure the important adjacent structures, namely the ureters, iliac vessels, and recto sigmoid.

Creation of the para-vesical and para-rectal spaces was performed bilaterally, which facilitated the identification of the ureters and iliac vessels, followed by ureterolysis and lateralization of both ureters. Dissection of the densely adherent recto-sigmoid off the back of the mass with development of the rectovaginal space and identification of uterosacral ligaments was done.

A decision was made to excise the fibroids from the cervical stump to optimize the exposure of the stump and allow a safe stumpectomy procedure (Fig. 3).

Excision of the cervical stump using the retrograde colpotomy approach was utilized for the preservation of maximal vaginal length. Then, suturing of the vaginal cuff with a single layer of continuous absorbable sutures was done. She did not require a blood transfusion intraoperatively.

Fig. 3 The surgical specimen showing multiple leiomyomata and the excised cervical stump

Postoperative course and follow-up

The patient’s postoperative course was uneventful. Her postoperative hemoglobin was 8.1 g/dl. A transfusion of two units of packed RBCs was performed, and she was discharged on the 5th postoperative day after regular bowel movements were returned and her hemoglobin level was 9.6 g/dl. Histopathological examination of the specimen confirmed the diagnosis of multiple benign leiomyomata of the cervical stump with marked hyaline, mucoid, and cystic degeneration with no atypical features.

Discussion

One of the simplest and most successful treatments for benign uterine disorders such as fibroids, adenomyosis, and functional uterine bleeding is hysterectomy.

Route of hysterectomy

Hysterectomies could be performed through minimally invasive approaches such as vaginal or laparoscopic (with or without robotic assistance) approaches or through an abdominal approach. Various factors could influence the selection of a certain route of hysterectomy, such as the size and shape of the uterus and vagina, the degree of extrauterine disease, the need for concurrent procedures, the surgeon’s training and experience, the average case volume, the hospital’s technology, devices, and support, the urgency or scheduling of the case, and the patient’s preference [11]. When possible, minimally invasive hysterectomy techniques (laparoscopic or vaginal, including robot-assisted laparoscopy) should be used due to their established benefits over abdominal hysterectomy.

Among the minimally invasive approaches, ACOG and SOGC recommend the vaginal method, as it was found to be associated with a faster return to normal activities and a better quality of life. Compared with laparoscopic hysterectomy, vaginal hysterectomy is also associated with a shorter operating time and hospital stay [12, 13].

Nevertheless, as per the guidelines and recommendations of the German, Austrian, and Swiss societies of gynecology and obstetrics (DGGG, OEGGG, and SGGG), patients should be given the ability to select the most appropriate therapeutic intervention for their benign uterine disease, considering their individual circumstances [14].

Total versus subtotal hysterectomy

Based on the extent of the surgery, hysterectomy could be classified into two categories: total hysterectomy (TH), which entails excision of the uterine body and the cervix, and subtotal or supracervical hysterectomy (SH), which describes removal of the uterine body with cervical stump preservation [15].

Before the era of readily available antibiotics and blood transfusions, SCH was much preferred to TH, as it was reported that TH was associated with a significantly higher complication rate, including mortality. At this time, the risk of death for a subtotal hysterectomy performed for fibroids was 1-2.5%, whereas the risk of death for TH performed for benign pathologies including endometriosis and tubo-ovarian abscesses was 3-6.5% [16].

For the following 3 decades, there was a remarkable shift towards total hysterectomies, with the prevalence of SH being approximately 1% of all hysterectomies [6]. The few remaining SH were likely to be conducted when the patient had co-morbidities that necessitated a shorter, less risky procedure, or when the surgeon encountered distorted pelvic anatomy or operative difficulties.

After that, in the late 1990s, subtotal/supracervical hysterectomy regained its popularity, especially due to the introduction of minimally invasive or laparoscopic approaches [17]. It was proposed that this was because SH is simpler to execute during a laparoscopy and because the consensus is that SH would have no or minimal effects on the nerves, vessels, and other pelvic structures, leading to better results in terms of urinary symptoms, pelvic support, and patients’ quality of life [18]. Since then, the merits and drawbacks of subtotal vs. total hysterectomy procedures have been addressed in numerous RCTs, meta-analyses, and Cochrane databases.

Moreover, among the indications of performing a SCH is pelvic organ prolapse (POP). Mesh erosion, a known consequence of mesh sacrocolpopexy following total hysterectomy, could be prevented with laparoscopic sacrocervicopexy, which has been shown to be an effective choice for the management of POP with an excellent safety profile [4, 19, 20].

Despite the historical claims that SH is associated with lower urinary tract complications, better sexual outcomes, and fewer pelvic floor symptoms compared to TH, supracervical hysterectomy has been usually criticized for the high possibility of postoperative long-term sequalae such as cervical dysplasia and carcinoma, cyclic vaginal bleeding, pelvic pain, vaginal discharge, cervical prolapse, and recurrence or de novo development of uterine disorders. Also, there is a significant risk of perioperative bleeding, urinary tract injuries, and gastrointestinal tract injuries in a subsequent extirpation of the cervical stump [10].

Risk of CIN and cervical carcinoma after SCH

The overall reported risk of cervical stump carcinoma is low; it was reported to be 1–3% of all women who underwent SH, and it represents approximately 3–9% of all cervical malignancies [21]. In a multicenter study on 903 women, only 3 cases (0.33%) of cervical stump carcinoma were observed [22]. It was found that most women undergoing SH are unaware of the recommendations for cervical screening after the hysterectomy [23].

In one survey of women who had minimally invasive hysterectomies, only 67% of women were able to correctly report if the cervix was removed during surgery and the need for future cervical screening as per recommendations [24]. This finding raises the concern that, before offering the option of subtotal hysterectomy, eligible women must be counseled about the importance of continuing their cervical screening program as per guidelines. Furthermore, SH should not be advised for women who have abnormal PAP smears or high-risk HPV infections, as these conditions increase the chance of developing cervical cancer. Historically, it was thought that electrocoagulation of the cervical mucosa during SH might reduce cervical stump carcinoma besides preventing cyclic bleeding after the procedure [25].

SOGC recommends the continuation of routine cervical screening for women with SH as women with an intact uterus. It is also recommended that women with a current or significant history of abnormal cervical cytological smears be informed about the advantages of vaginal or total hysterectomy over SH [26].

Cyclic vaginal bleeding after SCH

Women undergoing SH are prone to experiencing vaginal bleeding from the retained cervix, which may be persistent and cyclic in some cases. In most cases, this bleeding is minimal, tolerable, and self-limited, especially in well-counselored women [27, 28]. The reported incidence of postoperative bleeding after SH varies between numerous studies, being as low as 0.9% or as high as 25% [29–35], with the majority of studies reporting rates between 5 and 10% [36]. This difference in reported rates might be attributed to the fact that some studies report only cyclic bleeding and others document any form of postoperative bleeding [27]. However, it was found that only half of women undergoing SH were aware that they could suffer from this postoperative bleeding [37].

The available literature is conflicting regarding the risk factors for cyclic bleeding following SH. Heavy menstrual bleeding before hysterectomy was identified as a significant risk factor in one study [37]. While endometriosis was found to be significantly associated with postoperative bleeding in some studies [17, 28–38], others failed to identify a correlation between endometriosis and this bleeding [27].

There are many factors that have been reported to prevent postoperative bleeding after SH, such as older age [37], postmenopausal state [28], and bilateral oophorectomy during the hysterectomy [27]. Moreover, the removal or fulguration of the endocervix during the hysterectomy has been thoroughly studied with inconsistent conclusions [35, 37, 39].

Recurrence or De novo development of uterine diseases after SCH

Cervical stump leiomyomata, cervical stump cysts, endometriosis, adenomyosis, or cervical stump prolapse are among the comorbidities that may arise or recur in the retained cervix after SH [40]. Additionally, leiomyosarcoma is an extremely rare lesion that may arise in the cervical stump following a SH [41]. It is noteworthy that using power morcellation during laparoscopic supracervical hysterectomy (LSCH) might increase the frequency of recurring fibroids, endometriosis, and adenomyosis [42].

Fibroids have always been described as a “recurring disease.” After myomectomy, there are variable reported rates of recurrence, including 12–15%, 31–43%, 51–62%, and 84% at 1, 3, 5, and 8 years, respectively [43–50], and approximately10–20% of cases will undergo a hysterectomy within 5–10 years of myomectomy [49, 51].

The incidence of fibroids in the retained cervical stump after SCH ranges from 0.6 to 3.7% [9, 52]. In a retrospective analysis of 137 patients who underwent cervical stump resection after SCH, Neis F. et al. reported that 3.7% of these patients have fibroids in their cervical stumps [53]. Similarly, fibroids were found in 2 patients who underwent cervical stumpectomy after SCH in a cohort of 309 patients reported by Hilger et al. [54].

Similar to the case we presented here, recurrence or new development of fibroids over the cervical stump has been described not only after subtotal hysterectomy but also reported after total hysterectomy. Recently, a recurrence of adenomyosis was reported after LSCH with power morcellation [55]. Additionally, benign metastatic leiomyoma (BML) has been described as occurring even after total hysterectomy [56–60].

Among the reported lesions that may arise on top of the retained cervical stump are cervical cysts, which usually result from failure to completely remove all cervical glands. Those cysts are usually benign; however, they may encompass any grade of cervical intraepithelial dysplasia. Initially, cervical cysts may not cause any symptoms. However, persistent cervical cysts may result in a bulging vagina and compression symptoms, including urgency, frequent, and inefficient urination, which may have a major negative impact on the patients’ quality of life. [40, 61].

Table 1. summarizes the reported cases of benign cervical stump lesions reported in the literature. Thirteen cases—in addition to the currently presented case—of histologically proven benign leiomyoma on top of the cervical stump are described. The mean age at presentation is 51 ± 9.36 years, with a mean interval between hysterectomy and symptoms of 7.84 ± 5.8 years. Ten women (71%) had a history of SCH, and four women (29%) had undergone a TH. Preservation of at least one ovary was found in 9/14 (64%) of cases. The indications for the hystectomy were symptomatic fibroids in 10 cases (71%), menorrhagia in 3 cases (21%), and one case of endometriosis (8%). The clinical presentations were pelvic and abdominal pain, vaginal bleeding, and abdominal distention in the majority of cases. One case presented with dysparnia due to a prolapsed fibroid polyp. The mean largest diameter of the excised lesions was 12.4 ± 9.3 cm. Management was achieved via abdominal exploration and excision of the masses with stumpectomy in 9/14 (64%) of the cases; two cases were managed laparoscopically; two cases were managed by vaginal excision of the mass only; and robotically assisted excision of the mass and stumpectomy was performed in one case.

Moreover, cases of malignant leiomyosarcoma, although exceedingly rare, have also been reported after hyetrectomy, with one case from almost 100 years ago, summerized in Table 2 [41, 62, 63].

Nevertheless, patient satisfaction after supracervical hysterectomy was reported to be high [8, 37]. Hence, some patients may elect to have a supracervical hysterectomy even though the evidence shows that there is no clinically significant difference in the rate of complications (such as infection, blood loss, urinary tract, bowel, or vascular injury) and that there is unclear benefit in terms of favorable patient outcomes (such as sexual function, urinary function, or bowel function) between a supracervical hysterectomy and a total hysterectomy. An open abdominal or laparoscopic procedure is most suitable in these circumstances [64]. Therefore, gynecologists should be aware of the advantages and drawbacks of SCH vs. TH, and women requesting a SCH should be properly counseled about the long-term outcomes of the procedure.

Table 1 Reported cases of benign cervical stump lesions after supracervical hysterectomy

Author (year)	Patient age (years)	Time to presentation
(years)	Hysterectomy
Type & indication	Symptoms	Lesion size (cm)	Treatment & pathology	
Arthur E. Giles (1923) [65]	46	7	SCH with preservation of one ovary menorrhagia

Fibroid uterus

	Palpable pelvic mass	Not

reported

	Abdominal excision

Benign leiomyoma

	
Fuchs IB (2003) [66]	48	5	SCH with BSO

Endometriosis

	Severe lower abdominal pain & distention	9 × 6.5	Abdominal excision

Cystic adenomyoma

	
Hilger WS [67]	44	5	LSCH with preservation of ovaries

Menorrhagia and fibroids

	Pelvic pain

Pelvic mass

	3.2 × 2.7	Robotic assisted resection of the mass	
Yanamandra S.R.et al. (2007)

[68]

	47	8	TAH with preservation of ovaries

Menorrhagia

	Abdominal pain & brownish vaginal discharge	15 × 10	Abdominal excision

Benign leiomyoma

	
Ismail SM(2009) [69]	47	1	TAH

Menorrhagia

	Dyspareunia	3 × 3	Vaginal excision

Benign leiomyoma

	
Yarci A (2010) [70]	70	25	TAH with BSO

Fibroids

	Prolapsed vaginal mass	7 × 3	Vaginal excision

Leiomyoma with degeneration

	
Chu CM (2012) [1]	55	8	SCH with preservation of ovaries

Multiple fibroids

	Pelvic pain & vaginal bleeding	15 × 9	Abdominal excision

Degenerated leiomyoma

	
50	8	SCH

Symptomatic fibroids

	Vaginal bleeding

Pelvic pain

	20 × 5.7	Abdominal excision

Benign leiomyoma

	
Guraslan H (2015) [71]	62	10	TAH with BSO

Symptomatic Fibroids

	Abdominal pain & pelvic fullness	20 × 14 × 10	Abdominal excision

Cellular leiomyoma

	
Jayanthi K Krishnamoorthy (2018) [59]	40	6	SCH with preservation of ovaries

Fibroid uterus

	Abdominal distention	35 × 30 × 25	Abdominal excision after bilateral uterine artery embolization

Benign leiomyoma

	
Mathew and Abraham (2018) [60]	68	Not

reported

	SCH

Fibroid uterus

	Lower abdominal pain & distention	Not

reported

	Abdominal excision

Benign leiomyoma

	
Sezgin B (2021) [72]	50	10	SCH with BSO

Menorrhagia & fibroids

	Pelvic pain	4	Laparoscopic excision

Benign leiomyoma

	
Tien CT, Ding DC (2023) [55]	47	7	SCH with preservation of ovaries

Menorrhagia

	Vaginal bleeding	7	Laparoscopic excision

Adenomyoma

	
Present case (2024)	41	2	SCH with preservation of both ovaries

Symptomatic fibroids

	Pelvic pain, excessive vaginal discharge, bleeding	10.2 × 7.6	Abdominal excision

Benign leiomyomata

	

Table 2 Reported cases of malignant leiomyosarcoma after supracervical hysterectomy

Author (year)	Patient age (years)	Time to presentation
(years)	Hysterectomy
Type & indication	Symptoms	Lesion size (cm)	Treatment & pathology	
Barnard (1928) [60]	60	4	SCH

Fibroid uterus

	Pelvic mass & intestinal obstruction	Not reported	Resection of the mass – patient died 7 h. postoperative	
Sturdy (1959) [61]	42	5	SCH with ovarian preservation

Fibroid uterus

	Pelvic mass	20 × 9 × 7	Radical resection + radiotherapy	
Zhiqiang L (2016) [41]	46	3	SCH with ovarian preservation

Fibroid uterus

	Vaginal bleeding & abdominal pain	6 × 5	Radical resection with lymphadenectomy + chemotherapy + radiotherapy	

Conclusion

Recurrence or De novo development of leiomyomata and other crevical lesions might occur after supracervical or subtotal hysterectomy; thus, thorough pre-operative counseling for women requesting a SCH regarding the pros and cons of the procedure compared with total hysterectomy should be optimized. Meticulous follow-up, including the continuation of routine cervical cytological smears, is mandatory for patients with a retained cervix. We provided a case report of recurrent multiple leiomyomata on top of the cervical stump following a SCH with a comprehensive review of the previously reported cases.

Acknowledgements

The authors acknowledge the effort of the gynecology and anesthesia teams in El-shatby University Hospital, Alexandria, Egypt.

Author contributions

Ahmed Shoukry (AS) was the main surgeon and wrote the manuscript. Mahmoud Yousri (MS) was the main surgical assistant, read, revised, and approved the final manuscript.

Funding

The authors have received no external funding.

Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

Data availability

All data of this manuscript are available upon reasonable request.

Declarations

Consent to publish

Written informed consent was obtained from the patient for publication of this case report.

Competing interests

The authors declare no competing interests.

Abbreviations

SCH Supracervical Hysterectomy

TH Total Hysterectomy

MRI Magnetic Resonance Imaging

ACOG American College of Obstetrics and Gynecology

SOGC Society of Obstetricians and Gynecologists of Canada

CIN Cervical Intraepithelial Neoplasia

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
==== Refs
References

1. Chu CM Acholonu UC Chang-Jackson S-CR Nezhat FR Leiomyoma recurrent at the cervical stump: report of two cases J Minim Invasive Gynecol 2012 19 131 3 10.1016/j.jmig.2011.10.006 22196264
Chu CM, Acholonu UC, Chang-Jackson S-CR, Nezhat FR. Leiomyoma recurrent at the cervical stump: report of two cases. J Minim Invasive Gynecol. 2012;19:131–3. 10.1016/j.jmig.2011.10.006.22196264 10.1016/j.jmig.2011.10.006
2. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol. 2008;198. 10.1016/j.ajog.2007.05.039. :34.e1-7.
3. Thakar R Ayers S Clarkson P Stanton S Manyonda I Outcomes after total versus subtotal abdominal hysterectomy N Engl J Med 2002 347 1318 25 10.1056/NEJMoa013336 12397189
Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347:1318–25. 10.1056/NEJMoa013336.12397189 10.1056/NEJMoa013336
4. Dallas K Taich L Kuhlmann P Rogo-Gupta L Eilber K Anger JT Supracervical hysterectomy is protective against Mesh complications after minimally invasive abdominal sacrocolpopexy: a Population-based Cohort Study of 12,189 patients J Urol 2022 207 669 76 10.1097/JU.0000000000002262 34694142
Dallas K, Taich L, Kuhlmann P, Rogo-Gupta L, Eilber K, Anger JT, et al. Supracervical hysterectomy is protective against Mesh complications after minimally invasive abdominal sacrocolpopexy: a Population-based Cohort Study of 12,189 patients. J Urol. 2022;207:669–76. 10.1097/JU.0000000000002262.34694142 10.1097/JU.0000000000002262
5. Alkatout I, Mazidimoradi A, Günther V, Salehiniya H, Allahqoli L. Total or subtotal hysterectomy for the treatment of endometriosis: a review. J Clin Med. 2023;12. 10.3390/jcm12113697.
6. Kilkku P Grönroos M Hirvonen T Rauramo L Supravaginal uterine amputation vs. hysterectomy. Effects on libido and orgasm Acta Obstet Gynecol Scand 1983 62 147 52 10.3109/00016348309155779 6868963
Kilkku P, Grönroos M, Hirvonen T, Rauramo L. Supravaginal uterine amputation vs. hysterectomy. Effects on libido and orgasm. Acta Obstet Gynecol Scand. 1983;62:147–52. 10.3109/00016348309155779.6868963 10.3109/00016348309155779
7. Dedden SJ Werner MA Steinweg J Lissenberg-Witte BI Huirne JAF Geomini PMAJ Hysterectomy and sexual function: a systematic review and meta-analysis J Sex Med 2023 20 447 66 10.1093/jsxmed/qdac051 36857309
Dedden SJ, Werner MA, Steinweg J, Lissenberg-Witte BI, Huirne JAF, Geomini PMAJ, et al. Hysterectomy and sexual function: a systematic review and meta-analysis. J Sex Med. 2023;20:447–66. 10.1093/jsxmed/qdac051.36857309 10.1093/jsxmed/qdac051
8. Lieng M Lømo AB Qvigstad E Long-term outcomes following laparoscopic and abdominal supracervical hysterectomies Obstet Gynecol Int 2010 2010 989127 10.1155/2010/989127 20300594
Lieng M, Lømo AB, Qvigstad E. Long-term outcomes following laparoscopic and abdominal supracervical hysterectomies. Obstet Gynecol Int. 2010;2010:989127. 10.1155/2010/989127.20300594 10.1155/2010/989127
9. Kho RM Magrina JF Removal of the retained cervical stump after supracervical hysterectomy Best Pract Res Clin Obstet Gynaecol 2011 25 153 6 10.1016/j.bpobgyn.2010.10.007 21074497
Kho RM, Magrina JF. Removal of the retained cervical stump after supracervical hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2011;25:153–6. 10.1016/j.bpobgyn.2010.10.007.21074497 10.1016/j.bpobgyn.2010.10.007
10. McHale MP Smith AJB Fader AN Wethington SL Outcomes of women undergoing excision of the retained cervix after supracervical hysterectomy Obstet Gynecol 2021 137 831 6 10.1097/AOG.0000000000004360 33831922
McHale MP, Smith AJB, Fader AN, Wethington SL. Outcomes of women undergoing excision of the retained cervix after supracervical hysterectomy. Obstet Gynecol. 2021;137:831–6. 10.1097/AOG.0000000000004360.33831922 10.1097/AOG.0000000000004360
11. Committee opinion 701 Choosing the route of hysterectomy for benign disease Obstet Gynecol 2017 129 e155 9 10.1097/AOG.0000000000002112 28538495
Committee opinion 701. Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017;129:e155–9. 10.1097/AOG.0000000000002112.28538495 10.1097/AOG.0000000000002112
12. Pickett CM Seeratan DD Mol BWJ Nieboer TE Johnson N Bonestroo T Surgical approach to hysterectomy for benign gynaecological disease Cochrane Database Syst Rev 2023 8 CD003677 10.1002/14651858.CD003677.pub6 37642285
Pickett CM, Seeratan DD, Mol BWJ, Nieboer TE, Johnson N, Bonestroo T, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2023;8:CD003677. 10.1002/14651858.CD003677.pub6.37642285 10.1002/14651858.CD003677.pub6
13. Aarts JWM Nieboer TE Johnson N Tavender E Garry R Mol BWJ Surgical approach to hysterectomy for benign gynaecological disease Cochrane Database Syst Rev 2015 2015 CD003677 10.1002/14651858.CD003677.pub5 26264829
Aarts JWM, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BWJ, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;2015:CD003677. 10.1002/14651858.CD003677.pub5.26264829 10.1002/14651858.CD003677.pub5
14. Neis KJ Zubke W Römer T Schwerdtfeger K Schollmeyer T Rimbach S Indications and route of hysterectomy for benign diseases. Guideline of the DGGG, OEGGG and SGGG (S3 level, AWMF registry 015/070, April 2015) Geburtshilfe Frauenheilkd 2016 76 350 64 10.1055/s-0042-104288 27667852
Neis KJ, Zubke W, Römer T, Schwerdtfeger K, Schollmeyer T, Rimbach S, et al. Indications and route of hysterectomy for benign diseases. Guideline of the DGGG, OEGGG and SGGG (S3 level, AWMF registry 015/070, April 2015). Geburtshilfe Frauenheilkd. 2016;76:350–64. 10.1055/s-0042-104288.27667852 10.1055/s-0042-104288
15. Sloth SB Schroll JB Settnes A Gimbel H Rudnicki M Topsoee MF Systematic review of the limited evidence for different surgical techniques at benign hysterectomy: a clinical guideline initiated by the Danish Health Authority Eur J Obstet Gynecol Reprod Biol 2017 216 169 77 10.1016/j.ejogrb.2017.07.012 28779691
Sloth SB, Schroll JB, Settnes A, Gimbel H, Rudnicki M, Topsoee MF, et al. Systematic review of the limited evidence for different surgical techniques at benign hysterectomy: a clinical guideline initiated by the Danish Health Authority. Eur J Obstet Gynecol Reprod Biol. 2017;216:169–77. 10.1016/j.ejogrb.2017.07.012.28779691 10.1016/j.ejogrb.2017.07.012
16. Morrison JK The ureter and hysterectomy, including the effects of certain gynaecological conditions on the urinary tract J Obstet Gynaecol Br Emp 1960 67 66 73 10.1111/j.1471-0528.1960.tb06951.x 14424368
Morrison JK. The ureter and hysterectomy, including the effects of certain gynaecological conditions on the urinary tract. J Obstet Gynaecol Br Emp. 1960;67:66–73.14424368 10.1111/j.1471-0528.1960.tb06951.x
17. Okaro EO Jones KD Sutton C Long term outcome following laparoscopic supracervical hysterectomy BJOG 2001 108 1017 20 10.1111/j.1471-0528.2001.00252.x 11702830
Okaro EO, Jones KD, Sutton C. Long term outcome following laparoscopic supracervical hysterectomy. BJOG. 2001;108:1017–20. 10.1111/j.1471-0528.2001.00252.x.11702830 10.1111/j.1471-0528.2001.00252.x
18. Helström L Bäckström T Sörbom D Lundberg PO Sacral nervous function, hormonal levels and sexuality in premenopausal women before and after hysterectomy Acta Obstet Gynecol Scand 1994 73 570 4 10.3109/00016349409006275 8079609
Helström L, Bäckström T, Sörbom D, Lundberg PO. Sacral nervous function, hormonal levels and sexuality in premenopausal women before and after hysterectomy. Acta Obstet Gynecol Scand. 1994;73:570–4. 10.3109/00016349409006275.8079609 10.3109/00016349409006275
19. Rosati M Bramante S Conti F A review on the role of laparoscopic sacrocervicopexy Curr Opin Obstet Gynecol 2014 26 281 9 10.1097/GCO.0000000000000079 24950123
Rosati M, Bramante S, Conti F. A review on the role of laparoscopic sacrocervicopexy. Curr Opin Obstet Gynecol. 2014;26:281–9. 10.1097/GCO.0000000000000079.24950123 10.1097/GCO.0000000000000079
20. Rahmanou P White B Price N Jackson S Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively Int Urogynecol J 2014 25 131 8 10.1007/s00192-013-2209-5 24193261
Rahmanou P, White B, Price N, Jackson S. Laparoscopic hysteropexy: 1- to 4-year follow-up of women postoperatively. Int Urogynecol J. 2014;25:131–8. 10.1007/s00192-013-2209-5.24193261 10.1007/s00192-013-2209-5
21. Hellström A-C Hellman K Pettersson BF Andersson S Carcinoma of the cervical stump: fifty years of experience Oncol Rep 2011 25 1651 4 10.3892/or.2011.1228 21431283
Hellström A-C, Hellman K, Pettersson BF, Andersson S. Carcinoma of the cervical stump: fifty years of experience. Oncol Rep. 2011;25:1651–4. 10.3892/or.2011.1228.21431283 10.3892/or.2011.1228
22. Rechberger T Perzyło K Miotła P Nowak-Markwitz E Zaborowski M Lemańska A [Carcinoma of the cervical stump–multicenter study] Ginekol Pol 2014 85 435 40 10.17772/gp/1749 25029808
Rechberger T, Perzyło K, Miotła P, Nowak-Markwitz E, Zaborowski M, Lemańska A, et al. [Carcinoma of the cervical stump–multicenter study]. Ginekol Pol. 2014;85:435–40. 10.17772/gp/1749.25029808 10.17772/gp/1749
23. Andrikos D Andrikos A Naem A Ebertz O Devassy R De Wilde RL Advanced cervical stump cancer after laparoscopic subtotal hysterectomy: a case report of imaging, laparoscopic staging and treatment approach BMC Womens Health 2023 23 281 10.1186/s12905-023-02428-7 37221579
Andrikos D, Andrikos A, Naem A, Ebertz O, Devassy R, De Wilde RL, et al. Advanced cervical stump cancer after laparoscopic subtotal hysterectomy: a case report of imaging, laparoscopic staging and treatment approach. BMC Womens Health. 2023;23:281. 10.1186/s12905-023-02428-7.37221579 10.1186/s12905-023-02428-7
24. Mattingly M Juran R Su I Ebinger J Daggy J Tucker Edmonds B Patient knowledge of hysterectomy and pap screening after minimally invasive hysterectomy Patient Educ Couns 2017 100 121 5 10.1016/j.pec.2016.08.017 27575660
Mattingly M, Juran R, Su I, Ebinger J, Daggy J, Tucker Edmonds B. Patient knowledge of hysterectomy and pap screening after minimally invasive hysterectomy. Patient Educ Couns. 2017;100:121–5. 10.1016/j.pec.2016.08.017.27575660 10.1016/j.pec.2016.08.017
25. Kilkku P Grönroos M Peroperative electrocoagulation of endocervical mucosa and later carcinoma of the cervical stump Acta Obstet Gynecol Scand 1982 61 265 7 10.3109/00016348209156569 7124358
Kilkku P, Grönroos M. Peroperative electrocoagulation of endocervical mucosa and later carcinoma of the cervical stump. Acta Obstet Gynecol Scand. 1982;61:265–7. 10.3109/00016348209156569.7124358 10.3109/00016348209156569
26. Kives S Lefebvre G 238-Supracervical hysterectomy J Obstet Gynaecol Can 2018 40 e597 604 10.1016/j.jogc.2018.04.033 29921438
Kives S, Lefebvre G. 238-Supracervical hysterectomy. J Obstet Gynaecol Can. 2018;40:e597–604. 10.1016/j.jogc.2018.04.033.29921438 10.1016/j.jogc.2018.04.033
27. Ghomi A Hantes J Lotze EC Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy J Minim Invasive Gynecol 2005 12 201 5 10.1016/j.jmig.2005.03.008 15922975
Ghomi A, Hantes J, Lotze EC. Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy. J Minim Invasive Gynecol. 2005;12:201–5. 10.1016/j.jmig.2005.03.008.15922975 10.1016/j.jmig.2005.03.008
28. Sasaki KJ, Cholkeri-Singh A, Sulo S, Miller CE. Persistent bleeding after laparoscopic supracervical hysterectomy. JSLS 2014;18. 10.4293/JSLS.2014.002064
29. Morrison JE Jacobs VR 437 classic intrafascial supracervical hysterectomies in 8 years J Am Assoc Gynecol Laparosc 2001 8 558 67 10.1016/S1074-3804(05)60621-4 11677337
Morrison JE, Jacobs VR. 437 classic intrafascial supracervical hysterectomies in 8 years. J Am Assoc Gynecol Laparosc. 2001;8:558–67. 10.1016/S1074-3804(05)60621-4.11677337 10.1016/S1074-3804(05)60621-4
30. Kim DH Bae DH Hur M Kim SH Comparison of classic intrafascial supracervical hysterectomy with total laparoscopic and laparoscopic-assisted vaginal hysterectomy J Am Assoc Gynecol Laparosc 1998 5 253 60 10.1016/S1074-3804(98)80028-5 9668147
Kim DH, Bae DH, Hur M, Kim SH. Comparison of classic intrafascial supracervical hysterectomy with total laparoscopic and laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc. 1998;5:253–60.9668147 10.1016/S1074-3804(98)80028-5
31. Gimbel H Zobbe V Andersen BM Filtenborg T Gluud C Tabor A Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results BJOG 2003 110 1088 98 14664880
Gimbel H, Zobbe V, Andersen BM, Filtenborg T, Gluud C, Tabor A. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG. 2003;110:1088–98.14664880
32. Manyonda I, Thakar RB, Ayers S. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG. 2004;111. 10.1111/j.1471-0528.2004.00164.x. 760; author reply 760-1.
33. van der Stege JG van Beek JJ Problems related to the cervical stump at follow-up in laparoscopic supracervical hysterectomy JSLS 1999 3 5 7 10323162
van der Stege JG, van Beek JJ. Problems related to the cervical stump at follow-up in laparoscopic supracervical hysterectomy. JSLS. 1999;3:5–7.10323162
34. van Wijngaarden WJ Filshie GM Laparoscopic supracervical hysterectomy with Filshie clips J Am Assoc Gynecol Laparosc 2001 8 137 42 10.1016/s1074-3804(05)60563-4 11172129
van Wijngaarden WJ, Filshie GM. Laparoscopic supracervical hysterectomy with Filshie clips. J Am Assoc Gynecol Laparosc. 2001;8:137–42. 10.1016/s1074-3804(05)60563-4.11172129 10.1016/s1074-3804(05)60563-4
35. Nouri K Demmel M Greilberger U Fischer E-M Seemann R Egarter C Prospective cohort study and meta-analysis of cyclic bleeding after laparoscopic supracervical hysterectomy Int J Gynaecol Obstet 2013 122 124 7 10.1016/j.ijgo.2013.03.021 23731507
Nouri K, Demmel M, Greilberger U, Fischer E-M, Seemann R, Egarter C, et al. Prospective cohort study and meta-analysis of cyclic bleeding after laparoscopic supracervical hysterectomy. Int J Gynaecol Obstet. 2013;122:124–7. 10.1016/j.ijgo.2013.03.021.23731507 10.1016/j.ijgo.2013.03.021
36. Jenkins TR Laparoscopic supracervical hysterectomy Am J Obstet Gynecol 2004 191 1875 84 10.1016/j.ajog.2004.06.096 15592268
Jenkins TR. Laparoscopic supracervical hysterectomy. Am J Obstet Gynecol. 2004;191:1875–84. 10.1016/j.ajog.2004.06.096.15592268 10.1016/j.ajog.2004.06.096
37. Lieng M Qvigstad E Istre O Langebrekke A Ballard K Long-term outcomes following laparoscopic supracervical hysterectomy BJOG 2008 115 1605 10 10.1111/j.1471-0528.2008.01854.x 18752588
Lieng M, Qvigstad E, Istre O, Langebrekke A, Ballard K. Long-term outcomes following laparoscopic supracervical hysterectomy. BJOG. 2008;115:1605–10. 10.1111/j.1471-0528.2008.01854.x.18752588 10.1111/j.1471-0528.2008.01854.x
38. Baker PM Clement PB Bell DA Young RH Superficial endometriosis of the uterine cervix: a report of 20 cases of a process that may be confused with endocervical glandular dysplasia or adenocarcinoma in situ Int J Gynecol Pathol 1999 18 198 205 10.1097/00004347-199907000-00002 12090586
Baker PM, Clement PB, Bell DA, Young RH. Superficial endometriosis of the uterine cervix: a report of 20 cases of a process that may be confused with endocervical glandular dysplasia or adenocarcinoma in situ. Int J Gynecol Pathol. 1999;18:198–205.12090586 10.1097/00004347-199907000-00002
39. Schmidt T Eren Y Breidenbach M Fehr D Volkmer A Fleisch M Modifications of laparoscopic supracervical hysterectomy technique significantly reduce postoperative spotting J Minim Invasive Gynecol 2011 18 81 4 10.1016/j.jmig.2010.09.014 21094098
Schmidt T, Eren Y, Breidenbach M, Fehr D, Volkmer A, Fleisch M, et al. Modifications of laparoscopic supracervical hysterectomy technique significantly reduce postoperative spotting. J Minim Invasive Gynecol. 2011;18:81–4. 10.1016/j.jmig.2010.09.014.21094098 10.1016/j.jmig.2010.09.014
40. Zhang K Jiang J-H Hu J-L Liu Y-L Zhang X-H Wang Y-M Large pelvic mass arising from the cervical stump: a case report World J Clin Cases 2020 8 149 56 10.12998/wjcc.v8.i1.149 31970181
Zhang K, Jiang J-H, Hu J-L, Liu Y-L, Zhang X-H, Wang Y-M, et al. Large pelvic mass arising from the cervical stump: a case report. World J Clin Cases. 2020;8:149–56. 10.12998/wjcc.v8.i1.149.31970181 10.12998/wjcc.v8.i1.149
41. Zhiqiang L Bin S Min F Yufang L Leiomyosarcoma of cervical stump following subtotal hysterectomy: a case report and review of literature Eur J Gynaecol Oncol 2016 37 148 51 27048131
Zhiqiang L, Bin S, Min F, Yufang L. Leiomyosarcoma of cervical stump following subtotal hysterectomy: a case report and review of literature. Eur J Gynaecol Oncol. 2016;37:148–51.27048131
42. Hall T Lee SI Boruta DM Goodman A Medical device safety and surgical dissemination of unrecognized uterine malignancy: morcellation in minimally invasive gynecologic surgery Oncologist 2015 20 1274 82 10.1634/theoncologist.2015-0061 26382742
Hall T, Lee SI, Boruta DM, Goodman A. Medical device safety and surgical dissemination of unrecognized uterine malignancy: morcellation in minimally invasive gynecologic surgery. Oncologist. 2015;20:1274–82. 10.1634/theoncologist.2015-0061.26382742 10.1634/theoncologist.2015-0061
43. Yoo E-H Lee PI Huh C-Y Kim D-H Lee B-S Lee J-K Predictors of leiomyoma recurrence after laparoscopic myomectomy J Minim Invasive Gynecol 2007 14 690 7 10.1016/j.jmig.2007.06.003 17980328
Yoo E-H, Lee PI, Huh C-Y, Kim D-H, Lee B-S, Lee J-K, et al. Predictors of leiomyoma recurrence after laparoscopic myomectomy. J Minim Invasive Gynecol. 2007;14:690–7. 10.1016/j.jmig.2007.06.003.17980328 10.1016/j.jmig.2007.06.003
44. Shin DG Yoo HJ Lee YA Kwon IS Lee KH Recurrence factors and reproductive outcomes of laparoscopic myomectomy and minilaparotomic myomectomy for uterine leiomyomas Obstet Gynecol Sci 2017 60 193 9 10.5468/ogs.2017.60.2.193 28344961
Shin DG, Yoo HJ, Lee YA, Kwon IS, Lee KH. Recurrence factors and reproductive outcomes of laparoscopic myomectomy and minilaparotomic myomectomy for uterine leiomyomas. Obstet Gynecol Sci. 2017;60:193–9. 10.5468/ogs.2017.60.2.193.28344961 10.5468/ogs.2017.60.2.193
45. Radosa MP Owsianowski Z Mothes A Weisheit A Vorwergk J Asskaryar FA Long-term risk of fibroid recurrence after laparoscopic myomectomy Eur J Obstet Gynecol Reprod Biol 2014 180 35 9 10.1016/j.ejogrb.2014.05.029 25016181
Radosa MP, Owsianowski Z, Mothes A, Weisheit A, Vorwergk J, Asskaryar FA, et al. Long-term risk of fibroid recurrence after laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol. 2014;180:35–9. 10.1016/j.ejogrb.2014.05.029.25016181 10.1016/j.ejogrb.2014.05.029
46. Nezhat FR Roemisch M Nezhat CH Seidman DS Nezhat CR Recurrence rate after laparoscopic myomectomy J Am Assoc Gynecol Laparosc 1998 5 237 40 10.1016/s1074-3804(98)80025-x 9668143
Nezhat FR, Roemisch M, Nezhat CH, Seidman DS, Nezhat CR. Recurrence rate after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1998;5:237–40. 10.1016/s1074-3804(98)80025-x.9668143 10.1016/s1074-3804(98)80025-x
47. Fedele L Parazzini F Luchini L Mezzopane R Tozzi L Villa L Recurrence of fibroids after myomectomy: a transvaginal ultrasonographic study Hum Reprod 1995 10 1795 6 10.1093/oxfordjournals.humrep.a136176 8582982
Fedele L, Parazzini F, Luchini L, Mezzopane R, Tozzi L, Villa L. Recurrence of fibroids after myomectomy: a transvaginal ultrasonographic study. Hum Reprod. 1995;10:1795–6. 10.1093/oxfordjournals.humrep.a136176.8582982 10.1093/oxfordjournals.humrep.a136176
48. Rossetti A Sizzi O Soranna L Cucinelli F Mancuso S Lanzone A Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy Hum Reprod 2001 16 770 4 10.1093/humrep/16.4.770 11278231
Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod. 2001;16:770–4. 10.1093/humrep/16.4.770.11278231 10.1093/humrep/16.4.770
49. Singh SS Belland L Contemporary management of uterine fibroids: focus on emerging medical treatments Curr Med Res Opin 2015 31 1 12 10.1185/03007995.2014.982246 25365466
Singh SS, Belland L. Contemporary management of uterine fibroids: focus on emerging medical treatments. Curr Med Res Opin. 2015;31:1–12. 10.1185/03007995.2014.982246.25365466 10.1185/03007995.2014.982246
50. Kotani Y Tobiume T Fujishima R Shigeta M Takaya H Nakai H Recurrence of uterine myoma after myomectomy: open myomectomy versus laparoscopic myomectomy J Obstet Gynaecol Res 2018 44 298 302 10.1111/jog.13519 29227004
Kotani Y, Tobiume T, Fujishima R, Shigeta M, Takaya H, Nakai H, et al. Recurrence of uterine myoma after myomectomy: open myomectomy versus laparoscopic myomectomy. J Obstet Gynaecol Res. 2018;44:298–302. 10.1111/jog.13519.29227004 10.1111/jog.13519
51. Reed SD Newton KM Thompson LB McCrummen BA Warolin AK The incidence of repeat uterine surgery following myomectomy J Womens Health (Larchmt) 2006 15 1046 52 10.1089/jwh.2006.15.1046 17125423
Reed SD, Newton KM, Thompson LB, McCrummen BA, Warolin AK. The incidence of repeat uterine surgery following myomectomy. J Womens Health (Larchmt). 2006;15:1046–52. 10.1089/jwh.2006.15.1046.17125423 10.1089/jwh.2006.15.1046
52. Pratt JH Jefferies JA The retained cervical stump. A 25-year experience Obstet Gynecol 1976 48 711 5 995341
Pratt JH, Jefferies JA. The retained cervical stump. A 25-year experience. Obstet Gynecol. 1976;48:711–5.995341
53. Neis F Reisenauer C Kraemer B Wagner P Brucker S Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when? Arch Gynecol Obstet 2021 304 1519 26 10.1007/s00404-021-06193-6 34453213
Neis F, Reisenauer C, Kraemer B, Wagner P, Brucker S. Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when? Arch Gynecol Obstet. 2021;304:1519–26. 10.1007/s00404-021-06193-6.34453213 10.1007/s00404-021-06193-6
54. Hilger WS Pizarro AR Magrina JF Removal of the retained cervical stump Am J Obstet Gynecol 2005 193 2117 21 10.1016/j.ajog.2005.07.015 16325626
Hilger WS, Pizarro AR, Magrina JF. Removal of the retained cervical stump. Am J Obstet Gynecol. 2005;193:2117–21. 10.1016/j.ajog.2005.07.015.16325626 10.1016/j.ajog.2005.07.015
55. Tien C-T Ding D-C Adenomyoma recurrence 7 years after laparoscopic supracervical hysterectomy: a case report and literature review Med (Baltim) 2023 102 e36089 10.1097/MD.0000000000036089
Tien C-T, Ding D-C. Adenomyoma recurrence 7 years after laparoscopic supracervical hysterectomy: a case report and literature review. Med (Baltim). 2023;102:e36089. 10.1097/MD.0000000000036089.10.1097/MD.0000000000036089
56. Beck MM Biswas B D’Souza A Kumar R Benign metastasising leiomyoma after hysterectomy and bilateral salpingo-oophorectomy Hong Kong Med J 2012 18 153 5 22477740
Beck MM, Biswas B, D’Souza A, Kumar R. Benign metastasising leiomyoma after hysterectomy and bilateral salpingo-oophorectomy. Hong Kong Med J. 2012;18:153–5.22477740
57. Awonuga AO Rotas M Imudia AN Choi C Khulpateea N Recurrent benign metastasizing leiomyoma after hysterectomy and bilateral salpingo-oophorectomy Arch Gynecol Obstet 2008 278 373 6 10.1007/s00404-008-0581-z 18259767
Awonuga AO, Rotas M, Imudia AN, Choi C, Khulpateea N. Recurrent benign metastasizing leiomyoma after hysterectomy and bilateral salpingo-oophorectomy. Arch Gynecol Obstet. 2008;278:373–6. 10.1007/s00404-008-0581-z.18259767 10.1007/s00404-008-0581-z
58. Kyriakopoulos K Domali E Stavrou S Rodolakis A Loutradis D Drakakis P Recurrent benign leiomyomas after total abdominal hysterectomy. Rich or poor estrogenic environment may lead to their recurrence? Int J Surg Case Rep 2018 44 191 3 10.1016/j.ijscr.2018.02.029 29550681
Kyriakopoulos K, Domali E, Stavrou S, Rodolakis A, Loutradis D, Drakakis P. Recurrent benign leiomyomas after total abdominal hysterectomy. Rich or poor estrogenic environment may lead to their recurrence? Int J Surg Case Rep. 2018;44:191–3. 10.1016/j.ijscr.2018.02.029.29550681 10.1016/j.ijscr.2018.02.029
59. KRISHNAMOORTHY JK. Recurrent huge leiomyoma from the cervical stump-a rare case report. Univ J Surg Surg Specialities. 2018;4(4).
60. Mathew SD Abraham B Cervical stump Fibroidpost Supra-cervical hysterectomy Int J Health Sci 2018 6 2 97 9
Mathew SD, Abraham B. Cervical stump Fibroidpost Supra-cervical hysterectomy. Int J Health Sci. 2018;6(2):97–9.
61. Pelosi MA Pelosi MA Rudelli RD Symptomatic cervical macrocyst as a late complication of subtotal hysterectomy. A case report J Reprod Med 1999 44 567 70 10394555
Pelosi MA, Pelosi MA, Rudelli RD. Symptomatic cervical macrocyst as a late complication of subtotal hysterectomy. A case report. J Reprod Med. 1999;44:567–70.10394555
62. Barnard WG Recurrence of Leio-Myo-sarcoma of the Uterus in the cervical stump Proc R Soc Med 1928 21 538 19986278
Barnard WG. Recurrence of Leio-Myo-sarcoma of the Uterus in the cervical stump. Proc R Soc Med. 1928;21:538.19986278
63. Sturdy DE Leiomyosarcoma of cervical stump following subtotal hysterectomy Br J Surg 1959 46 369 70 10.1002/bjs.18004619812 13638574
Sturdy DE. Leiomyosarcoma of cervical stump following subtotal hysterectomy. Br J Surg. 1959;46:369–70. 10.1002/bjs.18004619812.13638574 10.1002/bjs.18004619812
64. Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database Syst Rev. 2012;CD004993. 10.1002/14651858.CD004993.pub3.
65. Giles AE Large fibroid of Cervix developing after Subtotal Hysterectomy Proc R Soc Med 1923 16 12 3 19983109
Giles AE. Large fibroid of Cervix developing after Subtotal Hysterectomy. Proc R Soc Med. 1923;16:12–3.19983109
66. Fuchs IB Henrich W Schmider A Lichtenegger W Endometriotic cyst after subtotal abdominal hysterectomy mimicking carcinoma of the cervical stump BJOG 2003 110 637 8 10.1046/j.1471-0528.2003.02123.x 12798488
Fuchs IB, Henrich W, Schmider A, Lichtenegger W. Endometriotic cyst after subtotal abdominal hysterectomy mimicking carcinoma of the cervical stump. BJOG. 2003;110:637–8.12798488 10.1046/j.1471-0528.2003.02123.x
67. Hilger WS Magrina JF Removal of pelvic leiomyomata and endometriosis five years after supracervical hysterectomy Obstet Gynecol 2006 108 772 4 10.1097/01.AOG.0000209187.90019.d3 17018497
Hilger WS, Magrina JF. Removal of pelvic leiomyomata and endometriosis five years after supracervical hysterectomy. Obstet Gynecol. 2006;108:772–4. 10.1097/01.AOG.0000209187.90019.d3.17018497 10.1097/01.AOG.0000209187.90019.d3
68. Yanamandra SR Redman CWE Coomarasamy A Varma R Leiomyoma appearing in the vaginal vault following hysterectomy J Obstet Gynaecol 2007 27 91 2 10.1080/01443610601076176 17365476
Yanamandra SR, Redman CWE, Coomarasamy A, Varma R. Leiomyoma appearing in the vaginal vault following hysterectomy. J Obstet Gynaecol. 2007;27:91–2. 10.1080/01443610601076176.17365476 10.1080/01443610601076176
69. Ismail SMF Adams SA Vaginal vault leiomyoma J Obstet Gynaecol 2009 29 160 1 10.1080/01443610802643972 19274562
Ismail SMF, Adams SA. Vaginal vault leiomyoma. J Obstet Gynaecol. 2009;29:160–1. 10.1080/01443610802643972.19274562 10.1080/01443610802643972
70. Yarci A Bayramov V Sükür YE Yüce T Berker B Vaginal vault leiomyoma: 25 years after total abdominal hysterectomy J Minim Invasive Gynecol 2010 17 116 7 10.1016/j.jmig.2009.10.004 20129345
Yarci A, Bayramov V, Sükür YE, Yüce T, Berker B. Vaginal vault leiomyoma: 25 years after total abdominal hysterectomy. J Minim Invasive Gynecol. 2010;17:116–7. 10.1016/j.jmig.2009.10.004.20129345 10.1016/j.jmig.2009.10.004
71. Guraslan H Senturk MB Helvacioglu C Aktas AG Yasar L Recurrent cellular leiomyoma 10 years after total abdominal hysterectomy J Obstet Gynaecol 2015 35 854 5 10.3109/01443615.2015.1009421 25692711
Guraslan H, Senturk MB, Helvacioglu C, Aktas AG, Yasar L. Recurrent cellular leiomyoma 10 years after total abdominal hysterectomy. J Obstet Gynaecol. 2015;35:854–5. 10.3109/01443615.2015.1009421.25692711 10.3109/01443615.2015.1009421
72. Sezgin B Camuzcuoğlu A Camuzcuoğlu H Laparoscopic removal of the cervical stump for a cervical solid mass in a patient with previous supracervical hysterectomy J Turk Ger Gynecol Assoc 2021 22 153 4 10.4274/jtgga.galenos.2019.2019.0143 31927814
Sezgin B, Camuzcuoğlu A, Camuzcuoğlu H. Laparoscopic removal of the cervical stump for a cervical solid mass in a patient with previous supracervical hysterectomy. J Turk Ger Gynecol Assoc. 2021;22:153–4. 10.4274/jtgga.galenos.2019.2019.0143.31927814 10.4274/jtgga.galenos.2019.2019.0143
