Total Versus Sub-Total Hysterectomy: A Meta-Analysis of Randomized Controlled Trials.

Abstract

<h4>Objective</h4>To provide available evidence comparing total (TH) versus subtotal hysterectomy (SH) for benign gynecological disease.<h4>Data sources</h4>Pubmed, Embase and ClinicalTrials.gov databases were searched up to Nov 1, 2025, using relevant meSH key words.<h4>Methods of study selection</h4>Randomized-controlled trials (RCTs) comparing short and long-term outcomes in women undergoing TH versus SH were eligible for inclusion. DerSimonian-Laird random effects meta-analysis was performed and pooled effect estimates and proportions with corresponding 95% confidence intervals were computed. Heterogeneity was assessed using the I² statistic.<h4>Tabulation, integration, and results</h4>Fourteen RCTs (1,921 women) were included, comparing total hysterectomy (TH; 51.5%) with subtotal hysterectomy (SH; 48.5%). TH was associated with a significant reduction in abnormal/cyclic vaginal bleeding at 1 year (RR 0.15, 95% CI: 0.07, 0.33, I²= 8.5%, p ≤ .01), confirmed in sensitivity analyses of highest quality studies. Conversely, operative time, blood loss, and hospital stay were slightly higher with TH, though differences were small and likely clinically negligible. TH was also associated with a lower risk of urinary incontinence (UI) beyond 1 year (up to 14 years) (RR 0.67, 95% CI: 0.49, 0.93, I²= 0%, p = .01); however, no differences were observed at 1 year, in the sensitivity analysis up to 2 years, nor when stress and urgency urinary incontinence were evaluated separately. No additional significant differences were found in urinary, sexual, or bowel function, or quality of life.<h4>Conclusion</h4>In this study, TH reduced long-term cyclical bleeding and UI compared with SH, which offered only minor short-term surgical benefits. Evidence indicates no differences in other urinary, sexual, or bowel function, or overall quality of life in the long term.<h4>Prospero registration number</h4>CRD420251059868.