••• CHAPTER 32^ Hysterectomy^313
❍ Why would hysterectomy reduce the risk of ovarian cancer?
Several possibilities exist. These include the opportunity to examine the ovaries at the time of hysterectomy and
remove the ones that are abnormal. Protection of the ovaries from environmental carcinogens, a possible reduction
or alteration in ovarian blood flow, or more frequent prior use of oral contraceptives could also be mechanisms.
❍ After hysterectomy with ovarian conservation, how many patients will require a subsequent operation for
ovarian or tubal pathology?
Approximately 1% to 2%.
❍ If granulation tissue forms at the vaginal cuff, how should this be treated?
This granulation tissue can be easily treated in the office by touching it with silver nitrate.
❍ How should prolapse of a fallopian tube be recognized and treated?
This rare complication is usually recognized when suspected granulation tissue fails to go away with silver nitrate
treatment, or when the “granulation tissue” seems to have a canal. This tissue can be excised vaginally, and the cuff
then closed. Most often, this is done in the operating room.
❍ In the United States, what is the most common cause of GU tract fistula?
While most fistulae worldwide are the result of obstetric trauma, the most common cause in the United States is
pelvic surgery. Most follow an abdominal hysterectomy for benign disease.
REFERENCE
Pinion SB, Parkin DE, Abramovich DR. Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial
resection for dysfunctional uterine bleeding. BMJ. 1994;309(6960):979–83.