The role of laparoscopy in the evaluation of candidates for sterilization reversal

 Laparoscopy  is  the  useful  diagnostic  procedure  for  evaluation  of  pelvic  organs  pathology.  Routine  laparoscopy  for  evaluation  of  the  patients  who  need  tubal  sterilization  reversal  has  been  used  in  some  institutes.  But  it  is  an  invasive  and  costly  procedure,  and  some  complications   may  occurred. Two  hundred  and  thirty  cases  of  women  who  underwent  laparoscopy  for    preoperative  evaluation  of  tubal  sterization  revesal  were  reviewed.  The  average  age  of  these  patient  was  31.9  years  with  average  number  of  pregnancies  of  1.9  times  and  average  duration  of  tubal  sterilization  of  6.8  years. The  majority of  these  women  70.0  percent stated  the  reversal  request  because  of  remarriage.  Laparoscopic  finding   revealed  that  Pomoroy’s  technic  of  tubal  sterilization  at  isthmus  part  of  the  fallopian  tubes  was  commonly  used  and  85.2  percent  of  cases  were  operable.  The  most  common  cause  of  inoperable  cases  was  bilateral  salpingectomy,  7.4  percent  and the  second  common  was  total  tubal  length  on  each  side  was  less  than  4  centimeters,  4.3  percent  From  this  result,  we  concluded  that  laparoscopy  has  little  benefit  in  the  evaluation  of  candidates  for  sterilization  reversal   but  had  benefit  in  evaluation  of  prognosis  and  with  the  good  counseling,  in  some  cases,  laparoscopy  may  be  unnecessary.

Endometriosis in Srinagarind Hospital

Background : Endometriosis is a relatively relatively common gynecological  condition. There  was no report  related to the prevalence and description in the  northeast region of Thailand.Objective : 1.To assess the prevalence of endometriosis in inpatient unit of Obstetric – Gynecology department of Srinagarind hospital. 2. To assess the characteristics of endometriotic patients regarding clinical manifestations, results of investigations, modalities of treatment and results.Design : A descriptive study.Setting : Srinagarind hospital, Khon Kaen University. Subjects : 3,626 gynecologic patients who were admitted to Srinagarind  hospital from January 1 , 1991 to  December 31, 1992.Main  Outcome Measures : The prudent indicators  used  in  this  study  were  the  prevalence  of  endometriosis,  ties  and  result  of  treatment.Results: The prevalence  of  endometriosis in Srinagarind  hospital during the study  period  was 8.6%  which consisted  of 3.1%  endometriosis externa, 3.1% adenomyosis , 0.8% combined  and 1.6% with  other diseases. In  the  adenomyosis group,  this study  revealed  the  mean age of  43.9 years.   The  most  common  presenting  symptoms were  abnormal  vaginal bleeding (42.9%), chronic pelvic  pain (33.9%)  and dysmenorrheal (21.4%). Most of  the  patients  were treated  by  hysterectome. The results  of  therapy  were good, 99.1%  of patients had no symptoms and  normal  pelvic  examination. In the endometriosis externa  group,  this  study  revealed  the  mean  age  of 32.5 years,  most  of  patients (54.4%) were nullipara. The most  common  presenting  symptoms  were infertility (46.5%) and  dysmenorrheal (44.7%). Most of the pathology were found  in  ovaries (52.6%) . forty  two percents  of  the patients were treated  by  surgery,  in which  74.2% were conservative surgery.  Other  patients  were treated  by  hormonat  therapy  and  combined  hormonal – surgical therapy in 30.7% and 15.8% respectively. Most of the  patients (76.3%) were lost follow  up.Conclusions : Endometriosis is  a  common  disease  in  Gynecologic  inpatient  unit  of  Srinagarind  hospital. The results of  therapy  especially  in  adenomyosis group was  quite effective but  there  was  a  high  rate  of  lost  follow  up in endometriosis externa  group  so  the success  rate  of  treatment  could  not   be  accurately evaluated.

Outpatiens’ Satisfaction to the Provision of Care at Gynecological Department, Srinagarind Hoapital

Background  :  Out patient Gynecology service have been carried out nearly twenty years for teaching purposes as well as to ascertian high quality of case is by means of assessing clients’ level of satisfaction. Thus, it is necessary to assess clients’ level of service satisfaction at regular intervals.Objective : To study the level of clients, satisfaction and related factors for out patient at gynecological service.Methods :  This descriptive study included 350 purposive sampling patients coming to out patient department with gynecological problem. Each patient was asked to fill the questionnaire which had been already tasted. The questionnaire consisted of general information and the level of satisfaction evaluation forms.Result :  The level of satisfaction to the services of gynecological department was high. In patients’ opinion, the waiting time approximate 78 minutes was quite long. High educated (bachelor degree). The ones who once received services form this hospital felt higher satisfaction than those who never did. The other factors including patients’s age, distance to the hospital, incomes, experience from other health service provider, doctor’s experience and doctor gender, were not significantly related to the level of satisfaction.Discussion :  The gynecological out patients are very appreciated in the service. However there are something have to be corrected for the top of the goal such as : systematic correction plan, increase management time for doctor and nursing care, and method for effective evaluation.Key Words :  Satisfaction, Outpatient, Gynecology

Reversal of Sterilization by Microsurgery in Srinagarind Hospital

Objective: To assess the success rate and factors influencing the success rate of sterilization reversal in Srinagarind hospitalDesign: A descriptive studySetting: Srinagarind hospital, Khon Kaen UniversitySubject: 206 patients who underwent microsurgical sterilization reversal in Srinagarind hospital between January 1, 1984 to June 30, 1993.Result: Mean age of the patients was 32.0 years, most of them were government officers and farmers. The  reasons for reversal were remarriage (68.0 percent) and death of their children (17.5 percent). Most of the patients had postpartum tubal reanastomosis was performed in 83.0 percent of the patients. Ampulla to ampulla was the most common type of reanastomosis.  The mean duration of the operation was 135.8 minutes.  Success rate of the operation as determined by delivery of the liveborn was 58.7 percent while abortion rate and ectopic pregnancy rate were 8.3 and 6.6 percent, respectively.  Most of the pregnancies occurred in the first two years after the operation with the mean interval between the operation and the commencement of pregnancy of 21.6 months. Factors that influence the success rate of sterilization reversal were age of the patients, time interval after sterilization, type of sterilization and part of the uterine tubes being reanastomosed.  This study revealed that the patients with age under 35 years, operation performed within 5 years after sterilization, interval type of sterilization, and isthmic-isthmic reanastomosis were the factors that resulted in the better success rate.Conclusion: sterilization reversal in Srinagarind hospital had a good success rate and factors that influenced the success were age of the patients, time interval after sterilization, type of sterilization, and part of the uterine tubes being reanastomosed