ABSTRACT
Background: Hysterectomy is a common gynecological surgery performed in premenopausal and menopausal age group. Different types of approaches are there with their advantages and disadvantages, it is mainly indicated for noncancerous conditions. Till today three different surgical approaches to hysterectomy are available: vaginal, abdominal and laparoscopic. TLH has been reported to result in shorter procedure durations, lower blood losses, and shorter hospital stays.Methods: This is a retrospective case study, was carried out over a 5-year period in a tertiary care institute. Study done on patients attending gynecology OPD at our tertiary care institute during the period since September 2013 to September 2018.Results: In present study out of 646 endoscopic hysterectomies in last five years authors studied 420 Total Laparoscopic Hysterectomies. Conversion to open surgery rate was 0.3%. Mean age was 49.26 years (SD-9.53), Performed for various indications with various BMI patients. Mean surgical duration was 116.55 minutes with SD 26.27. Major complication rate was 2.85% with 2 cases of bowel injuries and 3 cases of urological injuries.Conclusions: Total laparoscopic hysterectomy appears safe and effective approach for variety of indications with minimal morbidity. Beneficial for all age group all nulliparous /multiparous patients as well as obese patients. With the knowledge of all complication and its prevention, maximum surgeons can give benefit of advantages of total laparoscopic hysterectomy to all women. More and more randomized clinical trials will motivate surgeons for this approach.
ABSTRACT
Diagnosing the aetiology of jaundice is extremely important in pregnant patients as certain conditions like Acute fatty liver of pregnancy (AFLP), HELLP syndrome and intra-hepatic cholestasis of pregnancy (ICP) may require early termination of pregnancy even in the presence of jaundice and or coagulation failure. Once diagnosed, prompt delivery is associated with a significantly improved outcome. A 20 years old primigravida patient with 34 weeks pregnancy presented to outpatient department of obstetrics and gynecology department of SBH Government Medical College, Dhule, with nausea, vomiting, jaundice, ascites and coagulopathy. The patient was subjected to detailed work-up including laboratory investigations and radiological examinations. A diagnosis of acute fatty liver of pregnancy was made based on the Swansea criteria. The labour was induced with delivery of live male fetus of 2.1 kg in good condition. The case of AFLP was managed using supportive treatment in intensive care unit with blood products, careful fluid management and prevention of hypoglycaemia. Careful history and physical examination in conjunction with compatible laboratory and imaging results are often sufficient to make the diagnosis and liver biopsy is rarely indicated.