ABSTRACT
Background: Laparoscopic Assisted Vaginal Hysterectomy (LAVH) has become increasingly popular as a definite alternative to abdominal hysterectomy. Objective: To compare operative outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). Study design: Retrospective case control study. Materials and Methods: Data from medical records of 29 cases and 29 controls were reviewed and recorded. Study design: Retrospective case control study. Setting: A tertiary care hospital at Bareilly (UP). Subjects: Twenty nine patients who underwent LAVH between 01 October 2010 and 30 September 2011 were recruited as cases and controls were 29 patients, who underwent TAH during the same period. Inclusion criteria were that patients be matched in a case control manner for age, weight, diagnosis, and uterine size. Results: Basic characteristics such as age, parity, weight and uterine size of cases and controls were comparable. Mean operative time was 139±11 minutes for LAVH group which was significantly longer than 99±9 minutes for TAH group. Mean blood loss during surgery in LAVH group of patients was 250ml and it was 275 in abdominal hysterectomy patients, however observed differences were not significant. Mean Hb drop after 24 Hrs of surgery was 1.4g/dl in LAVH group and it was 1.6g/dl in TAH group and differences was not significant. Number of doses of injectable analgesics used per patients was significantly more in TAH group (2.3) in comparison to LAVH (1.2). Overall complication was 14% in LAVH and 10% in TAH and differences were not significant. The mean hospitalization was significantly shorter for LAVH group 2.7 days compared to 5.5 days in TAH group. Conclusion: LAVH had longer operative time but with shorter hospital stay in comparison with TAH.
ABSTRACT
Introduction: Contrary to previous belief many studies published now have shown that myomectomy during cesarean section (CS) is a safe procedure with no significant increased risk of intra and postoperative complications. Methods: This prospective study was carried out in antennal mothers from May09 to Sep 10 in a tertiary care hospital of Uttar Pradesh after taking institutional ethical committee approval. Diagnosis of myoma was confirmed by ultrsonography. Only those mothers were included in the study who gave the informed consent to participate in study. Cesarean myomectomy was planned in all mothers having myoma. Operative time, intraoperative haemorrhage and length of hospital stay of mothers having myoma were compared to matched pregnant women with CS alone (28cases). Data were collected on a questionnaire and analyzed by appropriate test of significance. Results: Out of 966 antenatal mothers registered during the study period myoma was detected in 14(1.18%) cases. Mean age mothers of having myoma were 27.08 years and 61.54% were primigravida and only 23.08 % were third gravida. In 61.54% mother’s parity was zero and only 15.39 % mothers were having parity two. Mean haemoglobin was 10.56 gm%. In all cases presentation of foetus was vertex. In 92.3% mothers location of myoma was at anterior wall and subserous and in 7.7% cases it was fundal . Size of myoma was less than 3.0 Cm in 38.50 cases , 3.1 Cm to 5.0 Cm in 23.1% cases and more than 5.1 Cm in 38.4% cases. There was no significant difference in operative time, intraoperative haemorrhage and length of hospital stay in comparison to matched pregnant women with CS alone. Postnatal period was uneventful and complication like PPH was nil in all in cesarean myomectomy cases. Conclusion: caesarean myomectomy can be safely performed in majority of patients with myomas without any serious or life threatening complication.