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The implementation of enhanced recovery after surgery (ERAS) pathways represents a concerted effort to optimize patient outcomes in the perioperative period while minimizing postoperative complications and readmissions. ERAS achieves these objectives through the integration of various elements into a comprehensive perioperative management program, aimed at reducing surgical stress and its associated repercussions. Key principles of ERAS encompass preoperative counselling, nutritional strategies, emphasis on regional anaesthesia and nonopioid analgesics, meticulous fluid balance, maintenance of normothermia, and promotion of postoperative recovery strategies such as early mobilization and thromboprophylaxis. The benefits of ERAS are manifold, including shorter hospital stays, diminished postoperative pain and analgesic requirements, expedited return of bowel function, reduced complication and readmission rates, and heightened patient satisfaction, all achieved without elevating readmission, mortality, or reoperation rates. Effective adoption of ERAS necessitates institutions to evaluate their infrastructure and patient flow to support its implementation adequately. Furthermore, sustainable ERAS programs should be seamlessly integrated as a standard model of care within healthcare delivery systems. The success of ERAS hinges upon the simultaneous implementation of its multiple components, underscoring its holistic approach. Institutions are urged to endorse the adoption of ERAS pathways emphatically as a means to enhance patient care and improve perioperative outcomes.
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Background: This study is aimed to review indications, demographic data of patients, clinical outcomes and safety of total laparoscopic hysterectomy.Methods: This is a prospective observational study of total 150 patients who underwent total laparoscopic hysterectomy (TLH) from 1st June 2017 to 30th November 2018 in GMERS Civil Hospital Sola.Results: ~45% patients were between 40-50 years age group; 60% patients had 2 or more deliveries; commonest indication was symptomatic adenomyosis ; uterine size in ~57% of patients were up to 6 weeks; duration of surgery in ~91% of patients <120 minutes; intraoperative blood loss in all cases <200ml; no intra-operative and postoperative complications were encountered.Conclusions: TLH is safe procedure with minimal blood loss, minimal postoperative pain and discomfort and shorter duration of hospital stay when performed via expert hands.
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Background: Hysterectomy, the most common gynaecologic surgery performed around the world. however, repeat gynaecologic intervention / surgery may be required for some conditions, adding cost and morbidity for patients and posing a burden on healthcare systems. The objective of the present study was to find out the incidence of and types of surgical intervention required post hysterectomy.Methods: A retrospective analysis of hospital records was done for gynecologic operative procedures done in post hysterectomy patients 2014-2016.Results: Out of a total of 1028 in the year 2014-2016 in our centre, 75 (7.3%) surgeries were performed for benign conditions in hysterectomized women. Hydrosalpinx(29%) was most common condition for surgery, followed by endometriosis(24%) with 31-40 years age group women undergoing the maximum surgeries. Vault prolapse(16%) in elderly and vaginal vault granulation(16%) in younger women also underwent a repeat gynecological procedure post hysterectomy.Conclusions: Some measures can be taken during the primary surgery(hysterectomy) to prevent a repeat gynaecological surgery in these women. Concurrent salpingectomy can prevent benign and malignant fallopian tube lesions and ovarian cancer . Endometriosis surgery should be precise to prevent any remnant ovarian or endometriotic foci. McCall’s culdoplasty in primary hysterectomy is proven to prevent vaginal vault prolapse. Most genitourinary fistulas can be prevented by detailed knowledge of pelvic anatomy, preoperative risk stratification of patients at higher risk of ureteric and urinary bladder injuries, meticulous surgical technique and judicious use of electrosurgical energy. Prevention is always better than a repeat surgery.
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Posotoprative nausea and vomiting remains a persistent and distressing problem inspite of many advances on perioperative care and anti-emetic drugs. A newer antiemetic drug Granisetron has not been studied in patients undergoing gynaecological surgery under spinal anaesthesia
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During the study period from January 2008 to December 2012, 177 women had transvaginal sacrospinous ligament fixation (SSF) for vault suspension at General Hospital Kuala Lumpur. Of the 177 women, 133 (75.1%) had severe uterovaginal prolapse while 44 (24.9%) had post-hysterectomy vault prolapse. All patients with severe uterovaginal prolapse and rectocele undergone vaginal hysterectomy and posterior colporrhaphy respectively. A hundred and seventy-four patients (98.3%) had anterior repair whilst 48 (27.1%) received midurethral sling as concomitant procedure to vault suspension (SSF). The mean duration of surgery was 92.1±30.2 minutes and the mean estimated blood loss was 319±199.3mls. There was no surgical mortality. Two patients (1.1%) had rectal injuries. No patient had bladder injury or de novo urinary symptoms. The commonest immediate postoperative complications was fever (98; 55.4%) followed by buttock pain in 18 (10.2%) patients. Both complications were resolved with conservative measures. Seven patients (3.9%) had sutures erosion as late complications. Of the 177 women, 158 (89.3%) and 141 (79.7%) came for the 6 and 12 months follow-up, respectively. The success rate for all three compartments ranged from 92.4% to 98.1% at 6 months and reduced to range from 85.7% to 94.4% at 12 months. The highest success rate was observed in the posterior compartment followed by apical and anterior compartment. Equally, the recurrence rate was lowest in the posterior compartment (1.9%), followed by the central (3.8%) and anterior compartment (7.5%) at 6 months’ review. This increased to 5.7% for rectocele, 7.8% for vault prolapse and 14.2% for cystocele at 12 months’ follow-up. None had repeated surgery for prolapse recurrence during the study period. In conclusion, SSF remains a high priority in our therapeutic regime for the treatment of severe uterovaginal and vault prolapse as it has a reasonably good success rate with lower serious complications in the skillful hands.
Subject(s)
Hysterectomy, VaginalABSTRACT
Background and Objectives: The residents of gynaecology should have sound knowledge on pelvic anatomy and have to be adequately trained on common surgical procedures. The training programme was conducted in the dissection hall of Anatomy department of Rural Medical college Loni .During residency, they may not receive adequate training on common surgical procedures for various reasons like shortage of cases, infrequent performance of certain procedures, inability of the faculty to give time ,attention for training in OT and fear of possible complications and medico legal litigations. Material and methods: Twelve residents in Gynaecology and two senior faculty members each from the department of Gynaecology and Anatomy participated in training programme. Five training sessions of dissection of a single human female cadaver ,each lasting for two and half hour duration, were conducted. Pretest and post test were performed with prevalidated and pre tested questionnaire and results compared to assess the impact of training. Level of satisfaction of residents about this innovative method of teaching and training was assessed through 7 point Likert scale. Results: Training programme resulted in significant improvement in the residents knowledge on pelvic surgical anatomy and common surgical gynaecological Procedures. Faculty members identified new insights into the interdisciplinary process of teaching . Conclusion: Surgical training using human cadaver was effective and feasible .It made the teaching process interactive and interesting. Residents expressed happiness about the innovative method of teaching.