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Resumen: ANTECEDENTES: El embarazo ectópico intersticial ocurre en 2.4% de los casos, quizá debido a la rotura uterina, con lo que se incrementa la morbilidad y mortalidad por hemorragia obstétrica. Los factores de riesgo son los mismos que para el embarazo ectópico tubárico. El tratamiento se establece en función del escenario clínico y deseo genésico de la paciente. CASO CLÍNICO: Paciente de 31 años, que ingresó al servicio de Urgencias por dolor abdominal severo e incapacitante en el hipogastrio, con índice de choque de 1.3 y signos de irritación peritoneal. La ecografía reportó líquido libre en el hueco pélvico y el espacio de Morrison; el saco gestacional extrauterino se encontraba en el anexo izquierdo, el feto sin latido cardiaco, con longitud craneocaudal de 11 semanas de gestación. La laparotomía exploradora evidenció: hemoperitoneo de 2800 cc, rotura uterina en el cuerno derecho, de aproximadamente 8 x 6 cm, visualización del feto e integridad de la bolsa amniótica. Puesto que la paciente manifestó no desear más embarazos se decidió efectuar la histerectomía total abdominal. CONCLUSIONES: El embarazo ectópico intersticial comparte los mismos factores de riesgo que el embarazo tubárico. Hoy día se dispone de diversos métodos de diagnóstico; sin embargo, la detección oportuna permite implementar el tratamiento conservador a seguir y, así, disminuir la morbilidad y mortalidad materna.
Abstract: BACKGROUND: Interstitial ectopic pregnancy occurs in approximately 2.4% of all cases, this tubal portion is located in the proximal segment and shares the muscular portion of the uterus, due to its great myometrial compliance, it facilitates late diagnosis and its clinical presentation is By means of uterine rupture and with it an increase in morbidity and mortality due to obstetric hemorrhage, the risk factors are the same as for tubal ectopic pregnancy, treatment is assessed based on preserving fertility and according to the patient's clinical setting. CLINICAL CASE: A 31-year-old patient who went to the emergency department for severe and disabling abdominal pain in the hypogastrium, shock index 1.3, with signs of peritoneal irritation, ultrasound was performed, which reported free fluid in the pelvic cavity and Morrison space, extrauterine gestational sac at the level of the left annex, embryo without heartbeat, craniocaudal length of 11 weeks of gestation, exploratory laparotomy was performed, in which hemoperitoneum of 2800 cc was observed, uterine rupture in the right cornual region of approximately 8x6cm, with fetus e integrity of the amniotic sac adjacent to the uterine rupture, the patient reported satisfied parity, and therefore a total abdominal hysterectomy was decided. CONCLUSIONS: Interstitial ectopic pregnancy shares the same risk factors as tubal pregnancy. Today, we have various diagnostic aids, so the cornerstone is timely detection, which will allow conservative treatments to decrease maternal morbidity and mortality.
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Background: Abdominal hysterectomy is the most frequented way of hysterectomy in the world; today we have a lot of techniques for hysterectomy. Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) needs experience an assessment of the learning curve. Objective of the study was to determine the feasibility and safety of TLH and TAH.Methods: Total 100 women were taken for study. Operating time, estimated blood loss, operating complication and length of stay in hospital were noted for each patient. The success rates of TLH were more compared to TAH. The operating time estimated blood loss, conversion to laparotomy was directly proportional to size of uterus.Results: There were no statistically significant differences between the two groups regarding age, body mass index (BMI), specimen weight, pre-operative hemoglobin (Hb) value and rates of the complications. The mean post-operative Hb value was significantly higher in group TLH than group TAH (11.3±0.7 gr/dl versus 10.6±1.6, p = 0.03). The mean time of operation was significantly longer in TLH than group TAH (105.4±22.9 minutes versus 74±18, p<0.001). The mean duration of hospital stay was statistically shorter in TLH compared to the TAH (2.47±0.5 days versus 4.86±1.1, p<0.001).Conclusions: Advantage of TLH over TAH are less blood loss, fewer wound infection and fever, smaller incisions, with less pain, shorter hospitalization time, speedier recovery.
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Background: Laparoscopic hysterectomy has become a widely accepted technique worldwide, since its introduction by Reich in 1989. The aim of the study was to compare the surgical results and intra- operative and post-operative complications between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH).Methods: Authors conducted a retrospective study at SMGS hospital, GMC Jammu between October 2016 to September 2018, 126 patients who underwent TLH and 126 patients who underwent TAH, were included.Results: Authors observed that there was no significant difference between the two groups in respect to patient’s age, parity and indication of surgery. Duration of surgery was found to be longer in TLH than TAH. The length of hospital stay was less in TLH than TAH. Hb drop was more in TAH group. 25 patients of TAH were given post op blood transfusion but only 9 patients of TLH were given post op blood transfusion. The time to ambulation in patients of TLH was much shorter than TAH. Wound infection was more common in TAH as compared to TLH, 5 patients had wound infection and in 4 patients resuturing was done for wound dehiscence. In 8 patients laparoscopy was converted to laparotomy because of adhesions, vascular injury and in one case because of bowel injury.Conclusions: This study showed that TLH can be safely performed by the experienced surgeon as an alternative to abdominal hysterectomy. It offers several benefits over TAH such as smaller incision, earlier ambulation, shorter hospital stay, faster recovery time and does not increase more serious complications than TAH.
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Background: Vaginal hysterectomy is preferable due to faster recovery, decreased morbidity and absence of an abdominal incision. The aim was to compare the risks and complications of laparoscopy assisted vaginal hysterectomy and total abdominal hysterectomy in terms of intra-operative and post-operative complications.Methods: A retrospective observational study was conducted in the Gynaecology ward at Vinakaya Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India. The data for the past 1-year record was taken for analysis. A total of 80 subjects were included in the study and were divided into two groups with 40 patients under TAH (total abdominal hysterectomy) group and 40 under LAVH (Laproscopic assisted vaginal hysterectomy) group. The primary outcome of the present analysis was incidence of perioperative complications like blood loss and the secondary outcomes were operating time, blood loss, urinary tract injury, rate of conversion to laparotomy, postoperative pain, and length of postoperative stay.Results: The mean intra-operative blood loss was measured among both the groups and it was found to be very high among TAH group (201 ml) compared to LAVH group (149.8 ml) and the difference was found to be statistically significant (p <0.05). Similarly, the duration of operative procedure was found to be less in LAVH group (57.9 mins) compared to TAH group (72.6 mins) and the difference was found to be statistically significant (p <0.05). Post-operative wound infection (14 vs 0) was found to be more among the patients in TAH group than that of the LAVH group and the difference was found to be statistically significant (p <0.05).Conclusions: LAVH is a safe and effective surgical treatment for benign gynaecological diseases and should be offered whenever possible, taking into account the low rate of complications and cost-effectiveness.
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Resumen OBJETIVO: Describir las pruebas paraclínicas y los medicamentos indicados para revertir la fiebre en las pacientes que la tuvieron en las siguientes 48 horas posteriores a la histerectomía total abdominal. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo, descrip-tivo, abierto, no controlado consistente en la revisión de los expedientes de pacientes con histerectomía total abdominal. Se incluyeron pacientes programadas en la consulta externa sólo para histerectomía total abdominal con fiebre en las primeras 48 horas posintervención. De acuerdo con la distribución de cada variable se utilizaron estadís-tica paramétrica y no paramétrica, prueba de Wilcoxon y diferencia de proporciones. RESULTADOS: De 181 histerectomías practicadas, 34 pacientes tuvieron fiebre en las primeras 48 horas del posquirúrgico (19%). El tiempo quirúrgico fue de 116.7 ± 29.4 minutos y el sangrado de 498.5 ± 221.4 mL. Los leucocitos se incrementaron en 30% luego de la detección de fiebre con respecto a los valores prequirúrgicos; la hemoglobina disminuyó en 14%. El examen general de orina se reportó alterado en 29%. El primer pico febril alcanzó 38.6 ± 0.5 °C a las 32.8 ± 8.3 horas poscirugía con persistencia de 1.5 ± 0.9 días. El 44% de las pacientes recibió un antibiótico luego de la evidencia de fiebre de causa infecciosa; los más indicados fueron: nitrofurantoína y ciprofloxacina. CONCLUSIONES: Ante la evidencia del primer pico febril es importante efectuar dos pruebas de laboratorio: biometría hemática y examen general de orina y con base en los reportes decidir si es necesaria la prescripción o no de antibiótico.
Abstract OBJECTIVE: To describe the paraclinical tests and the medications indicated to revert the fever in the patients who had it in the following 48 hours after the total abdominal hysterectomy. MATERIALS AND METHODS: Observational, cross-sectional, retrospective, descriptive, open, uncontrolled study consisting of the review of the records of patients with total abdominal hysterectomy. Patients scheduled in the outpatient clinic were included only for total abdominal hysterectomy with fever in the first 48 hours post-intervention. According to the distribution of each variable, parametric and non-parametric statistics, Wilcoxon test and proportional differences were used. RESULTS: Of 181 hysterectomies performed, 34 patients had fever in the first 48 hours after surgery (19%). The surgical time was 116.7 ± 29.4 minutes and the bleeding were 498.5 ± 221.4 mL. The leukocytes were increased by 30% after the detection of fever with respect to the presurgical values; hemoglobin decreased by 14%. The general urine test was reported altered in 29%. The first febrile peak reached 38.6 ± 0.5 °C at 32.8 ± 8.3 hours after surgery with a persistence of 1.5 ± 0.9 days. 44% of patients received an antibiotic after evidence of infectious cause fever; the most indicated were: nitrofurantoin and ciprofloxacin. CONCLUSIONS: Given the evidence of the first febrile peak, it is important to perform two laboratory tests: blood count and urinalysis, and based on the reports, decide whether the prescription of antibiotics is necessary.
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Introduction: Hysterectomy is a very common surgery and can be performed by abdominal, vaginal or laparoscopic method though the abdominal route is more popular. Vaginal hysterectomy has distinct health and economic benefits. We designed this study to compare the outcomes in TAH and non-descent vaginal hysterectomy and to determine which route of hysterectomy is superior, safe and effective. Aims of the study: To determine the safety and effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy and to compare both in terms of duration of surgery, blood loss, intra operative complications, postoperative complications and duration of hospital stay. Materials and methods: This was a prospective, study done on total of 100 patients were divided randomly into two groups. One group underwent total abdominal hysterectomy and the other underwent vaginal hysterectomy. Both groups were compared for patient demographics, indications for surgery, size of uterus, duration of surgery, blood loss, need for blood transfusions, complications and duration of hospital stay. Results: Fibroid was the most common indication in both the groups. Most of the patients had 6 – 8 weeks size uterus. Mean intra operative blood loss in TAH group was slightly more than NDVH group. The need for blood transfusion was similar. The mean duration of surgery was 100.2 minutes in TAH group and 83 minutes in NDVH group. Fever was the most common complication in both groups. Abdominal wound infection and secondary suturing was seen in TAH group. The mean postoperative stay was 8.1 days in TAH group and 5.8 days in NDVH group. P. Divya Daniel, D. Anupama. To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy. IAIM, 2017; 4(10): 77-86. Page 78 Conclusion: NDVH is associated with less duration of surgery, less blood loss, less postoperative stay than TAH. There was no difference between the need for blood transfusion between the two groups. Therefore, vaginal hysterectomy is safe and feasible in most of the women requiring hysterectomy for benign conditions and should therefore be attempted.
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Objective To evaluate the effect of comprehensive intervention measures on preventing and controlling surgical site infection (SSI)in patients undergoing total abdominal hysterectomy.Methods Patients undergoing total abdominal hysterectomy in a hospital between January 2011 and December 2014 were investigated retrospec-tively,patients in 2011 were as control group,from January 2012,a prospective monitoring on SSI was initiated, comprehensive intervention measures were taken,patients between January 2012 and December 2014 were as inter-vention group,SSI before and after the intervention was compared.Results A total of 1 052 patients undergoing to-tal abdominal hysterectomy were investigated,267 cases were monitored before intervention,25 patients (9.36%) developed healthcare-associated infection (HAI),12(4.49%)of whom were with SSI;785 cases were monitored af-ter intervention,13 (1 .66%)of whom were with SSI,incidence of SSI in 2012,2013,and 2014 were 2.31 %, 1 .89%,and 0.77% respectively,there was a decreasing tendency(χ2 =7.30,P <0.01 ).Conclusion Prospective monitoring on SSI and comprehensive intervention can reduce the incidence of SSI in patients undergoing total abdominal hysterectomy.
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Objective To investigate the incidence of surgical site infection(SSI)and compliance to bundle inter-vention measures on SSI following total abdominal hysterectomy in patients in department of gynaecology of a tertia-ry first-lass hospital,and evaluate the efficacy of bundle intervention measures in prevention and control of SSI. Methods From March 2014 to October 2015,all gynecology patients undergoing total abdominal hysterectomy were as targeted monitored subjects,March-September 2014 was baseline investigation stage,October 2014 to Oc-tober 2015 was intervention stage(new bundle intervention measures were performed),compliance to bundle inter-vention measures and incidence of SSI before and after intervention were compared.Results A total of 222 episodes of total abdominal hysterectomy were monitored,the incidence of SSI was 5 .86% ,the operation P75 time were 2 hours. Compared with the baseline stage,the compliance to most traditional intervention measures improved after intervention,the largest increase in the compliance to interventions was follow-up after surgery (increased by 64.16% ),followed by preoperative perineal disinfection(increased by 39.07% )and hand hygiene(increased by 21 .34% ). Compliance to new intervention measures was 100.00% . Incidence of SSI following total abdominal hys-terectomy after intervention was significantly lower than before intervention(2.27% [3/132]vs 11.11% [10/90]), difference was significant (χ2= 7.583,P<0.05).Conclusion Targeted monitoring on SSI following total abdomi-nal hysterectomy can improve compliance to bundle intervention measures and decrease incidence of SSI.
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Objective To investigate two different hysterectomy ( total abdominal hysterectomy and total laparoscopic hysterectomy ) on short-term efficacy and influence on sexual functions . Methods The retrospective records of 100 cases of total laparoscopic hysterectomy ( TLH) and 100 cases of total abdominal hysterectomy ( TAH) from January 2009 to December 2012 were reviewed.The operation time, intraoperative blood loss, postoperative hospital stay, and sexual satisfaction at 12 months postoperatively were compared between the two groups . Results The operation time was longer in the TLH Group than that in the TAH Group [(128 ±11) min vs.(87 ±33) min, t=-11.787, P=0.000].The intraoperative blood loss was less in the TLH Group than that in the TAH Group [(108 ±37) ml vs.(155 ±28) ml, t=-10.129, P=0.000].The hospital stay was shorter in the TLH Group than that in the TAH Group [(5.5 ±1.9) d vs.(8.2 ±1.6) d, t =-10.870, P =0.000].There were no significant differences between the two groups in sexual frequency (Z=-1.300, P=0.193), libido (Z=-0.564, P=0.573), achievement of orgasm (Z =-1.591, P=0.112), sexual intercourse disorder (Z =-0.478, P =0.633), and the overall satisfaction (Z=-0.083, P=0.934).Extent of dyspareunia was worse in the TLH Group than in the TAH Group (Z=-3.752, P=0.000). Conclusions TLH has less blood loss and shorter hospitalization time than TAH .Hysterectomy has a certain influence on sex functions .Differences in the sexual satisfaction are not statistically significant between the two procedures .
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Isolated tubal torsion is a rare disease that causes acute lower abdominal pain. In most of cases, the ovary and the fallopian tube are together twisted due to an ovarian tumor, but the fallopian tube alone is rarely twisted. Tubal torsion mainly occurs in fertile women, and it rarely occurs prior to menarche and during menopause. We experienced a case where isolated tubal torsion occurred in a perimenopausal female with total abdominal hysterectomy, while the findings showed a normal ovary. We report this case with a brief review of related literature.
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Female , Humans , Abdominal Pain , Fallopian Tubes , Hysterectomy , Menarche , Menopause , Ovary , Rare DiseasesABSTRACT
OBJECTIVE: To compare the clinical results for women undergoing total abdominal hysterectomy (TAH), laparoscopic assisted vaginal hysterectomy (LAVH) and total vaginal hysterectomy (TVH). METHODS: We reviewed the medical records of patients who underwent TAH (n=97), LAVH (n=112) and TVH (n=95) from June 2002 to June 2005. We compared and evaluated patient's characteristics, previous abdominal operation histories, indication of hysterectomy, uterine weight, operative time, perioperative hemoglobin and hematocrit change, the degree of postoperative pain, hospital stay and complications. RESULTS: The patient's characteristic (age, weight, height, parity, perioperative hemoglobin and hematocrit change, complication rate) had no statistical difference in all three groups. In the TVH group, the rate of previous abdominal operations (25%) was significantly lower than TAH (56%), and LAVH (40%) (p=0.023). The mean uterine weight was the heaviest in TAH group (443.6+/-407.3 g), compared to LAVH group (301.9+/-133.9 g) and TVH group (225.3+/-91.8 g) (p<0.001). Operative time was the longest for LAVH group (p=0.001), and there was no significant difference between TAH group and TVH group (p=0.087). The TAH group had the highest postoperative pain scale and the length of hospital stay. The LAVH group and TVH group had almost the same postoperative pain scale and the length of hospital stay. CONCLUSION: Both LAVH and TVH had the following advantages compared with total abdominal hysterectomy: less pain, shorter hospital stay, cosmetic advantages. But limited operation field in TVH and expensive operative cost in LAVH were disadvantages. Specific guidelines for determining the route of hysterectomy result in decreased morbidity and lower costs, and thus the gynecologist can ensure that the patient receives the best possible surgical care.
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Female , Humans , Hematocrit , Hysterectomy , Hysterectomy, Vaginal , Length of Stay , Medical Records , Operative Time , Pain, Postoperative , ParityABSTRACT
OBJECTIVE: To compare the clinical results between total laparoscopic Hysterectomy (TLH) and total abdominal hysterectomy (TAH). METHODS: 100 cases of TLH and 95 cases of TAH, which were performed at Pocheon CHA university from January 2001 to September 2004. We analyzed the results with regard to patient's characteristics (age, parity), uterine weight, operative time, blood loss, hospital stay and complications. RESULTS: There were no differences in terms of patient's age, parity, main operative indication and total operating time between the 2 groups. The mean uterine weight of TAH group was larger than TLH (291 +/- 239 gm for TLH, 404 +/- 174 gm for TAH, p<.05) group. The estimated blood loss was significantly lower for TLH (239.00 +/- 155.63 mL) than for TAH (333.68 +/- 228.4 mL) (p<.05). The length of hospital day was significantly shorter for TLH (6.78 +/- 1.70 day) than for TAH (7.39 +/- 1.49 day) (p<.05). Post-operative complications in the TLH group were dysuria in 2 cases, major hemorrhage requiring transfusion in 4 cases, trocar site hematoma in 1 case and bowel injury in 1 case. Post-operative complications In the TAH group were major hemorrhage requiring transfusion in 7 cases, wound infection in 3 cases and bowel injury in one case. CONCLUSION: The present study demonstrates that, given adequate training in laparoscopic surgery, TLH may replace TAH in most patients who require a hysterectomy, showing clear advantages of shorter hospitalization and the acceptable complication rate.
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Female , Humans , Dysuria , Hematoma , Hemorrhage , Hospitalization , Hysterectomy , Laparoscopy , Length of Stay , Operative Time , Parity , Surgical Instruments , Wound InfectionABSTRACT
OBJECTIVE: To evaluate the safety of the incidental appendectomies in women who undergo total abdominal hysterectomies for benign diseases. METHODS: This was a retrospective case-controlled study of patients who did (n=54) or did not (n=70) undergo incidental appendectomies at the time of an total abdominal hysterectomy between January 2002 and December 2003. Data were obtained about operation time, the number of days with nothing by mouth, the length of hospital stay (LOS), postoperative complications and pathology of appendix. Data were analyzed using student t-test. RESULTS: 1) There was no significant difference between two groups in operation time. The mean time was 120.0+/-23.8 in incidental appendectomy group and 112.5+/-23.9 minutes in control group. 2) There was no significant difference between two groups in the days with nothing by mouth. The mean was 1.06+/-0.23 in incidental appendectomy group and 1.03+/-0.17 days in control group. 3) There was no significant difference between two groups in the length of hospital stays. The mean was 7.34+/-0.68 in incidental appendectomy group and 7.14+/-1.15 days in control group. 4) There were no significant differences between two groups with respect to the post operative complications; fever, wound infection, stump disruption, and postoperative bleeding. 5) Seventy-six percent of the histologic specimens were abnormal, with fecalith being most common, and there were three cases of acute appendicitis. CONCLUSION: An incidental appendectomy at the time of hysterectomy does not increase operation time, the days with nothing by mouth, LOS, and postoperative complication rates. The incidental appendectomies during total abdominal hysterectomy may be safe procedures.
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Female , Humans , Appendectomy , Appendicitis , Appendix , Case-Control Studies , Fecal Impaction , Fever , Hemorrhage , Hysterectomy , Length of Stay , Mouth , Pathology , Postoperative Complications , Retrospective Studies , Wound InfectionABSTRACT
Objective To explore the clinical value of total laparoscopic hysterectomy(TLH).Methods Retrospective analysis was conducted on clinical data of 38 cases of TLH(Laparoscopic Group)and 40 cases of total abdominal hysterectomy(Open Group)from November 2005 to October 2006 in our hospital,to compare operative time,intraoperative blood loss,the incidence of postoperative pyrexia,recovery time of bowel movement,and hospital stay in both groups.Results The operative time in the Laparoscopic Group(85.8?13.8)min was significantly shorter than that in the Open Group(99.3?9.3)min(t=-5.923,P=0.000).The blood loss was significantly less in the Laparoscopic Group(105.8?32.4)ml than that in the Open Group(166.0?67.4)ml(t=-4.930,P=0.000).The incidence of postoperative pyrexia was distinctively lower in the Laparoscopic Group(3 cases)than that in the Open Group(15 cases)(?2=9.270,P=0.002).The time to first flatus was significantly shorter in the Laparoscopic Group(26.2?4.2)h than that in the Open Group(40.5?4.9)h(t=-13.601,P=0.000).The postoperative hospital stay in the Laparoscopic Group(6.8?0.9)d was distinctively shorter than that in the Open Group(10.6?0.8)d(t=-19.612,P=0.000).Follow-up examination for six months showed that two cases of poor healing of incision and two cases of vaginal residual granulation in the Open Group and one case of vaginal residual granulation in Laparoscopic Group,and no other complications were found.Conclusions TLH gets the advantage over total abdominal hysterectomy.If surgeons are familiar with the laparoscopic operative skills,TLH can be an ideal procedure for hysterectomy.
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OBJECTIVE: The most common operation in gynecology is hysterectomy. To compare the indications, patient characteristics and clinical outcome, complication between total abdominal hysterectomy (TAH) and vaginal total hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: This study was designed to analyze 147 patients of TAH (Group I) from January 2003 to September 2003, 48 patients of TVH (Group II), 108 patients of LAVH (Group III) at Eulji medical center of obstetrics and gynecology from January 2002 to September 2003. We analyzed the result with patient characteristics, parity, medical disease, history of previous operation, indication of hysterectomy, uterine weight, concurrent surgical procedure, operation time, bleeding amount, complication and length of hospital stay. Uterine prolapse was excluded in the analysis of this study. RESULTS: Patient characteristics, parity, medical disease were no differences. Number of previous operation were 63 cases (42.9%) in TAH group, 10 cases (20.8%) in TVH group, 43 cases (39.8%) in LAVH group, and the most common of operation was tubal ligation in three gropups. Most common indication of hysterectomy was uterine leiomyoma. The mean uterine weight was 374.31 +/- 250.26 gm in TAH group, 187.70 +/- 109.62 gm in TVH group and 203.26 +/- 94.92 gm in LAVH group. The mean operation time was 89.61 +/- 25.24 min in TAH group, 73.39 +/- 21.80 min in TVH group and 96.18 +/- 27.98 min in LAVH group. Postoperative complication was observed 60 cases (40.8%) in TAH group, 8 cases (16.7%) in TVH group, 19 cases (17.6%) in LAVH group. Most common complication was bleeding and required transfusion (TAH 32 cases (21.8%), TVH 3 cases (6.3%), LAVH 10 cases (9.3%)). CONCLUSION: LAVH and TVH present superior result in terms of complication when compared with TAH. LAVH and TVH have advantage of lower morbidity, less pain, shorter hospital stay and convalescence. LAVH should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.
Subject(s)
Female , Humans , Bleeding Time , Convalescence , Gynecology , Hemorrhage , Hysterectomy , Hysterectomy, Vaginal , Leiomyoma , Length of Stay , Obstetrics , Parity , Postoperative Complications , Sterilization, Tubal , Uterine ProlapseABSTRACT
A total abdominal hysterectomy may cause a postoperative vesicourethral dysfunction due to an injury to the pelvic nerves. However, many incontinent women with benign diseases of the uterus and its adnexae have undergone a Burch colposuspension with a concomitant abdominal hysterectomy. This study was undertaken to compare the outcomes of a Burch colposuspension performed alone with that of a Burch with a concomitant abdominal hysterectomy. This study included 132 women, who, were treated for primary urinary incontinence from February 1999 to February 2002 and were diagnosed with stress urinary incontinence by means of the urodynamic test at the Department of Obstetrics and Gynecology at Yonsei University Hospital. Forty-two women underwent a Burch colposuspension alone (Burch group) and 90 women underwent a Burch colposuspension with a concomitant abdominal hysterectomy (hysterectomy group). Between the Burch and hysterectomy groups, the mean age, parity, menopausal rate, Hormone Replacement Therapy (HRT) rate, 1 year follow-up outcomes and postoperative complications were compared using the subjective and objective stress tests according to the retrospective chart review. The mean age (54.6 +/- 0.5 vs 58.6 +/- 9.2 years, p=0.382), parity (3.3 +/- 1.2 vs 3.6 +/- 1.7), menopausal rate (71.4 vs 77.7%), or HRT rate (23.3 vs 11.2%) of the two groups were similar. Complications related to surgery were encountered in 5 patients (11.9%) in the Burch group and in 7 patients (7.8%) in the hysterectomy group (p=0.842). One year follow-up subjective symptoms were encounterd in 2 patients in the Burch group and in 4 patients in the hysterectomy group (p=1.00). The stress test was positive in only one patient in the hysterectomy (p=1.00). No significant difference was observed in the 1 year follow-up outcomes, which were 91.4% (32/35 patients) in the Burch and 91.2% (73/80) in the hysterectomy groups. The results showed that there were no adverse effects on the 1 year follow-up outcomes or complications in patients who underwent a Burch colposuspension with an abdominal hysterectomy.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Colpotomy/methods , Comparative Study , Follow-Up Studies , Hysterectomy/methods , Pempidine/analogs & derivatives , Postoperative Complications , Retrospective Studies , Treatment Outcome , Urinary Incontinence/surgeryABSTRACT
Background: Post operative nausea, vomiting and pain are the most common distressing symptoms following surgery. Recently much interest has been shown in the influence of auditory stimuli during anesthesia, and studies suggest that thinking may occur while under adequate general anesthesia. The aim of my study was to investigate the effect of intraoperative positive suggestion on the incidence of post operative pain, nausea, vomiting, general well being and gas output time. METHODS: Following ethics committee approval of our hospital, informed written consent was obtained from 60 ASA 1 or 2 patients scheduled for major gynecological surgery. Patients were allocated randomly to study or control groups. Those in the study group were played tapes containing positive suggestions ; those in control group were played a blank tape. Anesthesia was induced with propofol, succinycholine, vecuronium, and was maintained with enflurane 1.5 vol% in a 50% mixture of oxygen in nitrous oxide. Head phones were applied and patients in study group were played a tape suggesting that there would be no pain, nausea or vomiting and that they would be comfortable after the operation. The tape was played repeatedly throughout surgery until skin closure. The severity of postoperative nausea, vomiting, pain, postpoerative well being state and gas output were assessed using a four-point 0-3 verbal rating score (VRS) and scores were collected in the recovery room, at a postoperative 3 hr, 6 hr, 12 hr, 24 hr and 5 days. RESULTS: There was no significant difference between groups for any VRS parameter, i.e., postoperative pain, nausea, vomiting, general state of being or gas output time. CONCLUSIONS: Despite hearing positive suggestion in patients undergoing total hysterectomy surgery during general anesthesia, we were unable to demonstrate any reduction in the incidence of postoperative pain, nausea, vomiting, general well being state scores and gas output time.
Subject(s)
Female , Humans , Anesthesia , Anesthesia, General , Enflurane , Ethics Committees , Gynecologic Surgical Procedures , Head , Hearing , Hysterectomy , Incidence , Nausea , Nitrous Oxide , Oxygen , Pain, Postoperative , Postoperative Nausea and Vomiting , Propofol , Recovery Room , Skin , Thinking , Vecuronium Bromide , VomitingABSTRACT
OBJECTIVE: This study was aimed to detail the effects of various time intervals between large loop excision of transformation zone (LLETZ) and total abdominal hysterectomy (TAH) upon post-operative morbidity. METHODS: The charts of 169 patients selected among 306 patients who had underwent LLETZ followed by type 1 extended abdominal hysterectomy from Jan. 1996 to Dec. 2001 at Yonsei University Medical Center were retrospectively reviewed for post-operative morbidity. The patients were categorized into three groups according to time interval: within 48 hours, within 48 hours to 6 weeks, longer than 6 weeks. Correlation of post-operative morbidity and time interval was evaluated. One way ANOVA and chi-square test were used for statistical analysis. RESULTS: There were no significant differences in demographic and obstetric characteristics among three groups. There were no significant differences in operative time (104.3 min, 99.6 min, 102.4 min), blood loss (190 ml, 182 ml, 160 ml), hemoglobin change (1.12 g/dl, 0.92 g/dl, 1.28 g/dl), febrile morbidity (6.7%, 6.8%, 0.0%), wound problems (6.7%, 9.1%, 10.0%) and urinary difficulty (2.9%, 0.0%, 5.0%). CONCLUSION: We found no significant differences in post-operative morbidity according to various time intervals between LLETZ and TAH. It could be recommended for TAH after LLETZ to be performed regardless of the intervening interval because there is no specific suitable time for the patients.
Subject(s)
Humans , Academic Medical Centers , Analysis of Variance , Chi-Square Distribution , Hysterectomy , Operative Time , Retrospective Studies , Wounds and InjuriesABSTRACT
OBJECTIVE: This study was aimed to detail the effects of various time intervals between large loop excision of transformation zone (LLETZ) and total abdominal hysterectomy (TAH) upon post-operative morbidity. METHODS: The charts of 169 patients selected among 306 patients who had underwent LLETZ followed by type 1 extended abdominal hysterectomy from Jan. 1996 to Dec. 2001 at Yonsei University Medical Center were retrospectively reviewed for post-operative morbidity. The patients were categorized into three groups according to time interval: within 48 hours, within 48 hours to 6 weeks, longer than 6 weeks. Correlation of post-operative morbidity and time interval was evaluated. One way ANOVA and chi-square test were used for statistical analysis. RESULTS: There were no significant differences in demographic and obstetric characteristics among three groups. There were no significant differences in operative time (104.3 min, 99.6 min, 102.4 min), blood loss (190 ml, 182 ml, 160 ml), hemoglobin change (1.12 g/dl, 0.92 g/dl, 1.28 g/dl), febrile morbidity (6.7%, 6.8%, 0.0%), wound problems (6.7%, 9.1%, 10.0%) and urinary difficulty (2.9%, 0.0%, 5.0%). CONCLUSION: We found no significant differences in post-operative morbidity according to various time intervals between LLETZ and TAH. It could be recommended for TAH after LLETZ to be performed regardless of the intervening interval because there is no specific suitable time for the patients.
Subject(s)
Humans , Academic Medical Centers , Analysis of Variance , Chi-Square Distribution , Hysterectomy , Operative Time , Retrospective Studies , Wounds and InjuriesABSTRACT
OBJECTIVES: The most often perfomed major operation in gynecology is hysterectomy.Our purpose was to compare the indications, charateristics and outcomes of patients undergoing total abdominal hysterectomy and total vaginal hysterectomy and to help to establish guidelines to determine the route of hysterectomy. METHOD: The hospital charts of 400 women who underwent elective inpatient hysterectomy at Kyung-Hee University hospital from January 1994 to January 1999, were abstracted retrospectively. Data were collected regarding patients, age, parity, preoperative indications, the route of hysterectomy, uterine weight, operative and postoperative complications and the length of stay. The operative indications were benign uterine disease except from uterine prolapse. Bisection or combined morcellation were used in most cases to obtain reduction in uterine size. RESULT: Patients in whom the vaginal route was successful included 18% of those with uterine weights exceeding 280gm. There was statistically significant difference for uterine weight, operative time, bleeding amount, the length of stay in two camparative group. 4% of vaginal hysterectomy and 7% of total abdominal hysterectomy has documented operative complications. CONCLUSIONS: Vaginal hysterectomy is safe operation with few intraoperative and postoperative complications without notable blood loss. Vaginal hysterectomy allow one to shorten the operating time and allows early postoperative discharge of some patients from hospital. Skilled performance of vaginal hysterectomy is worth greater attention and should be used more often in gynecological study.