MODALITIES OF TREATMENT OF PELVIC ORGAN PROLAPSE IN A TERTIARY CARE HOSPITAL (GMCH) AND ITS SHORT TERM FOLLOW UP

Pelvic organ prolapse is an increasingly common condition seen in women with advancing age. The objective of this study is to observe the different modalities of treatment of pelvic organ prolapse and evaluate its outcome. In this study, all patients with pelvic organ prolapse, attending Gynae OPD or admitted in GMCH were included. In this study, 45(22.5%) patients were advised to use vaginal tampon, 9(4.5%) patients were advised Kegel's Results: exercise, 125(62.50%) patients were treated with VH + PFR, , 15 (7.5%) patients underwent vaginal hysterectomy (VH), 4(2%) patients underwent VH + PFR + Sacrospinous ?xation and 2 (1%) patients were treated with Fothergills' surgery. The feedback received revealed that 118(59%) were satis?ed and responded well to the treatment, 26 (13%) patients were not satis?ed and from the remaining 56(28%) patients, no feedback had been received. It was observed that satisfaction was higher in patients who had surgical intervention.

¿Cómo decidir el abordaje más adecuado para realizar una histerectomía por patología benigna? revisión bibliográfica / How to select the surgical route of hysterectomy for benign pathology? literature review

La histerectomía es uno de los principales procedimientos quirúrgicos en ginecología. Se calcula que en EE.UU. se realizan unas 500,000 anualmente y que una de cada nueve mujeres a lo largo de su vida se realizará dicha intervención. Los distintos abordajes (abdominal, vaginal, laparoscópico y robótico) presentan diferencias respecto al tiempo quirúrgico, complicaciones, dolor postoperatorio, estancia hospitalaria y gasto sanitario. Factores como el tamaño uterino, la accesibilidad vaginal, la historia de cirugías pélvicas previas, la existencia de patología extrauterina o la experiencia del cirujano influyen a la hora de decidir la vía de abordaje. Revisar la evidencia disponible respecto a la vía de elección de la histerectomía por patología benigna y cómo decidir el abordaje más adecuado para cada paciente. Búsqueda bibliográfica de literatura en las bases de datos PubMed, Medline, Embase, BioMed Central y SciELO. La vía vaginal es el abordaje de elección para realizar una histerectomía dada su menor invasividad, menor tiempo de recuperación y menor tasa de complicaciones. La generalización del uso de algoritmos para la elección de la vía de abordaje incrementaría la tasa de acceso vaginal y asociaría con ello una disminución del gasto sanitario.

Hysterectomy is one of the most common surgical procedures in gynecology. It is calculated that over 500,000 hysterectomies are performed in the USA per year and that 1 out of 9 women will undergo this surgery in their lifetime. Diverse surgical approaches are possible (abdominal, vaginal, laparoscopic and robotic) with differences in operative time, complication rates, postoperative pain, hospital stay, and health care cost. Factors such as uterus size, vaginal access, prior pelvic surgery, extrauterine pathology and surgeon experience may influence the route selection. To collect the current evidence regarding the preferred route in hysterectomy for benign pathology and how to select the adequate approach for every patient. Bibliographic literature search through the PubMed, Medline, Embase, BioMed Central and SciELO databases. Vaginal hysterectomy is the preferred approach in benign indications. It is less invasive, and it shows shorter operative time, shorter recovery time and less complications. The use of decision algorithms to select the hysterectomy route may increase the vaginal approach and decrease health care costs.

Modified sacrospinous ligament fixation in treatment of pelvic organ prolapse / 中华内分泌外科杂志

Objective:To study the clinical effect of sacrospinous ligament fixation (SSLF) and traditional vaginal hysterectomy on pelvic organ prolapse (POP) .Methods:A retrospective analysis was performed on 68 patients with POP of degree II-IV admittedl from Jan. 2017 to Dec. 2019. Among them, 33 patients were treated with SSLF (observation group) and 35 patients were treated with vaginal total hysterectomy (control group). Intraoperative blood loss, operative time, postoperative indwelling catheter and average length of hospital stay were compared between the two groups. The patients were followed up for 6 months, and the scores of pelvic floor dysfunction questionnaire-20 (PFDI-20) and sexual quality questionnaire -12 (PISQ-12) were used to evaluate the subjective satisfaction degree of postoperative recovery.Results:In the observation group, the intraoperative blood loss (173.94±52.14) ml, postoperative indurating catheter time (2.72±0.45) d and average length of hospital stay (7.09±0.63) d were observed. There were statistically significant differences in intraoperative blood loss (228.86±53.40) ml, postoperative induration time (4.54±0.61) d and mean hospital stay (9.22±0.81) d in the control group ( P<0.05). There was no significant difference in the operation time between the observation group (99.57±9.50) min and the control group (101.06±8.64) min, ( P>0.05). The improvement of PFDI-20 and PISQ-12 in both groups was significant before and after treatment. The PISQ-12 score of the observation group was higher than that of the control group 6 months after surgery, and the difference was statistically significant ( P <0. 05). There was no significant difference in PFDI-20 score between the two groups ( P>0.05). There was statistical significance in the positions of pop-Q indicators in the two surgical methods ( P < 0.05) . Conclusions:SSLF with uterus preservation and total vaginal hysterectomy are both effective in treatment of moderate and severe POP. However, SSLF with uterus preservation has less intraoperative blood loss, and the postoperative recovery is significantly better than that with total vaginal hysterectomy. In addition, it satisfies patients’ desire to preserve uterus, improves the postoperative sexual life quality, which is worthy of promotion.

Laparoscopic assisted vaginal hysterectomy: an experience at a Fortis Escorts hospital

Background: The objective of this study was to evaluate the laparoscopic assisted vaginal hysterectomy (LAVH) in terms of demographic data of patients, indications, uterine size, intraoperative and postoperative complications, amount of blood loss, operative time and duration of hospital stay.Methods: A retrospective study was conducted on 160 cases, who underwent laparoscopic assisted vaginal hysterectomy in the period between October 2018 to November 2019 at the Fortis Escorts Hospital, Faridabad, Haryana, India.Results: Majority of patients (58.75%) belongs to age group between 40-50 year. Only 30.62% cases had a history of one previous abdomino-pelvic surgery. Majority of cases (52.5%) in the study group had uterine size between 6-12 weeks. Most common indication of hysterectomy in this study was fibroid uterus which account for 49.37% of cases followed by dysfunctional uterine bleeding (16.87%) cases. Mean time of surgery in this study was 114.4±0.59 min and average blood loss was 135.62±47.63 ml. The mean weight of uterus was 243.75±82.94 gm. 5% cases had major intraoperative complications while minor postoperative complications were seen in 16.87% cases. Bladder injury was seen in 1.25%. Major haemorrhage occur in 1.25%. In this study conversion to laparotomy rate was 1.25%. Only one case of ureteric injury and one case of bowel injury was noted. Among minor complications fever (6.25%) and urinary tract infection (5.62%) were mainly seen. Mean duration of hospital stay was 2.82±1.17 days.Conclusions: LAVH enables the surgeon to convert most of the abdominal hysterectomies into vaginal ones and hence decreases postoperative pain, decreases complications, lesser duration of hospital stay and rapid return to normal activity.

Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study

Background: Non-descent vaginal hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. As there is an increase in caesarean section, hysterectomy in women with previous caesarean section is also increasing. The objective of this study is to assess the feasibility and safety of non-descent vaginal hysterectomy in patients with previous caesarean section.Methods: This is a retrospective study conducted in the department of obstetrics and gynecology, Government Medical College, Thrissur from January 2017 to December 2018. Non-descent vaginal hysterectomy in 24women with previous caesarean section was studied. Details regarding age, parity, number of caesarean sections, indication of surgery, intraoperative and postoperative complications were evaluated.Results: All 24 women underwent non-descent vaginal hysterectomy successfully. 10 women (41.7%) were between 46-49 years. Commonest indication of hysterectomy was fibroid uterus (41.7%) and most common complaint was heavy menstrual bleeding (79%). There was bladder injury in one woman with history of previous 2 caesarean section. 3 women developed UTI in postoperative period.Conclusions: Vaginal hysterectomy is associated with lower complications and more rapid recovery. A successful NDVH in previous caesarean section depends on the expertise and experience of the surgeon. NDVH in previous caesarean is safe in expert hands.

Hysterectomy: retrospective analysis of 476 cases

Background: Diseases of the female genital tract are commonly encountered in clinical practice. Hysterectomy is the definite treatment for many of the pelvic pathologies. The present study is aimed at analysis of age and types of hysterectomy and evaluation of histopathological reports of the hysterectomy specimens.Methods: A total of 476 consecutive hysterectomy were studied over a period of two years from January 2016 to December 2017.Results: The peak age group of hysterectomy was 41-50 years with 221 (46.43%) cases. The commonest type of hysterectomy was abdominal. The most common endometrial pathology was atrophic endometrium, seen in 131 (27.52%) cases. In myometrium, the most common pathology was leiomyoma in 179 (37.61%) cases. Among cervical lesions, chronic cervicitis was the most common finding, seen in 274 (57.56%) cases.Conclusions: The experience with various types of hysterectomies at our institution has been reviewed. A wide spectrum of lesions were observed when histopathology reports of the hysterectomy specimens were analysed.

A Clinical Comparative Study of Dexmedetomidine with Fentanyl as an Adjuvant to Intrathecal Hyperbaric Bupivacaine for Vaginal Hysterectomy.

Currently only few local anaesthetics are used for intrathecal administration, like bupivacaine, lignocaine, ropivacaine and tetracaine. Opioid analogues have been used as additive in spinal anaesthesia to improve the onset of action, to prolong the duration of block and to improve the quality of intraoperative and postoperative analgesia. Fentanyl is a partial agonist on μ-opioid receptors and Dexmedetomidine is a α2-agonist. Intrathecal dexmedetomidine when combined with spinal bupivacaine prolongs the sensory block by depressing the release of C-fibers transmitters and by hyperpolarization of post-synaptic dorsal horn neurons.1 We compared the effects of adding Dexmedetomidine and Fentanyl as an adjuvant to intrathecal hyperbaric bupivacaine for vaginal hysterectomy.METHODSA total of 100 patients of age 35 to 65 yrs. of body mass index (BMI) within normal range (18.5 to 24.9 Kg/m2) posted for vaginal hysterectomy were divided into two equal groups (Group 1 and 2) in a prospective, randomized, double-blind fashion. In Group 1 (n=50), (2.5 ml) Hyperbaric Bupivacaine + (0.5 ml) Dexmedetomidine (5 mcg) and in Group 2 (n=50) (2.5 ml) Hyperbaric Bupivacaine + (0.5 ml) Fentanyl (25 mcg) were used. Total volume injected intrathecally was 3.0 ml. We observed the effect on onset of sensory and motor blockade, maximum level of sensory and motor blockade, haemodynamic effects during intraoperative period (for 120 min), effect on overall duration and quality of analgesia during postoperative period using VAS score and any side effects.RESULTSWe observed that mean time to achieve sensory block and motor block/ Bromage-3 was shorter in dexmedetomidine group. There was no statistically significant difference for the onset of sensory and motor block in dexmedetomidine and fentanyl group (p value > 0.05). The sensory and motor block were more prolonged in dexmedetomidine group than fentanyl group showing significant difference among the two groups (p value<0.001). Overall duration of analgesia was significantly longer in dexmedetomidine group than fentanyl group showing significant difference among the two groups (p value <0.001).CONCLUSIONSIn our opinion adding Dexmedetomidine 5 mcg to Bupivacaine 12.5 mg not only provides rapid onset, profound analgesia with good relaxation for surgery but also prolongs the duration of sensory and motor blockade. The overall effect and duration are superior to addition of 25 mcg of Fentanyl.

Abdominal sacrohysteropexy versus vaginal hysterectomy for pelvic organ prolapse in young women

Background: Pelvic organ prolapse (POP) is the descent of the pelvic organs beyond their anatomical confines. The definitive treatment of symptomatic prolapse is surgery but its management in young is unique due to various considerations. Aim of this study was to evaluate anatomical and functional outcome after abdominal sacrohysteropexy and vaginal hysterectomy for pelvic organ prolapse in young women.Methods: A total 27 women less than 35 years of age with pelvic organ prolapse underwent either abdominal sacrohysteropexy or vaginal hysterectomy with repair. In all women, pre-op and post-op POP-Q was done for evaluation of anatomical defect and a validated questionnaire was given for subjective outcome.Results: Anatomical outcome was significant in both groups as per POP-Q grading but the symptomatic outcome was better for sacrohysteropexy with regard to surgical time, bleeding, ovarian conservation, urinary symptoms, sexual function.Conclusions: Sacrohysteropexy is a better option.

A comparative study of non-descent vaginal hysterectomy and total laparoscopic hysterectomy

Background: Hysterectomy is the second most common operation performed by the gynecologists, next only to caesarean section. Objective of the study was to compare fall in blood haemoglobin level, duration of operation, intra- and post-op complications between non-descent vaginal hysterectomy and total laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus.Methods: A retrospective comparative study of 90 hysterectomies was done from a period of May 2018 - April 2019 at GMERS Medical College and Hospital Sola, with 45 cases in group of non-descent vaginal hysterectomy (NDVH) and 45 in group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra- operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. Those patients having malignancy as diagnosed by Pap smear or by D and C were excluded from the studyResults: The most common age in both groups was 41-50 years. Adenomyotic uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 45 min while it was 80 min in TLH group. p<0.001 suggested significant difference when operative time were compared between both groups. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups.Conclusions: In which way to approach the uterus shall depend upon skill of the surgeon, size and pathological nature of uterus, technology available in the hospital and preference of patient as well as surgeon.

Comparative study of intra and post-operative complications between total abdominal hysterectomy and laparoscopic assisted vaginal hysterectomy

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.

Feasibility of bilateral salpingo-oophorectomy during vaginal hystertectomy for benign uterine diseases

Background: Prophylactic bilateral salpingo-oophorectomy (BSO) remains the best measure in the prevention of ovarian cancer as it lacks an effective screening tool. The need to perform prophylactic BSO shouldn't dictate the route of surgery. To assess the feasibility of prophylactic BSO during vaginal hysterectomy. To analyze the safety of the vaginal BSO.Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynaecology at Velammal Medical College, Madurai, Tamilnadu, India from June 2016 to June 2018 over a period of 3 years. 54 women who underwent hysterectomy for benign uterine disease in whom concomitant prophylactic BSO was attempted were included in the study. Preoperative data like age, parity, menopausal status, BMI, previous pelvic surgeries were noted from the admission record. Intraoperative details like indication for surgery, surgical procedure, duration of surgery and complications like hemorrhage, bladder, ureter and bowel injury were collected from the operative record. Postoperative recovery details were also noted down from the case sheet. The collected data were then analyzed.Results: Of the 54 women included in the study, transvaginal BSO was successful in 53 (98.1%) women. There was one case of primary haemorrhage due to slippage of ovarian pedicle, another patient required laparotomy for completing BSO. None had bladder, ureter or bowel injury.Conclusions: Prophylactic BSO is both feasible and safe in almost all patients undergoing vaginal hysterectomy. Developing the skill to perform transvaginal BSO can inspire gynaecologists to move a step forward and deal with benign adnexal pathology concomitantly at vaginal hysterectomy. The risk of remnant ovarian syndrome post vaginal oophorectomy is unknown.

Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

Background: Vaginal hysterectomy is less commonly performed for benign pathologies if the uterine size exceeds 12 weeks in the belief that complications could be higher in this group. The aim of this prospective study was to compare surgical outcomes and safety of vaginal hysterectomy in women with non-prolapsed uteri of >12 weeks size to those with uteri of<12 weeks removed vaginally for similar indications.Methods: In this prospective cohort study, 92 patients were included who underwent NDVH for benign uterine conditions between May 2016 to December 2018. The index group comprised 32 women who underwent vaginal hysterectomy for non-prolapse uterus with uterine enlargement (>12 weeks), while the control group consisted of 60 women with uteri <12 weeks. Demographic data, duration of surgery, blood loss, intraoperative and postoperative complications were compared.Results: Women in the two groups had statistically similar mean age, Body Mass Index and parity (44 vs 42.77 years, 20.8 vs 21.56 kg m3 and 3.26 vs 3.83, respectively; p > 0.05). The mean operative time was significantly longer in the index group (62.47min; vs 48.17 min; p <0.0001). Women with enlarged uteri had greater mean estimated blood loss (123.2 ml vs 75.9 ml; p < 0.0001) but the mean length of hospital stay was similar (5.531 days vs 5.177 days; p > 0.05). Intra- and post-operative complications such as blood transfusion and pelvic sepsis, post-operative febrile illness and systemic infections were comparable in both groups.Conclusions: Vaginal hysterectomy in larger non-prolapsed uteri takes longer to perform and is associated with more blood loss compared to uteri <12 weeks but is not associated with a significant increase in complication rates.

Vaginal hysterectomy a safe option in non-descent uterus as compared to abdominal hysterectomy

Background: The objective of present study was to compare the advantage of vaginal hysterectomy over abdominal hysterectomy in non-descent uterus.Methods: A non-randomized controlled trial was carried out in the Bundelkhand Medical College, Sagar and associated hospital from October 2015 to September 2017. A total of 150 cases were included in the study. Out on 150, 75 underwent vaginal hysterectomy for non-descent uterus and other 75 underwent abdominal hysterectomy for similar indications.Results: Among total 150 cases, 75 were underwent non-descent vaginal hysterectomy and similar number of cases underwent abdominal hysterectomy. Common age group was 35-54 years. Commonest indication was DUB (48.7%). Postoperatively, complications were more common in those who underwent abdominal hysterectomy such as ambulation (18 hours), incidence of nausea, vomiting, abdominal discomfort, bladder injury and wound infection were less in vaginal hysterectomy compared to abdominal hysterectomy. It was also observed that blood transfusion requirement, operative timing and hospital stay (3 days) were less in vaginal hysterectomy group.Conclusions: Vaginal hysterectomy for benign gynecological disorders is a safe, effective, least invasive and is associated with lesser complications as compare to abdominal hysterectomy. Today in the era where patient is more cosmetically concern, vaginal hysterectomy for non-descent uterine disorder needs to be considered as good and safe option.

Comparative study of non-descent vaginal hysterectomy with abdominal hysterectomy

Background: Hysterectomy is one of the most common operation performed in Obstetrics and Gynecology next to caesarean section. Due to its advantages vaginal hysterectomy are more and more performed now. Only drawback is lack of expertise. Present study focuses on comparison between outcomes in abdominal versus vaginal hysterectomy and to determine which route of hysterectomy is superior, safer and effective.Methods: The study is a prospective study conducted in the department of obstetrics and Gynecology. Civil hospital, Ahmedabad between the period of Jan 2016 to 2017. Of 100 patients. Fifty patients who underwent hysterectomy by vaginal route are taken as study group A, and the remaining 50 patients who underwent by the abdominal route are taken as study group B.Results: Majority of women undergoing hysterectomy were in age group of 30-50 years; postmenopausal age group women were less;13 NDVH and 5 in AH. Majority of the women were multipara in both age groups. Menorrhagia was found to be major indication with 42 in NDVH and 40 in AH. There is much significant difference in the postoperative pain in both groups with less in NDVH group. There is not much significant difference in blood loss in both the groups. Postoperative complications were more with AH.Conclusions: Thus, it can be concluded that NDVH is feasible, safe and provide more patient comfort without increasing the duration of surgery and other post-operative complications.

Estudio Retrospectivo: Histerectomía Abdominal vs Histerectomía Vaginal, Análisis de Complicaciones Hospitalarias. Hospital San Francisco de Quito. Quito - Ecuador, 2014 - 2015 / Retrospective Cohort Research: Abdominal Hysterectomy vs Vaginal Hysterectomy, Analysis of Hospital Complications. San Francisco de Quito Hospital. Quito - Ecuador, 2014 ­ 2015

INTRODUCCIÓN: La histerectomía es la extirpación quirúrgica del útero, cuyas técnicas quirúrgicas han evolucionado a través del tiempo; es una de las cirugías ginecológicas más frecuentes en el mundo. El objetivo del estudio fue evaluar la frecuencia de complicaciones postquirúrgicas por vía de abordaje y correlacionarlas con factores de riesgo. MÉTODOS: Se diseñó un estudio retrospectivo. Se seleccionó al total de mujeres sometidas quirúrgicamente a histerectomía durante los años 2014 y 2015, el universo lo conformó 409 mujeres intervenidas, de las cuales se obtuvo una muestra de 384, en el servicio de Ginecología. El análisis estadístico se realizó en la herramienta estadística SPSS 17.0. En el análisis de los resultados se utilizaron el test de U Mann-Whitney, Chi cuadrado y Riesgo Relativo. RESULTADOS: El promedio de edad fue 85 % con una edad menor a 50 años. El tiempo medio de procedimiento quirúrgico fue 104 minutos, y un tiempo de hospitalización promedio de 2.7 días. Los antecedentes patológicos fueron la cirugía gineco-obstétrica previa 62 %. El 88 % de las histerectomías fueron por la vía abdominal. La incidencia total de complicaciones en general fue del 3.38 %; el 100 % de las complicaciones se presentaron en la histerectomía abdominal. No existió correlación estadística significativa con factores de riesgo como la obesidad (P 0.15 y RR: 0.39). CONCLUSIONES: La histerectomía vaginal tiene menos complicaciones postquirúrgicas, menos días de hospitalización y un menor tiempo quirúrgico comparado con el abordaje de la vía abdominal. Es recomendable realizar más estudios en otros establecimientos de salud en el Ecuador y comparar las diferentes vía de abordaje incluido la vía laparoscópica.

BACKGROUND: Hysterectomy is the surgical removal of the uterus, whose surgical techniques have evolved over time; it is one of the most frequent gynecological surgeries in the world. The objective of the study was to evaluate the frequency of postsurgical complications through theapproach and correlate them with risk factors. METHODS: A retrospective study was designed. The total number of women surgically undergoing hysterectomy was selected during the years 2014 and 2015. The universe consisted of 409 women undergoing surgery, of whom a sample of 384 was obtained at the Gynecology Department. The statistical analysis was realized in the statistical tool SPSS 17.0. In the analysis of the results, U Mann-Whitney test, Chi square and Relative Risk were used. RESULTS: It was obtained that the average age was 85 % with an age under 50 years. The average time of surgical procedure was 104 minutes, and an average hospitalization time of 2.7 days. The pathological antecedents were the gynecological-obstetric surgery previous 62 %. 88 % of the hysterectomies. The total incidence of complications due to hysterectomy in general was 3.38 %; 100 % of complications occurred in abdominal hysterectomy. There was no significant statistical correlation with risk factors such as obesity (P 0.15 and RR: 0.39). CONCLUSIONS: Vaginal hysterectomy has fewer postsurgical complications, less days of hospitalization and a shorter surgical time compared to the abdominal approach; however, abdominal hysterectomy is the most frequent of treatment choice. It is recommendable to realize more studies in other health institutions in Ecuador.

Comparison of application value of LTH and LAVH in hysterectomy / 中国内镜杂志

Objective To investigate the effect of total laparoscopic hysterectomy (LTH) and laparoscopic assisted vaginal hysterectomy (LAVH) for hysterectomy. Methods From February 2015 to February 2017, 182 patients with total hysterectomy were enrolled, among them, LTH was performed in 97 patients, and LAVH was performed in 85 patients, the operation time, intraoperative blood loss, the length of scar, postoperative anal exhaust time and so on were observed in the two groups, C reactive protein (CRP), interleukin -2 (IL-2) and IL-6 were detected before and after operation in two groups. Results In group LTH, the amount of bleeding and the length of scar were (104.33 ± 40.20) ml and (2.03 ± 0.84) cm respectively, which were significantly lower than those in group LAVH (P < 0.05); There was no significant difference between LTH group and LAVH group in postoperative anal exhaust time, hospital stay, postoperative analgesia and hospitalization costs (P > 0.05); The CRP and IL-6 in the LTH group postoperative were (26.43 ± 6.11) mg/L and (40.04 ± 11.03) ng/ml, significantly lower than those in LAVH group (P < 0.05), while IL-2 was (44.20 ± 12.29) ng/ml, was significantly higher than that of the control group (P < 0.05); The incidence of postoperative complications in LTH group was 6.19%, which was significantly lower than that of LAVH group (P < 0.05). Conclusion LTH is a safe and reliable method for hysterectomy, has the advantages of less complications, less influence on immune function and so on, is worthy of clinical application.

Total laparoscopic versus hysterectomy

Background: Total laparoscopic hysterectomy (TLH) is now emerging as a safe procedure even in patients suitable for vaginal hysterectomy (VH) due to its advantages like better visualisation, less post-operative pain and shorter hospital stay. This study was conducted to compare between laparoscopic hysterectomy and vaginal hysterectomy in females with benign disorders. Materials and methods: This was retrospective study conducted in Department of Obstetrics and Gynaecology, Laxmi Narasimha Hospital, Warangal. The patients who were indicated for vaginal hysterectomy or total laparoscopic hysterectomy were included. This study was conducted during the period of July 2015 to October 2016. Forty eight patients were included in the TLH group who underwent total laparoscopic hysterectomy and forty three patients were included in the VH group who underwent vaginal hysterectomy. Results: Operation time was higher in TLH group which was 112.56 hours when compared to VH group which was 101.42 hours (p<0.001). Hospital stay was more in VH group which was 5.77 days when compared to TLH group which was 4.05 days (p<0.001). Analgesia dosage was higher in VH group which was 1.64 when compared to that in TLH group which was 1.28 (p<0.001). The rate of complications in both the groups was found to be non-significant statistically. One woman who was undergoing VH had bladder injury which was recognised intraoperatively and treated and another one had vault hematoma in post-operative period which was also managed. In one case of VH, conversion to laparotomy was done due to difficulty but all cases were posted for TLH. Conclusion: Compared to Vaginal hysterectomy, total laparoscopic hysterectomy was more advantageous as it showed lesser hospital stay and lesser analgesia dose.

Impact on quality of life and sexual satisfaction of total abdominal hysterectomy and vaginal hysterectomy in the absence of prolapse. Cohort study, Medellín, 2015 / Impacto de la histerectomía abdominal total y de la histerectomía vaginal sin prolapso en la calidad de vida y la satisfacción sexual. Estudio de cohortes, Medellín, 2015

ABSTRACT Objective: To identify differences in quality of life and sexuality in women without genital prolapse taken to vaginal or abdominal hysterectomy. Materials and methods: Prospective cohort study including women with no vaginal prolapse and benign conditions, with no adhesions and a uterus of less than 1000cc, amenable to surgery through the abdominal or vaginal approach, coming to a private clinic in Medellín, Colombia. The SF12 score was used for quality of life assessment two and four months after surgery, and sexuality was assessed before and four months after the procedure, using the Female Sexual Function Index. Comparisons were made using ANCOVA, adjusted on the basis of baseline values and other characteristics. Approval by the ethics committee as well as informed consents were obtained. Results: The study included women with similar pre-operative characteristics. Of them, 24 were included in the vaginal hysterectomy group and 22 in the abdominal hysterectomy group. Quality of life and sexual function improved for the women in both groups following the procedure. Postoperative physical health: adjusted score for vaginal hysterectomy, 49.5 (SD ± 1.6) and for abdominal hysterectomy, 43.8 (SD ± 1.7), with a difference of 5.6 points (95% CI 0.87-10.4). Mental health: 51.0 (SD ± 1.7) and 59.3 (SD ± 1.6) points, respectively; adjusted difference 8.4 (95% CI 3.6-13.3). Sexuality: 22.7 (SD ± 1.8) and 26.5 (SD ± 1.7), respectively; difference, 3.8 points (95% CI -1.2-8.7). Conclusion: Although statistically significant differences were found for quality of life, the score obtained is not clinically significant.

RESUMEN Objetivo: Identificar diferencias en calidad de vida y sexualidad en mujeres sin prolapso genital intervenidas con histerectomía vaginal o abdominal. Materiales y métodos: Estudio de cohortes prospectivo. Se incluyeron mujeres sin prolapso vaginal con condiciones benignas, sin adherencias, con útero menor de 1000 cc, que fueran susceptibles de ser intervenidas tanto por vía abdominal como vaginal en una clínica privada de Medellín, Colombia. Evaluación de calidad de vida con la escala SF-12 antes, a los 2 y 4 meses posquirúrgico y de la sexualidad con la escala índice de Función Sexual Femenina, antes y a los 4 meses posoperatorio. Comparaciones con ANCOVA ajustadas porlos valores basales y por otras características. Se contó con aprobación de comité de ética y se tomó consentimiento informado. Resultados: Se incluyeron 24 mujeres en el grupo de histerectomía vaginal y 22 en el grupo de histerectomía abdominal, con características similares antes de la cirugía. Ambos grupos mejoraron en calidad de vida y en satisfacción sexual después del proce- dimiento. Los puntajes para histerectomía vaginal e histerectomía abdominal fueron, respectivamente: salud física posoperatoria: puntaje ajustado en histerectomía vaginal 49,5 (DE ± 1,6) e histerectomía abdominal 43,8 (DE ± 6,7), diferencia 5,6 puntos (IC 95%: 0,87-10,4). Salud mental: 51,0 (DE ± 1,7) y 59,3 (DE ± 1,6) puntos, respectivamente, diferencia ajustada 8,4 (IC 95%: 3,6-13,3). Sexualidad: 22,7 (DE ± 1,8) y 26,5 (DE ± 1,7), respectivamente, diferencia 3,8 puntos (IC 95%: -1,2-8,7). Conclusión: Aunque se encontraron diferencias estadísticamente significativas en la calidad de vida, el puntaje alcanzado no es clínicamente significativo.

To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy

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.

Intrathecal buprenorphine as an adjuvant to 05% bupivacaine in vaginal hysterectomy

Background: One of the most suitable modality of anaesthesia for lower abdominal surgeries is spinal anaesthesia. The relatively short duration of action of local anaesthetics necessitates the supplementation of local anaesthetics with adjuvants which help to reduce the dose of local anaesthetic, minimize side effects and prolong the duration of anaesthesia at a relatively lesser cost to the patient. Aim: To evaluate the characteristics of subarachnoid block, the postoperative analgesia and side effects of intrathecal buprenorphine 150 µg when used as adjuvant to 0.5% bupivacaine, for vaginal hysterectomy. Materials and methods: After approval from the hospital ethical committee and informed consent from the patients a prospective pilot study was undertaken to evaluate the efficacy of intrathecal buprenorphine when used as an adjuvant to 0.5% bupivacaine. All patients belonged to American Society of Anesthesiologist’s Physical status I and II and aged between 33 and 60 years. Patients were allocated into two groups. Group A were to receive 0.5% bupivacaine 2.5 mL. Group B were to receive 0.5% bupivacaine 2.5mL with buprenorphine 150 µg. It was observed that most of group A patients had to receive general anaesthesia in addition to subarachnoid block due to inadequate pain relief. The data of group B patients were analysed. Results: Of the 49 patients analyzed, 13 patients had pain free interval which lasted more than 24 hours. Twelve patients who received a single dose of diclofenac 75 mg intravenously before the onset of pain had a pain free interval which lasted more than 24 hours. The average duration of analgesia of 37 patients was 1027 minutes ± 706.662. Jagadish Chandra Mishra, Pradip Kumar Maharana. Intrathecal buprenorphine as an adjuvant to 0.5% bupivacaine in vaginal hysterectomy. IAIM, 2017; 4(11): 99-105. Page 100 Conclusions: A single dose of intrathecal buprenorphine 150 µg added to bupivacaine may provide analgesia for a significant length of time in patients who have undergone vaginal hysterectomy without significant side-effects.