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1.
Rev. Hosp. Clin. Univ. Chile ; 32(3): 258-268, 2021.
Article in Spanish | LILACS | ID: biblio-1353226

ABSTRACT

Hysterectomy is the most common gynecological surgery in non-pregnant women. There are different surgical approaches for total hysterectomy, abdominal, vaginal, laparoscopic and robotic routes. The choice is determined by different factors such as uterine size, malformations, surgical risks, skill of the surgeon, expected postoperative quality of life, and monetary costs. The surgical technique is well described in the literature, however, there are certain anatomical and functional considerations that must be known before performing the hysterectomy to avoid complications. The most frequent complications are hemorrhage, infections, thromboembolism, urinary and gastrointestinal tract injuries. Majority can be avoided with an adequate procedure and management of pre-existing comorbidities. (AU)


Subject(s)
Humans , Female , Hysterectomy/adverse effects , Hysterectomy/methods , Gynecologic Surgical Procedures/methods , Hysterectomy/trends
3.
Femina ; 48(12): 747-752, 20201231. tab
Article in Portuguese | LILACS | ID: biblio-1141185

ABSTRACT

A qualidade de vida sexual é frequentemente afetada após tratamento oncológico em ginecologia. Reportamos a qualidade de vida sexual de pacientes em seguimento no serviço de Oncologia Ginecológica da Universidade Federal do Triângulo Mineiro, por meio da aplicação do questionário validado FSFI (Female Sexual Function Index), comparando pacientes diagnosticadas com câncer de colo uterino que receberam tratamento radioterápico com aquelas que foram submetidas a tratamento para câncer de colo uterino no qual não foi necessária a realização de radioterapia. Foi realizada análise estatística utilizando os testes D'Agostino-Pearson e o teste não paramétrico Mann-Whitney. Concluiu-se que a diminuição do desejo e da excitação foi mais frequente nas mulheres tratadas com radioterapia e que não houve diferença significativa entre as pacientes a respeito de lubrificação, orgasmo, satisfação e dispareunia.(AU)


Quality of sexual life is often affected after oncological treatment in gynecology. We report the quality of sexual life of patients in a follow-up at the Gynecological Oncology service of the Federal University of Triângulo Mineiro, through the application of a questionnaire validated in the Portuguese language. The purpose of this study was to compare cervical cancer patients diagnosed who received radiotherapy with those who have been submitted to treatment for cervical cancer in which it was not necessary to perform radiotherapy. Decreased desire and arousal were more frequent in women treated with radiotherapy. Statistical analysis was performed using the D'Agostino-Pearson tests and the non-parametric Mann-Whitney test. It was concluded that decreased desire and arousal were more frequent in women treated with radiotherapy, and that there was no significant difference between patients regarding lubrication, orgasm, satisfaction and dyspareunia.(AU)


Subject(s)
Humans , Female , Quality of Life , Radiotherapy/adverse effects , Uterine Cervical Neoplasms/physiopathology , Sexuality , Hysterectomy/adverse effects , Brazil/epidemiology , Uterine Cervical Neoplasms/radiotherapy , Surveys and Questionnaires , Data Interpretation, Statistical , Statistics, Nonparametric
4.
Säo Paulo med. j ; 138(5): 414-421, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139713

ABSTRACT

ABSTRACT BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication from general anesthesia that impacts on postoperative recovery. OBJECTIVE: To evaluate prophylactic rewarming following general anesthesia, so as to decrease the incidence of PONV among patients undergoing laparoscopic hysterectomy. DESIGN AND SETTING: Prospective randomized clinical study at a hospital in China. METHODS: Sixty-two patients were randomly assigned into two groups. The forced air warming (FAW) group received pre-warmed Ringer's solution with FAW until the end of surgery. The control group received Ringer's solution without FAW. The pre-warmed Ringer's solution was stored in a cabinet set at 40 °C. The FAW tube was placed beside the patient's shoulder with a temperature of 43 °C. RESULTS: Sixty patients completed the study. The FAW group showed significant differences versus the controls regarding temperature. At 6, 24 and 48 hours postoperatively, the incidences of PONV were 53.3%, 6.7% and 3.3% in the FAW group versus 63.3%, 30% and 3.3% in the controls. VAS scores were significantly lower in the FAW group than in the controls at 24 hours (P= 0.035). Forty-item questionnaire total scores in the FAW group were significantly higher than in the controls. The physical independence and pain scores at 24 hours and emotional support and pain scores at 48 hours in the FAW group were higher than in the controls (P < 0.05). There was no difference in hemodynamics or demographics between the two groups (P > 0.05). CONCLUSIONS: Prophylactic rewarming relieved PONV and improved the quality of postoperative recovery. CHINESE CLINICAL TRIAL REGISTER (ChiCTR): ChiCTR-IOR-17012901.


Subject(s)
Humans , Female , Laparoscopy/adverse effects , Rewarming , Postoperative Nausea and Vomiting/prevention & control , Hysterectomy/adverse effects , Hysterectomy/methods , China , Prospective Studies , Treatment Outcome
5.
Fisioter. Pesqui. (Online) ; 27(1): 28-33, jan.-mar. 2020. tab
Article in Portuguese | LILACS | ID: biblio-1090415

ABSTRACT

RESUMO O objetivo deste artigo é avaliar o índice de função sexual de mulheres submetidas à histerectomia total com ooforectomia bilateral (HT-OB), a prevalência de incontinência urinária por esforço (IUE) e sua associação com a realização desse procedimento cirúrgico em um hospital de referência em Belém (PA). Foram incluídas 162 mulheres, com vida sexual ativa, alocadas em dois grupos: aquelas que realizaram HT-OB em período superior a 12 meses (n=68), e aquelas que não realizaram (n=94). Utilizou-se o questionário female sexual function index (FSFI) para avaliação da função sexual, e um questionário desenvolvido pelos pesquisadores para coletar dados sociais, econômicos e clínicos, incluindo informações quanto à presença de IUE. O valor de significância foi definido como p<0,05. Houve diferença significativa no índice de função sexual entre o grupo HT-OB e o grupo-controle, com escore geral do FSFI de 23,56 e 28,68, respectivamente (p=0,0001). Os domínios desejo, excitação, lubrificação (p<0,0001), orgasmo (p=0,04), satisfação (p=0,0006) e dor (p=0,015) apresentaram escores inferiores em mulheres histerectomizadas. A prevalência de sintomas de IUE no grupo HT-OB foi de 35,3%, sendo observada associação significativa entre a presença desses sintomas e a realização da histerectomia (p=0,02). Mulheres que realizam HT-OB têm maior risco de disfunção sexual, e este procedimento cirúrgico é associado ao desenvolvimento de IUE.


RESUMEN El presente artículo tuvo el objetivo de evaluar el índice de función sexual de mujeres sometidas a histerectomía total con ooforectomía bilateral (HT-OB), la prevalencia de incontinencia urinaria de esfuerzo (IUE) y su asociación con la realización de este procedimiento quirúrgico en un hospital de referencia en Belém (Brasil). Se incluyeron a 162 mujeres con vida sexual activa, que fueron divididas en dos grupos: las que se sometieron a HT-OB durante el período superior a 12 meses (n=68) y las que no lo había hecho (n=94). Se les aplicaron el cuestionario female sexual function index (FSFI), para evaluar la función sexual, y un cuestionario desarrollado por investigadores para recopilar datos sociales, económicos y clínicos, con informaciones en cuanto a la presencia de IUE. El valor de significación fue de p<0,05. Hubo una diferencia significativa en el índice de función sexual entre el grupo HT-OB y el grupo control, con un puntaje general de FSFI de 23,56 y 28,68, respectivamente (p=0,0001). Los dominios deseo, excitación, lubricación (p<0,0001), orgasmo (p=0,04), satisfacción (p=0,0006) y dolor (p=0,015) tuvieron puntajes más bajos en mujeres histerectomizadas. La prevalencia de síntomas de IUE fue del 35,3% en el grupo HT-OB, además se observó una asociación significativa entre la presencia de estos síntomas y la realización de la histerectomía (p=0,02). Las mujeres que se someten a HT-OB tienen un mayor riesgo de disfunción sexual, y este procedimiento quirúrgico está asociado al desarrollo de IUE.


ABSTRACT The objective of this article was to evaluate the sexual function index of women submitted to total hysterectomy with bilateral oophorectomy (THBO), the prevalence of urinary incontinence (SUI) and its association with the performance of this surgical procedure in a reference hospital in Belém, Pará. One hundred sixty-two women with active sexual life were included in two groups: those who have undergone THBO for more than 12 months (n=68), and those who have not (n=94). The Female Sexual Function Index (FSFI) questionnaire was used to evaluate sexual function along with a questionnaire developed by the researchers to collect social, economic and clinical data, including information on the presence of SUI. The significance level was defined as p<0.05. There was a significant difference in the sexual function index between THBO group and the control group, with an FSFI overall score of 23.56 and 28.68, respectively (p=0.0001). Desire, arousal, lubrication (p<0.0001), orgasm (p=0.04), satisfaction (p=0.0006) and pain (p=0.015) domains had lower scores in hysterectomized women. The prevalence of SUI symptoms in THBO group was 35.3%, and a significant association was observed between the presence of SUI and hysterectomy (p=0.02). Women who undergo THBO have a higher risk of sexual dysfunction, and this surgical procedure is associated with the development of SUI.


Subject(s)
Humans , Female , Adult , Middle Aged , Sexual Dysfunction, Physiological/etiology , Urinary Incontinence/etiology , Hysterectomy/adverse effects , Hysterectomy/methods , Postoperative Complications , Quality of Life , Urinary Incontinence/epidemiology , Prevalence , Surveys and Questionnaires , Sexuality , Evaluation Study
6.
Autops. Case Rep ; 10(4): e2020182, 2020. graf
Article in English | LILACS | ID: biblio-1131858

ABSTRACT

Intrauterine bony fragments (IUBF) are an unusual finding in hysterectomy specimen received in a histopathology laboratory. Females harboring IUBF may present non-specific symptoms like vaginal bleeding, leukorrhea, chronic pelvic pain, and secondary infertility. Herein we report the case of a 35-year-old female who presented vaginal discharge and bleeding for two years, since when she had an abortion. Later, hysterectomy specimen revealed bone pieces in the uterine cavity.


Subject(s)
Humans , Female , Adult , Hysterectomy/adverse effects , Abortion, Incomplete , Dilatation and Curettage , Abortion
7.
Rev. bras. ginecol. obstet ; 41(12): 718-725, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057886

ABSTRACT

Abstract Objective To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital. Methods A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program. Results A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p=0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p=0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p=0.030), logistic regression did not find any association between uterine volume and surgical time (p=0.103). Conclusion The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.


Resumo Objetivo Avaliar o impacto do treinamento laparoscópico sistematizado de habilidades e sutura (TLSHS) nos resultados intra e pós-operatórios da histerectomia laparoscópica em um hospital universitário brasileiro. Métodos Estudo observacional transversal de revisão de 244 prontuários de pacientes submetidas a histerectomia total laparoscópica (HTL) operadas entre 2008 e 2014. Os fatores específicos das pacientes (idade, paridade, cesariana prévia, cirurgias abdominais, e endometriose) e as variáveis relacionadas à cirurgia (tempo de hospitalização, tempo de cirurgia, volume uterino e complicações operatórias) foram analisados em três grupos temporais: 2008-09 (I-1) - HTLs realizadas por médicos experientes; 2010-11 (I-2) - HTLs realizadas por residentes sem TLSHS; 2012-2014 (I-3) - HTLs realizadas por residentes após a implementação do TLSHS. Resultados Um total de 244 pacientes submetidas a HTLs foram incluídas (média de idade de 45,93 anos): 24 operadas no período I1, 55 no I2, e 165 no I3. A principal indicação para HTL foi mioma uterino (66,4%). O grupo I-3 apresentou diminuição no tempo cirúrgico quando comparado ao grupo I-2 (p=0,010). Hospitalização superior a 2 dias diminuiu no grupo I-3 comparado ao grupo I-2 (p=0,010). Apesar de observarmos diminuição no volume uterino dos pacientes do grupo I-2 (154,2 cm3) em comparação com os do grupo I-1 (217,8 cm3) (p=0,030), a regressão logística não revelou associação entre volume uterino e tempo cirúrgico (p=0,103). Conclusão O tempo cirúrgico na HTL foi significativamente menor no grupo de pacientes submetidas à cirurgia após a implantação do TLSHS em nosso hospital.


Subject(s)
Humans , Female , Adult , Suture Techniques/education , Clinical Competence , Laparoscopy/education , Hysterectomy/education , Brazil , Cross-Sectional Studies , Laparoscopy/adverse effects , Laparoscopy/methods , Operative Time , Hospitals, Teaching , Hysterectomy/adverse effects , Hysterectomy/methods , Intraoperative Complications , Length of Stay , Middle Aged
8.
Rev. cir. (Impr.) ; 71(5): 442-445, oct. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1058298

ABSTRACT

Resumen Introducción: Las fístulas secundarias a una enfermedad diverticular complicada son una indicación formal de cirugía electiva en el 4 a 23% de los casos. Caso Clínico: Se presenta el caso de una mujer de 52 años con antecedentes de una histerectomía subtotal por miomatosis uterina que consulta por cuadro de dolor abdominal en hipogastrio acompañado de fiebre de 4 días de evolución. La tomografía computada (TC) de abdomen y pelvis describe una diverticulitis complicada con absceso peridiverticular. Tratada con antibióticos con buena respuesta clínica consulta a los 3 meses en nuestro servicio por pérdida de material fecal por vagina. Nueva TC confirma la presencia de una colección perisigmoidea y engrosamiento de la pared vesical. La colonoscopía informa una estenosis franqueable a nivel de sigmoides y se constata salida de gases por vagina. La corrección quirúrgica electiva incluyó una sigmoidectomía abierta con traquelectomía en block, cierre de la cúpula vaginal y anastomosis colorrectal mecánica, con buena evolución posoperatoria, sin recidiva a los 12 meses de seguimiento. La fístula sigmoido-cervical es una complicación rarísima de la enfermedad diverticular complicada que puede ocurrir en pacientes sometidas a una histerectomía subtotal previa. Aunque el diagnóstico de la fístula es clínico, la colonoscopía y la TC permiten descartar otras etiologías. La resección radical del segmento afectado es el tratamiento estándar en pacientes aptos.


Introduction: Diverticular disease is complicated by fistulas in 4% to 23% of patients. Case Report: A woman 52 years-old previously operated on with parcial histerectomy was successfully treated with antibiotics due to diverticulitis complicated with an abscess. Three months later the patient presented with vaginal discharge of faeces. Computed tomography showed wall thickening of sigmoid colon and vesical wall. Colonoscopy exclude cancer and confirmed the exit of gas through vagina. En-bloc resection of the sigmoid colon with traquelectomy with primary anastomosis was performed. The postoperative course was good without recurrence after 12 months of follow up. Sigmoido-cervical fistula is a very rare benign fistula due to diverticular disease. Diagnosis is basically clinic, but tomography and colonoscopy are important to exclude other causes of fistulas. Radical surgery with primary anastomosis is the standard treatment.


Subject(s)
Humans , Female , Middle Aged , Sigmoid Diseases/surgery , Sigmoid Diseases/diagnosis , Uterine Cervical Diseases/etiology , Intestinal Fistula/etiology , Diverticular Diseases/complications , Diverticular Diseases/diagnosis , Tomography, X-Ray Computed , Abdominal Pain/etiology , Treatment Outcome , Diverticular Diseases/drug therapy , Hysterectomy/adverse effects , Anti-Bacterial Agents/therapeutic use
9.
Rev. chil. obstet. ginecol. (En línea) ; 84(3): 245-256, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1020643

ABSTRACT

RESUMEN Introducción y objetivo: La histerectomía es la segunda cirugía ginecológica más frecuente, después de la cesárea, afectando a un importante porcentaje de la población femenina, con un gran impacto emocional. El objetivo de esta revisión es describir las consecuencias psiquiátricas y sus factores predisponentes, en las mujeres histerectomizadas no oncológicas posterior a la cirugía. Material y métodos: Se incluyeron investigaciones en inglés, español y portugués, con un máximo de 15 años de antigüedad. Se excluyeron investigaciones realizadas en mujeres histerectomizadas oncológicas y/o con antecedentes psiquiátricos previos a la cirugía. Resultados: Posterior a la histerectomía por causa benigna, aparecen trastornos depresivos y/o ansiosos en las mujeres en frecuencias variadas. En el post-operatorio inmediato de la histerectomía, se reportan prevalencias de hasta un 84% para depresión y hasta un 92% para ansiedad, respectivamente. En cuanto a los factores que predisponen a la incidencia de estos problemas, se encuentran; la paridad relacionado con la cantidad de hijos engendrados y el deseo de tener más hijos, la nuliparidad, la edad, la falta de información y educación previa a la cirugía, la soledad y escaso apoyo familiar, los mitos y creencias sociales en torno al procedimiento, entre otros. Conclusiones: El significado social del útero y el enjuiciamiento que vive la mujer histerectomizada, son factores relevantes en la aparición de trastornos depresivos y/o ansiosos. La importancia de la educación es esencial para el afrontamiento eficaz por parte de la mujer en este procedimiento.


ABSTRACT Introduction and objective: Hysterectomy is the second most frequent gynecological surgery, after caesarean section, affecting an important percentage of the female population, with a great emotional impact. The objective of this review is to describe the psychiatric consequences and their predisposing factors in non-oncological hysterectomized women after surgery. Material and methods: Research was included in English, Spanish and Portuguese, with a maximum of 15 years old. We excluded investigations carried out in oncological hysterectomized women and / or with psychiatric antecedents prior to surgery. Results: After hysterectomy due to benign cause, depressive and / or anxious disorders appear in women at varied frequencies. In the immediate postoperative period of the hysterectomy, prevalences of up to 84% are reported for depression and up to 92% for anxiety, respectively. As for the factors that predispose to the incidence of these problems, they are found; parity related to the number of children conceived and the desire to have more children, nulliparity, age, lack of information and education prior to surgery, loneliness and poor family support, myths and social beliefs about the procedure, among others. Conclusions: The social meaning of the uterus and the judgment of the hysterectomized woman are relevant factors in the appearance of depressive and / or anxious disorders. The importance of education is essential for effective coping by women in this procedure.


Subject(s)
Humans , Female , Anxiety , Depression/etiology , Depression/epidemiology , Hysterectomy/psychology , Postoperative Complications , Hysterectomy/adverse effects
10.
Clinics ; 74: e946, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011912

ABSTRACT

OBJECTIVES: Women with invasive placentation (IP) are at high risk of life-threatening hemorrhage. In the last two decades, less invasive surgical approaches combined with endovascular procedures have proven to be safe. Most case series describe the use of temporary balloon occlusion and embolization, either combined or not. Concerning hemorrhage rates, each separate interventional approach performs better than surgery alone does, yet it is not clear whether the combination of multiple interventional techniques can be beneficial and promote a lower incidence of intrapartum bleeding. We aim to evaluate whether combining temporary balloon occlusion of the internal iliac artery and uterine artery embolization promotes better hemorrhage control than do other individual interventional approaches reported in the scientific literature in the context of cesarean birth followed by hysterectomy in patients with IP. METHODS: This is a retrospective analysis of patients with confirmed IP who underwent temporary balloon occlusion and embolization of the internal iliac arteries followed by puerperal hysterectomy. We compared patient results to data extracted from a recent systematic review and meta-analysis of the current literature that focused on interventional procedures in patients with IP. RESULTS: A total of 35 patients underwent the procedure during the study period in our institution. The mean volume of packed red blood cells and the estimated blood loss were 487.9 mL and 1193 mL, respectively. Four patients experienced complications that were attributed to the endovascular procedure. CONCLUSION: The combination of temporary balloon occlusion and uterine artery embolization does not seem to promote better hemorrhage control than each procedure performed individually does.


Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Uterine Hemorrhage/prevention & control , Uterus/surgery , Balloon Occlusion/methods , Uterine Artery Embolization/methods , Hysterectomy/adverse effects , Aorta, Abdominal , Placentation , Uterus/blood supply , Cesarean Section , Retrospective Studies , Blood Loss, Surgical/prevention & control , Combined Modality Therapy , Endovascular Procedures , Iliac Artery
11.
Einstein (Säo Paulo) ; 17(2): eRW4320, 2019. tab, graf
Article in English | LILACS | ID: biblio-1001904

ABSTRACT

ABSTRACT Objective: To evaluate the best surgical approach for the female urinary incontinence. Methods: Systematic review conducted in MEDLINE® Cochrane, EMBASE and LILACS database up to September 1st, 2017. Articles were selected according to study type, type of intervention and outcomes. Articles were selected by more than one researcher based on title, abstract and full text. The SIGN checklist was used for bias assessment. Results: A total of 165 articles were retrieved from MEDLINE® . Twenty-five studies were elected for full text reading, and 11 of them were selected for the final text analysis. The heterogeneity between questionnaires used in different studies precluded a meta-analysis of results. Conclusion: This study yielded evidences supporting the hypothesis that total and subtotal hysterectomy have different impacts on urinary function of patients with benign uterine diseases. Articles revealed higher frequency of urinary incontinence following subtotal compared to total hysterectomy.


RESUMO Objetivo: Avaliar qual a melhor conduta cirúrgica na incontinência urinária feminina. Métodos: Revisão sistemática conduzida no MEDLINE®, Cochrane, EMBASE e LILACS até 1º de setembro de 2017. Os artigos foram escolhidos de acordo com o tipo de estudo e de intervenção, e seus resultados. Os artigos foram selecionados por mais de um pesquisador, com base no título, no resumo e no texto completo. O checklist SIGN foi usado para avaliar vieses. Resultados: No MEDLINE®, foram recuperados 165 artigos. Foram escolhidos 25 estudos para leitura do texto completo, e somente 11 foram escolhidos para análise do texto final. Não foi realizada metanálise dos resultados devido à heterogeneidade dos questionários usados em cada estudo. Conclusão: Encontrou-se evidência que suporta a hipótese de que as histerectomias total e subtotal causam impactos diferentes na função urinária de pacientes com doença uterina benigna. Os artigos mostraram maior frequência de incontinência urinária após histerectomia subtotal quando comparada à total.


Subject(s)
Humans , Female , Postoperative Complications , Urinary Incontinence/etiology , Hysterectomy/adverse effects , Hysterectomy, Vaginal/adverse effects , Time Factors , Uterine Diseases/surgery , Randomized Controlled Trials as Topic , Surveys and Questionnaires
12.
Säo Paulo med. j ; 136(5): 385-389, Sept.-Oct. 2018. tab
Article in English | LILACS | ID: biblio-979376

ABSTRACT

ABSTRACT BACKGROUND: The number of hysterectomized patients with previous cesarean sections (CSs) has increased due to increasing CS rates. A previous history of CS has been demonstrated to be an important risk factor for major complications in total laparoscopic hysterectomy. The aim here was to evaluate the major complications and safety of TLH in patients with previous CS. DESIGN AND SETTING: Retrospective analysis in a tertiary-level center. METHODS: The medical records of 504 total laparoscopic hysterectomy patients operated between May 2013 and May 2017 were reviewed retrospectively. Data on age, parity, surgical indications, duration of operation, length of hospital stay, histopathological diagnosis and major intra and postoperative complications were gathered. The patients were categorized into two groups according to their CS history, namely those with and those without previous CS. Major complications were defined as the presence of lower urinary tract injury (bladder or ureter injury), enterotomy/colostomy, bowel serosal injury or vascular injury. RESULTS: There was no difference between the groups in terms of parity, duration of operation, hospital stay or pre and postoperative hemoglobin levels. The conversion rates to laparotomy in the previous CS and no CS groups were 2% and 1.7%, respectively. The rates of major complications in the previous CS and no CS groups were 5% and 1.3%, respectively, and these results did not differ significantly (P > 0.05). CONCLUSION: TLH could be performed safely in the previous CS group, since the complication rate was not different from that of the patients without previous CS.


Subject(s)
Humans , Female , Adult , Middle Aged , Cesarean Section/adverse effects , Laparoscopy/methods , Hysterectomy/methods , Postoperative Complications/etiology , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Laparoscopy/adverse effects , Hysterectomy/adverse effects , Length of Stay
13.
Rev. cuba. cir ; 57(3): e706, jul.-set. 2018. tab
Article in Spanish | LILACS | ID: biblio-985520

ABSTRACT

Introducción: Las histerectomías constituyen uno de los procedimientos quirúrgicos más realizados a nivel global. Las ventajas de la histerectomía laparoscópica incluyen menos sangrado intraoperatorio, menor estancia hospitalaria, recuperación más rápida y disminución de la tasa de infección del sitio quirúrgico. Sin embargo, todo esto a expensas de un tiempo quirúrgico mayor, costo superior, e incremento en las lesiones ureterales y vesicales. Objetivo: Identificar los factores de riesgo que influyen en la prolongación del tiempo quirúrgico en las pacientes sometidas a una histerectomía laparoscópica. Método: Estudio observacional analítico de casos y testigos fueron evaluadas las pacientes sometidas a una histerectomía laparoscópica videoasistida desde enero del 2012 hasta diciembre 2016 en el Hospital Universitario Carlos Manuel de Céspedes. Bayamo, Granma, Cuba. Estas pacientes constituyeron la población de estudio. La muestra estuvo formada por los casos, que lo constituyeron todas las pacientes con tiempo quirúrgico prolongado (≥; 130 minutos), y los controles que fueron aquellas pacientes con tiempo quirúrgico inferior a 130 minutos. Se realizó un muestreo probabilístico con pareamiento aproximado para cada variable. Resultados: En el análisis univariado constituyeron factores de riesgo en la demora del tiempo de duración de este tipo de intervención el antecedente de cesáreas previas (p 0,001), útero con peso superior a 320 gramos (p= 0,001), movilidad al tacto vaginal (p= 0,013), dificultad en el descenso uterino al tacto vaginal (p= 0,003), y la ejecución de otra intervención durante la histerectomía (p= 0,003). En el análisis multivariado el útero con peso superior a 320 g (p 0,012), la realización de otra intervención durante el procedimiento (p= 0,021) y la cesárea previa (p= 0,043), fueron los principales factores de riesgo identificados. Conclusiones: Los factores que más influyeron en la prolongación del tiempo de duración de la histerectomía fueron el antecedente de cesárea, útero con peso estimado superior a los 320 g y la ejecución de otras intervenciones durante el mismo procedimiento(AU)


Introduction: Hysterectomies are one of the surgical procedures most performed worldwide. Among the advantages of laparoscopic hysterectomy, we can mention less intraoperative bleeding, shorter hospital stay, faster recovery, and decreased infection rate in the surgical site. However, all this is achieved at the expense of a longer surgical time, higher cost, and increase in ureteral and bladder injuries. Objective: To identify the risk factors that influence the lengthening of surgical time in patients undergoing a laparoscopic hysterectomy. Method: An analytical, observational case-control study. We evaluated the patients performed video-assisted laparoscopic hysterectomy from January 2012 to December 2016 at Carlos Manuel de Céspedes University Hospital in Bayamo, Granma (Cuba). These patients made up the study population. The sample consisted of the cases, made up by all patients with lengthened surgical time (130 minutes or more), and the controls, those patients with surgical time less than 130 minutes. A probabilistic sampling was carried out with approximate matching for each variable. Results: In the univariate analysis, the risk factors were the delay for this type of intervention, the antecedents of previous caesarean sections (p=0.001), uterus weighing more than 320 grams (p=0.001), mobility to vaginal touch (p=0.013), difficulty in uterine descent to vaginal touch (p=0.003), and the execution of another intervention during hysterectomy (p=0.003). In the multivariate analysis, we identified the uterus weighing more than 320 g (p=0.012), performing another procedure during the procedure (p=0.021), and previous caesarean section (p=0.043) as the main risk factors. Conclusions: The factors that influenced the lengthening of the hysterectomy most were antecedents of cesarean section, uterus with an estimated weight greater than 320 g, and the execution of other interventions during the same procedure(AU)


Subject(s)
Humans , Bronchoscopy/adverse effects , Risk Factors , Hysterectomy/adverse effects
14.
Rev. chil. obstet. ginecol. (En línea) ; 82(6): 666-674, Dec. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899959

ABSTRACT

RESUMEN: La Histerectomía es uno de los procedimientos quirúrgicos ginecológicos más frecuentes en el tratamiento de patologías uterinas. La literatura destaca al útero como un símbolo de identidad femenina y aunque existen diferencias individuales de afrontamiento, su extirpación puede causar alteraciones en la dimensión psicológica, física, social y sexual. El objetivo del estudio es determinar la importancia de una intervención psicoeducativa en mujeres ginecológicas histerectomizadas, para prevenir el riesgo potencial de presentar alteraciones emocionales y disfunciones sexuales post cirugía. METODOLOGÍA: Se revisaron 106 artículos originales de fuente primaria, en inglés, español, francés y portugués, publicados entre los años 2004 y 2016, en PubMed, Scielo, CINAHL, Ciber Index Cuiden, Lilacs, Elsevier y Scopus. RESULTADOS: El 100% de artículos reconocen en mujeres histerectomizadas, el riesgo de sufrir alteraciones emocionales y trastornos sexuales y el 61% reconoce, además la importancia de entregar educación sexual formal a la mujer y pareja, para prevenir trastornos sexuales, especialmente en histerectomizadas oncológicas, considerando intervinientes individuales y multidimensionales, temáticas de interés y capacitación de profesionales sanitarios en educación sexual. CONCLUSIONES: Una intervención psicoeducativa en la mujer y pareja, puede prevenir especialmente en histerectomizadas oncológicas la aparición de alteraciones emocionales y disfunciones sexuales, propiciar la recuperación física y emocional, un retorno a una vida sexual activa satisfactoria. Se sugieren estudios que comprueben la magnitud de esta intervención, para ser incorporada en un futuro al protocolo de atención de Garantías Explicitas en Salud en mujeres con cáncer cérvico uterino.


ABSTRACT: Hysterectomy is one of the most frequent gynecological surgical procedures in the treatment of uterine pathologies. Literature stands out uterus as a symbol of female identity and although there are individual differences in confronting, their extirpation can cause alterations in the psychological, physical, social and sexual dimensions. The objective of the study is to determine the importance of a psychoeducational intervention in hysterectomized gynecological women in order to prevent the potential risk of presenting emotional alterations and sexual dysfunctions after surgery. METHODOLOGY: 106 original articles of primary source in English, Spanish, French and Portuguese, published between 2004 and 2016, in PubMed, Scielo, CINAHL, Ciber Index Cuiden, Lilacs, Elsevier and Scopus were reviewed. RESULTS: 100% of articles recognize in hysterectomized women, the risk of suffering emotional alterations and sexual disorders, and 61% also recognize the importance of providing formal sexual education to women and partners in order to prevent sexual disorders, especially in oncological hysterectomized, considering individual and multidimensional interveners, topics of interest and training of health professionals in sexual education. CONCLUSIONS: A psychoeducational intervention in the woman and couple can prevent, especially in oncological hysterectomized, the appearance of emotional alterations and sexual dysfunctions, to propitiate the physical and emotional recovery, a return to an active satisfactory sexual life. Studies to prove the magnitude of this intervention are suggested in order to be incorporated in future to the care protocol for Explicit Health Guarantees in women with cervical cancer.


Subject(s)
Humans , Female , Sexual Dysfunction, Physiological/prevention & control , Sex Education , Sexual Dysfunctions, Psychological/prevention & control , Hysterectomy/adverse effects , Hysterectomy/psychology , Sexual Dysfunction, Physiological/etiology , Sexuality , Sexual Dysfunctions, Psychological/etiology
15.
Rev. medica electron ; 39(5): 1133-1142, set.-oct. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902229

ABSTRACT

Los cuerpos extraños olvidados en el abdomen después de una operación quirúrgica, también denominados textilomas tienen una incidencia de 1 por cada 1500 laparotomías, aunque resulta muy difícil evaluar la real estadística por los escasos reportes debido a las posibles implicaciones médico-legales que en muchos países traen aparejadas. En el presente trabajo se realiza la presentación de un interesante caso intervenido en el Hospital Universitario "Dr. Mario Muñoz Monroy" del municipio Colón. Se trata de una paciente femenina de 47 años de edad operada inicialmente de Histerectomía Total Abdominal que dos meses después regresa con una Oclusión Intestinal Completa y es llevada al quirófano donde se encuentra un "Plastrón Abscedado". La Evolución clínica post-operatoria fue excelente. El estudio de la pieza anatómica demostró la presencia de una compresa totalmente "enrollada" dentro de la luz del intestino por lo que se deduce que el cuerpo extraño "provocó" una fístula peritoneo-entérica, con el paso total de la compresa hacia la luz del intestino, causando un cuadro oclusivo. Cada uno de los médicos especializados en ramas quirúrgicas está expuesto a la ocurrencia de dicha contingencia que es multicausal y completamente ajena a la voluntad del equipo a cargo del paciente. Por tal motivo resulta vital la exploración cuidadosa de todos los medios usados en cada una de las laparotomías (AU).


Foreign bodies left in the abdomen after surgery, also called gossypibomas have an incidence ranging between 1 in 1500 laparotomy, although it is very difficult to assess the actual statistics for scarce reports due to possible medico-legal implications in They rigged bring many countries. In this paper presenting an interesting case involved the University Hospital "Dr. is done Mario Muñoz Monroy "Columbus Township. This is a female patient of 47 years initially operated total abdominal hysterectomy two months later he returns with a complete intestinal occlusion and is taken to the operating room where there is a "Plastron abscessed". The postoperative clinical evolution was excellent. The study of the anatomical specimen showed a pad completely "wrapped" into the lumen of the intestine so it follows that the foreign body "caused" a fistula peritoneal-enteral, with the full bore of the pad into the light bowel, causing occlusive condition. Each specialized doctors in surgical branches exposed to the occurrence of such a contingency that has multiple causes and completely beyond the control of the team in charge of the patient. Therefore it is vital careful examination of all the media used in each of the laparotomy (AU).


Subject(s)
Humans , Female , Adult , Abdominal Cavity/surgery , Foreign Bodies , Peritoneovenous Shunt/methods , Medical Records , Intraabdominal Infections , Hysterectomy/adverse effects , Hysterectomy/methods , Intestinal Obstruction/surgery , Intestinal Obstruction/complications , Intestinal Obstruction/diagnosis
16.
Rev. chil. obstet. ginecol. (En línea) ; 82(4): 408-415, oct. 2017. tab
Article in English, Spanish | LILACS | ID: biblio-899923

ABSTRACT

INTRODUCCION La histerectomía obstétrica es procedimiento de urgencia para resolver una situación grave, su incidencia es de 5 a 15 por cada 1000 eventos obstétricos OBJETIVO GENERAL Determinar la frecuencia y factores asociados a la histerectomía obstétrica en un hospital de segundo nivel en México. METODOLOGIA Estudio descriptivo, transversal y retrospectivo en el periodo de Enero de 2014 a Diciembre del 2016, se incluyeron todos los casos de histerectomía posterior a un evento obstétrico, se estudiaron: edad, paridad, vía de interrupción del embarazo, antecedente de cesárea previa, indicaciones y complicaciones de la histerectomía, ingreso al servicio de terapia intensiva y mortalidad, el análisis se realizó con estadística descriptiva. RESULTADOS Durante el periodo de estudio, se atendieron 37 308 eventos obstétricos, efectuándose histerectomía obstétrica a 153 pacientes que representan el 0.57%, es decir, una HO por cada 243 embarazos. La edad promedio de quienes se les efectuó la histerectomía fue de 34 años de edad, siendo más frecuente en el grupo de mayores de 35 años, que habían tenido dos o tres embarazos previos. El antecedente de cesárea previa fue del 69.2%. La vía de interrupción del embarazo actual fue de cesárea en el 72.1%. La principal indicación fue la atonía uterina en 51 casos (33.3%). La complicación más frecuente fue la anemia aguda en el 83%. Hubo 1 muerte materna (0.6%). CONCLUSIONES La Histerectomía obstétrica es una cirugía de urgencia, por lo que se deben de identificar durante el control prenatal los factores asociados a las principales indicaciones de esta complicación.


INTRODUCTION Obstetric Hysterectomy (OH) is an emergency procedure to solve a life threatening condition, and its incidence is 5 to 15 per 1000 obstetric events. GENERAL OBJETIVE To determine the frequency and factors related with obstetric hysterectomy at a secondary hospital in Mexico. METHODOLOGY Descriptive, cross-sectional and retrospective study from January 2014 to December 2016 including all hysterectomy cases due to an obstetric event. Factors such as Age, number of deliveries, abortions, and previous cesarean sections, admission to the Intensive care unit, surgical indications, complications and mortality because of hysterectomy were analyzed thru descriptive statistics. RESULTS 37 308 obstetric events were registered and 153 were treated with Obstetric Hysterectomy representing 0.57% of the total, meaning one OH per every 243 pregnancies. The average age of those who had a hysterectomy was 28.5 years, and the procedure had its peak at the group of age older than 35 years who had had two or more pregnancies. The history of previous cesarean section was 39.2%. In 72.1% the pregnancy was terminated with a cesarean section. The main indication for hysterectomy was Uterine Atony in 33.3% (51 cases). The most frequent complication was acute anemia in 83%. There was a maternal death (0.6%). CONCLUSIONS Obstetric Hysterectomy is an emergency surgery, there are related factors that must be identified during the prenatal control to avoid this complication.


Subject(s)
Humans , Female , Adult , Young Adult , Pregnancy Complications/surgery , Hysterectomy/statistics & numerical data , Parity , Cesarean Section/statistics & numerical data , Incidence , Cross-Sectional Studies , Retrospective Studies , Age Distribution , Emergencies , Hysterectomy/adverse effects , Mexico
17.
Rev. cuba. obstet. ginecol ; 43(3): 28-40, jul.-set. 2017. tab
Article in Spanish | LILACS, CUMED | ID: biblio-901312

ABSTRACT

Introducción: es necesario sopesar los beneficios y riesgos de la implementación de la histerectomía totalmente laparoscópica frente a la abdominal. Objetivos: describir el comportamiento de la histerectomía totalmente laparoscópica en el Hospital General Docente Iván Portuondo de San Antonio de los Baños. Métodos: estudio observacional descriptivo en una serie de casos, en el Hospital General Docente Iván Portuondo de San Antonio de los Baños, desde enero de 2013 hasta diciembre de 2015. La muestra quedó constituida por 36 pacientes con diagnósticos que necesitaron se les realizara histerectomía por vía abdominal. Los datos se recopilaron y procesaron mediante el uso del paquete estadístico SPSS versión 21.0 para Windows. Se realizaron los gráficos, cuadros y análisis correspondientes a las variables estudiadas, causa de la operación, peso estimado del útero medido en gramos, complicaciones intraoperatorias y posoperatorias, tiempo quirúrgico, cantidad de sangrado, estadía hospitalaria y tiempo de reinserción a la vida cotidiana. Las variables cuantitativas y cualitativas se expresaron en sus respectivas medidas de resumen: por ciento y el establecimiento de intervalos de confianza para las variables cuantitativas, así como la posible asociación entre ellas. Resultados: el mioma uterino fue la principal indicación de la cirugía, en la medida que se avanzó en la curva de aprendizaje, se disminuyó en el tiempo quirúrgico y la cantidad de sangrado. El sangramiento de la arteria uterina fue la principal complicación, que provocó conversión en tres de las pacientes operadas. Del total de pacientes, 91,6 por ciento de nuestras pacientes tuvieron una corta estadía hospitalaria y 80,5 por ciento una rápida reinserción a la vida cotidiana. Estos resultados estuvieron relacionados con la introducción de un nuevo proceder(AU)


Introduction: It is necessary to weigh the benefits and risks of the implementation of entire laparoscopic hysterectomy versus abdominal hysterectomy. Objectives: Describe the behavior of the entire laparoscopic hysterectomy in Iván Portuondo General Teaching Hospital in San Antonio de los Baños. Methods: A descriptive observational study was conducted in a series of cases, at Iván Portuondo General Teaching Hospital in San Antonio de los Baños, from January 2013 to December 2015. Thirty-six (36) patients formed the sample. Their diagnoses confirmed the need of performing abdominal hysterectomy. The data was collected and processed by using the statistical package SPSS version 21.0 for Windows. The graphs, charts and analyzes corresponding to the variables studied, cause of the operation, estimated weight of the uterus measured in grams, intraoperative and postoperative complications, surgical time, amount of bleeding, hospital stay and time of reintegration into daily life were performed. The quantitative and qualitative variables were expressed in their respective summary measures: percent and the establishment of confidence intervals for the quantitative variables, as well as the possible association between them. Results: Uterine myoma was the main indication for surgery, as the learning curve progressed, the surgical time and the amount of bleeding decreased. Bleeding of the uterine artery was the main complication, which caused conversion in three of the operated patients. 91.6 percent of our patients had a short hospital stay and 80.5 percent a rapid reintegration into daily life. These results were related to the introduction of a new procedure(AU)


Subject(s)
Humans , Female , Laparoscopy , Hysterectomy/methods , Epidemiology, Descriptive , Learning Curve , Observational Study , Hysterectomy/adverse effects
18.
Acta cir. bras ; 32(7): 576-586, July 2017. tab, graf
Article in English | LILACS | ID: biblio-886217

ABSTRACT

Abstract Purpose: To evaluate the inflammatory responses induced by laparoscopic hysterectomies with multiport and singleport approaches. Methods: This was a pilot prospective randomized study that included 42 women candidates for hysterectomy at School of Medicine, Hospital das Clínicas, USP. The patients were randomized to two groups: MP-TLH (total laparoscopic hysterectomy with 3 abdominal incisions), and SP-TLH (total laparoscopic hysterectomy with a single umbilical incision).We evaluated the inflammatory response (via CRP, IL-6, IL-10, TNFα, VEGF and leukogram assessments), surgical time, postoperative pain, blood loss and surgical complications in both groups. Results: Both techniques were similar regarding C-reactive protein (p=.666), IL-6 (p=.833), IL-10 (p=.420), TNF-α(p=.098), VEGF (p=.092) and the leukogram (p=.712) measures. The operative time was significantly longer in the SP-TLH group than in the MP-TLH group (p=.001). The pain evaluation was similar in both groups (p=.170). Hemoglobin variation and the aspirated blood volume were similar in both groups (p=.493 and p=.347). There were no major complications. Conclusions: Multiport and singleport laparoscopic approaches are both safe methods for hysterectomy. Although SP-TLH resulted in a significantly longer operative time than MP-TLH, no differences were observed between the groups in inflammatory responses, blood loss and postoperative pain.


Subject(s)
Humans , Female , Adult , Middle Aged , Biomarkers/blood , Hysterectomy/methods , Inflammation/etiology , Pain, Postoperative , Prospective Studies , Treatment Outcome , Laparoscopy/adverse effects , Laparoscopy/methods , Operative Time , Hysterectomy/adverse effects , Inflammation/diagnosis , Length of Stay
19.
J. coloproctol. (Rio J., Impr.) ; 37(2): 157-159, Apr.-June 2017. ilus
Article in English | LILACS | ID: biblio-893972

ABSTRACT

ABSTRACT Appendico-cutaneous fistulas not related to acute appendicitis or cancer are rare and show spontaneous resolution after conservative treatment, mainly when they show low output, absence of obstruction or sepsis and in patients with good nutritional status. We found no report in the literature on appendico-cutaneous fistula after hysterectomy. The evolution of this case shows that this type of fistula can have low, but persistent debt, requiring definitive surgery.


RESUMO Fístulas apendico-cutâneas não relacionadas à apendicite aguda ou neoplasias são raras e de resolução espontânea após tratamento conservador, sobretudo quando se apresentam com baixo débito, ausência de obstrução ou sepse e em pacientes em bom estado nutricional. Não encontramos relato na literatura de fístula apendico-cutânea após histerectomia. A evolução desse caso demonstra que a esse tipo de fístula pode apresentar débito baixo, mas persistente, demandando cirurgia definitiva.


Subject(s)
Humans , Female , Adult , Digestive System Fistula/pathology , Hysterectomy/adverse effects
20.
Acta cir. bras ; 32(4): 307-318, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-837699

ABSTRACT

Abstract Purpose: To evaluate the postoperative analgesic and adverse effects of three doses of dexamethasone, administered epidurally in combination with lignocaine, in dogs undergoing ovariohysterectomy (OVH). Methods: Twenty-four female dogs undergoing ovariohysterectomy were pre-medicated with acepromazine and general anaesthesia was induced and maintained with propofol. Animals were randomly allocated into four groups of six. The control group was given lignocaine 2% (LI) and the treatment groups were given lignocaine with either 2 mg dexamethasone (LIDEX2), 4 mg dexamethasone (LIDEX4) or 8 mg dexamethasone (LIDEX8) administered at the lumbosacral epidural space. Duration of postoperative analgesia, first analgesic rescue, motor blockade, heart rate, blood pressure, respiratory rate, and rectal temperature were evaluated. Results: The duration of postoperative analgesia was 19.5 (SD 6) hours for LIDEX8 (p=0.001), 10 (SD 2) hours for LIDEX4 (p=0.002), 4 (SD 2) hours for LIDEX2 (p=0.074) treatments compared with values for the LI control treatment 2.2 (SD 1.6) hours. All treatments had significant cardiovascular and respiratory alterations but they were within acceptable range in these clinically healthy female dogs. Conclusion: Dexamethasone added to epidural lignocaine significantly extends the postoperative analgesia after ovariohysterectomy in female dogs.


Subject(s)
Animals , Female , Dogs , Dexamethasone/administration & dosage , Ovariectomy/veterinary , Analgesia, Epidural/veterinary , Analgesics/administration & dosage , Hysterectomy/veterinary , Lidocaine/administration & dosage , Pain, Postoperative/prevention & control , Pain Measurement/veterinary , Ovariectomy/adverse effects , Dose-Response Relationship, Drug , Hysterectomy/adverse effects
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