Purohit technique of vaginal hysterectomy in nulliparous women: is it a matter waste of time?

To ease intraoperative access to parauterine space at vaginal hysterectomy, we choose the purohit technique of vaginal hysterectomy using a right angle forceps, electrocautery and 10 mm telescope with light source, to evaluate the role of parity. The study comprised a total of 30 women without prolapse who requested hysterectomy for different benign diseases of the uterus between April 2001 and March 2003. They were grouped to two distinct groups according to parity; group 1 [G1] 14 nuillparous and group 2 [G2] 16 parous women. Exclusion criteria included uterine size above 16 weeks, known pelvic endometriosis and early stages of organ confined malignancy. We compared vaginal hysterectomy success, failure and safety according to parity. Safety was measured from intra and postoperative complications, duration of operation and hospital stay. The overall complication rate showed no significant difference between the two groups as regard to intraoperative and postoperative complications. The mean operative time was significantly longer in nulliparous group [99 SD +/- 55.6 vs 72 SD +/- 32.8 minutes, p<0.05]. However the mean hospital stay showed no significant difference between the two groups [in nulliparous group 6.42 +/- 4.52 and 6.22 +/- 3.92 in parous groups]. The success rate was 85.7% [12/14] in nulliparous group and 87.5% [14/16] in parous group. So, it could be concluded that, using this technique nulliparity was not an obstacle to the vaginal route and, purohit technique of vaginal hysterectomy is not a waste of time in nulliparous women

Reliability of combined hysteroscopy and laparoscopy for management of cornual ectopic pregnancy

Active surgical treatment in the form of hysteroscopy under laparoscopic control was carried out on 15 women with diagnosed cornual ectopic pregnancy over 3 years period. The mean age of the patients was 26.2 years and most of cases were suffering from acute abdomen and vaginal bleeding after a period of amenorrhoea. Transvaginal ultrasound examination revealed an empty uterus, gestational sac separated <1cm from the most lateral edge of the uterine cavity and thin myometrial layer surrounding the sac. Color Doppler mapping of cornual region showed a vascular ring at the periphery. Serial beta hCG quantitative levels were static. General physical and abdominal examinations as well as laboratory profile of all cases were within normal. Patients were scheduled for operation within hours from their attendance, in all cases hysteroscopic management was done by using a small suction cannula for complete removal of the conceptus, avoiding the need for forceps or curette. Performing the procedure under laparoscopic control and injecting vasopressin minimised the risks of bleeding and rupture. The average operation time was 60 minutes and hospital stay ranged from [1-2] days. All patients tolerated the surgical procedure without complication. Based on the preceding results it would appear that this procedure is expeditious and showed immediate evidence of success or failure

Effect of hysterectomy on ovarian blood supply and function

The objective of this study was to determine whether hysterectomy has an effect on ovarian blood supply and functions or not and to make a decision to preserve or remove apparently normal ovaries in premenopausal women. Fifty premenopausal women, where ovarian blood supply and function were assessed before and after hysterectomy, were included in this study. Transvaginal color Doppler resistance index values of ovarian artery and hormonal levels [E2, FSH and LH] were measured. At the end of the 6th postoperative month, all these measurements were repeated. Serum levels of all hormones remained unchanged for six months after surgery. There was no significant difference between the pre and postoperative resistance index of ovarian arteries