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Introducción: La cirugía laparoscópica ginecológica permite intervenir a la paciente sin tener que abrir el abdomen, pues consiste en realizar pequeñas incisiones. Actualmente se emplea en enfermedades como el cáncer o en la extracción de quistes y miomas, por lo que se puede aplicar en casi cualquier intervención de cirugía ginecológica. Objetivo: Caracterizar los procedimientos laparoscópicos del Servicio de Ginecología en el Hospital Materno-Infantil Ángel Arturo Aballí en el período comprendido entre enero del 2018 y diciembre del 2021. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo de corte longitudinal con el fin de describir la actividad asistencial laparoscópica. La muestra fue de 180 pacientes, según el criterio de selección no probabilístico de los investigadores. Resultados: La edad promedio fue 41,6 años. Según los antecedentes, predominó el tamaño del útero con 91,1 por ciento (n = 164). Dentro de las indicaciones quirúrgicas, se encontró la paridad satisfecha en un 34,4 por ciento, seguido del tumor de ovario (18,9 por ciento), las neoplasias intraepiteliales cervicales (13,4 por ciento) y el fibroma uterino sintomático. En cuanto a la cirugía mayor, se encontró la histerectomía abdominal laparoscópica en un 49,0 por ciento (n = 78), seguido de la salpingectomía con un 38,9 por ciento, resultados con significación desde el punto de vista estadístico (p = 0,004). En cuanto a la cirugía menor, el 11,6 por ciento de la muestra recibió la ablación de los focos endometriales. Las complicaciones fueron escasas. Conclusiones: Los procederes laparoscópicos del Servicio de Ginecología del Hospital Materno-Infantil Ángel Arturo Aballí se consideraron adecuados de acuerdo a los indicadores quirúrgicos(AU)
Introduction: Laparoscopic gynecological surgery allows for the patient to undergo surgery without having to open their abdomen, since it consists in making small incisions. It is currently used in diseases such as cancer or in the removal of cysts and myomas; therefore, it can be applied in almost any gynecological surgery. Objective: To characterize the laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí, in the period from January 2018 to December 2021. Methods: An observational, descriptive, retrospective and longitudinal study was carried out in order to describe the laparoscopic assistance activity. The sample consisted of 180 patients, according to the researchers' nonprobabilistic selection criteria. Results: The mean age was 41.6 years. Concerning antecedents, uterine size predominated, with 91.1 percent (n = 164). Among surgical indications, satisfied parity was found in 34.4 percent , followed by ovarian tumor (18.9 percent ), cervical intraepithelial neoplasms (13.4 percent ) and symptomatic uterine fibroid. With respect to major surgery, laparoscopic abdominal hysterectomy was found in 49.0 percent (n = 78), followed by salpingectomy, with 38.9 percent ; such results are statistically significant (p = 0.004). Regarding minor surgery, 11.6 percent of the sample received ablation of endometrial focuses. Complications were rare. Conclusions: The laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí are considered adequate according to the surgical indicators(AU)
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Humanos , Feminino , Adulto , Procedimentos Cirúrgicos em Ginecologia/métodos , Epidemiologia Descritiva , Estudos Retrospectivos , Estudos Observacionais como AssuntoRESUMO
Abstract Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery. Methods: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg−1 loading, 0.6 µg.kg−1.h−1 infusion) (Group 2), lidocaine (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion), and dexmedetomidine infusions (1 µg.kg−1 loading, 0.5 µg.kg−1.h−1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg−1.h−1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge. Results The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively. Conclusion: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.
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Humanos , Feminino , Dexmedetomidina/uso terapêutico , Procedimentos Cirúrgicos Robóticos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Infusões Intravenosas , Fentanila , Método Duplo-Cego , Estudos Prospectivos , Flatulência , Histerectomia , Lidocaína/uso terapêuticoRESUMO
Background: Laparoscopic surgery is associated with more favorable clinical outcome than conventional open surgery. This might be related to the magnitude of tissue trauma and tissue stress response. This study compares the intensity of tissue injury by assessing plasma C-reactive protein (CRP), lactic dehydrogenase (LDH), and cancer antigen 125 (CA 125) in patients undergoing laparoscopic hysterectomy compared to abdominal hysterectomy.Methods: This study was conducted at Ain Shams University Maternity Hospital from May 2018 to February 2020. 74 women candidate for hysterectomy were recruited and randomized into two groups: group A included 37 cases who underwent abdominal hysterectomy, and group B included 37 cases that underwent laparoscopic hysterectomy.Results: CRP, LDH and CA125 significantly increased post-operatively in both groups. Postoperative mean serum CRP, LDH and CA125 were significantly higher in the laparotomy group (10.84±2.47, 262.21±76.77, and 13.41±2.6 respectively) compared to laparoscopy group (7.92±2.25, 148.53±43.56, 11.79±2.77 respectively) (p<0.05).Conclusions: Surgery is a significant cause of tissue injury that can be assessed by specific markers. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and LDH values, which might account for the earlier recovery and reduced hospital stay in laparoscopic surgery.
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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.
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Resumen: ANTECEDENTES: El embarazo ectópico intersticial ocurre en 2.4% de los casos, quizá debido a la rotura uterina, con lo que se incrementa la morbilidad y mortalidad por hemorragia obstétrica. Los factores de riesgo son los mismos que para el embarazo ectópico tubárico. El tratamiento se establece en función del escenario clínico y deseo genésico de la paciente. CASO CLÍNICO: Paciente de 31 años, que ingresó al servicio de Urgencias por dolor abdominal severo e incapacitante en el hipogastrio, con índice de choque de 1.3 y signos de irritación peritoneal. La ecografía reportó líquido libre en el hueco pélvico y el espacio de Morrison; el saco gestacional extrauterino se encontraba en el anexo izquierdo, el feto sin latido cardiaco, con longitud craneocaudal de 11 semanas de gestación. La laparotomía exploradora evidenció: hemoperitoneo de 2800 cc, rotura uterina en el cuerno derecho, de aproximadamente 8 x 6 cm, visualización del feto e integridad de la bolsa amniótica. Puesto que la paciente manifestó no desear más embarazos se decidió efectuar la histerectomía total abdominal. CONCLUSIONES: El embarazo ectópico intersticial comparte los mismos factores de riesgo que el embarazo tubárico. Hoy día se dispone de diversos métodos de diagnóstico; sin embargo, la detección oportuna permite implementar el tratamiento conservador a seguir y, así, disminuir la morbilidad y mortalidad materna.
Abstract: BACKGROUND: Interstitial ectopic pregnancy occurs in approximately 2.4% of all cases, this tubal portion is located in the proximal segment and shares the muscular portion of the uterus, due to its great myometrial compliance, it facilitates late diagnosis and its clinical presentation is By means of uterine rupture and with it an increase in morbidity and mortality due to obstetric hemorrhage, the risk factors are the same as for tubal ectopic pregnancy, treatment is assessed based on preserving fertility and according to the patient's clinical setting. CLINICAL CASE: A 31-year-old patient who went to the emergency department for severe and disabling abdominal pain in the hypogastrium, shock index 1.3, with signs of peritoneal irritation, ultrasound was performed, which reported free fluid in the pelvic cavity and Morrison space, extrauterine gestational sac at the level of the left annex, embryo without heartbeat, craniocaudal length of 11 weeks of gestation, exploratory laparotomy was performed, in which hemoperitoneum of 2800 cc was observed, uterine rupture in the right cornual region of approximately 8x6cm, with fetus e integrity of the amniotic sac adjacent to the uterine rupture, the patient reported satisfied parity, and therefore a total abdominal hysterectomy was decided. CONCLUSIONS: Interstitial ectopic pregnancy shares the same risk factors as tubal pregnancy. Today, we have various diagnostic aids, so the cornerstone is timely detection, which will allow conservative treatments to decrease maternal morbidity and mortality.
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Background: Abdominal hysterectomy is the most frequented way of hysterectomy in the world; today we have a lot of techniques for hysterectomy. Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) needs experience an assessment of the learning curve. Objective of the study was to determine the feasibility and safety of TLH and TAH.Methods: Total 100 women were taken for study. Operating time, estimated blood loss, operating complication and length of stay in hospital were noted for each patient. The success rates of TLH were more compared to TAH. The operating time estimated blood loss, conversion to laparotomy was directly proportional to size of uterus.Results: There were no statistically significant differences between the two groups regarding age, body mass index (BMI), specimen weight, pre-operative hemoglobin (Hb) value and rates of the complications. The mean post-operative Hb value was significantly higher in group TLH than group TAH (11.3±0.7 gr/dl versus 10.6±1.6, p = 0.03). The mean time of operation was significantly longer in TLH than group TAH (105.4±22.9 minutes versus 74±18, p<0.001). The mean duration of hospital stay was statistically shorter in TLH compared to the TAH (2.47±0.5 days versus 4.86±1.1, p<0.001).Conclusions: Advantage of TLH over TAH are less blood loss, fewer wound infection and fever, smaller incisions, with less pain, shorter hospitalization time, speedier recovery.
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Background: Laparoscopic hysterectomy has become a widely accepted technique worldwide, since its introduction by Reich in 1989. The aim of the study was to compare the surgical results and intra- operative and post-operative complications between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH).Methods: Authors conducted a retrospective study at SMGS hospital, GMC Jammu between October 2016 to September 2018, 126 patients who underwent TLH and 126 patients who underwent TAH, were included.Results: Authors observed that there was no significant difference between the two groups in respect to patient’s age, parity and indication of surgery. Duration of surgery was found to be longer in TLH than TAH. The length of hospital stay was less in TLH than TAH. Hb drop was more in TAH group. 25 patients of TAH were given post op blood transfusion but only 9 patients of TLH were given post op blood transfusion. The time to ambulation in patients of TLH was much shorter than TAH. Wound infection was more common in TAH as compared to TLH, 5 patients had wound infection and in 4 patients resuturing was done for wound dehiscence. In 8 patients laparoscopy was converted to laparotomy because of adhesions, vascular injury and in one case because of bowel injury.Conclusions: This study showed that TLH can be safely performed by the experienced surgeon as an alternative to abdominal hysterectomy. It offers several benefits over TAH such as smaller incision, earlier ambulation, shorter hospital stay, faster recovery time and does not increase more serious complications than TAH.
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Background: Vaginal hysterectomy is preferable due to faster recovery, decreased morbidity and absence of an abdominal incision. The aim was to compare the risks and complications of laparoscopy assisted vaginal hysterectomy and total abdominal hysterectomy in terms of intra-operative and post-operative complications.Methods: A retrospective observational study was conducted in the Gynaecology ward at Vinakaya Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India. The data for the past 1-year record was taken for analysis. A total of 80 subjects were included in the study and were divided into two groups with 40 patients under TAH (total abdominal hysterectomy) group and 40 under LAVH (Laproscopic assisted vaginal hysterectomy) group. The primary outcome of the present analysis was incidence of perioperative complications like blood loss and the secondary outcomes were operating time, blood loss, urinary tract injury, rate of conversion to laparotomy, postoperative pain, and length of postoperative stay.Results: The mean intra-operative blood loss was measured among both the groups and it was found to be very high among TAH group (201 ml) compared to LAVH group (149.8 ml) and the difference was found to be statistically significant (p <0.05). Similarly, the duration of operative procedure was found to be less in LAVH group (57.9 mins) compared to TAH group (72.6 mins) and the difference was found to be statistically significant (p <0.05). Post-operative wound infection (14 vs 0) was found to be more among the patients in TAH group than that of the LAVH group and the difference was found to be statistically significant (p <0.05).Conclusions: LAVH is a safe and effective surgical treatment for benign gynaecological diseases and should be offered whenever possible, taking into account the low rate of complications and cost-effectiveness.
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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.
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Leiomyoma uterus is the most common benign solid tumor in female. Most of it situated in the body of the uterus. cervical myoma account 3%-8% of uterine myoma. Cervical myoma can frequently cause diagnostic dilemmas. Pedunculated cervical myoma can arise from the endocervical canal or from the uterine cavity and protrude through the cervix, may become necrotic, infected and gangrenous due to inadequate blood circulation through a long pedicle or if the pedicle of leiomyoma twists. This can cause menometrorrhagia, recurrent vaginal discharge leading to anemia and sepsis. A case of huge pedunculated cervical leiomyoma has been reported here. A 40 years old female, para 4, with menometrorrhagia, excessive vaginal discharge and severe anemia with haemoglobin 5gm% and challenging huge cervical pedunculated leiomyoma of size 13cm*9cm*9cm prolapsed outside introitus which is congested necrotic, infected causing uterine prolapse with bilateral hydroureter and hydronephrosis. Patient underwent bilateral internal iliac artery ligation and fibroid excision followed by total abdominal hysterectomy with bilateral salpingectomy after tracing both ureters. Post-operative period was uneventful. Histopathology was confirmatory of leiomyoma.
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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.
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Background: The objective is to study complication rate, advantages and outcome of different route of hysterectomy.Methods: A prospective study of 175 women over a period of 1 year i.e. from 01/01/2011 to 31/12/2011 SSG hospital, Vadodara. Depending on the patient profile, experience of surgeon optimum route of hysterectomy was decided.Results mean operating time in AH group was 68.4±14.4min, which was 80±10.3min, 115.8±40.6min and 148.8±25.5min in NDVH, LAVH and TLH group respectively. TLH was performed by consultants. Febrile morbidity was significantly high in AH (23%). Bladder and ureteral injuries were seen in 4% and 3% cases of NDVH and AH group. Wound complications were seen in AH (10%), whereas vault complications were higher in TLH. The hospital stay was shortest in TLH. Women with TLH had early ambulation, early resumption to normal diet, early return to routine work and better sexual function.Conclusions: Women with excessively enlarged uteri, significant pelvic pathology, or cancer are obvious candidates for AH. On the other hand, VH is frequently chosen for the small uterus in a multiparous woman with a large pelvis and no prior pelvic inflammatory disease or surgery. Although TLH, LAVH have significantly lower complication rate than AH, but overall cost is higher owing to the high operating room charges. The final selection of hysterectomy route should be based on surgeon’s experience and indication for surgery.
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La presencia de gasas intracavitarias posterior a procedimientos quirúrgicos es una situación que genera importantes complicaciones, con graves repercusiones médico-legales. El objetivo de este estudio es describir la presencia de un cuerpo extraño vesical como complicación iatrogénica. Se presentan dos casos, el primero es de un hombre de 63 años de edad, con antecedente de prostatectomía simple por hiperplasia prostática benigna, quien acude por episodio de retención aguda de orina (RAO); y el segundo es de una mujer de 65 años, con antecedente de histerectomía abdominal por leiomiomatosis uterina, quien presenta dolor pélvico crónico e infecciones urinarias a repetición. A los pacientes se les realizó un ecosonograma pélvico que reportó lesión ocupante de espacio en vejiga, la urotomografia (urotac) evidencia un cuerpo extraño intravesical de apariencia radiopaca, y en la uretrocistoscopia se visualiza material sintético intravesical flotando. Al primer paciente se le realiza una cistotomía con extracción de material compatible con gasa y a la segunda paciente se le realiza extracción endoscópica de la misma, ambos presentando evolución satisfactoria. La revisión del sitio quirúrgico y el contaje transoperatorio de gasas antes de la síntesis final de los tejidos es un paso fundamental para el éxito de una cirugía pélvica(AU)
The presence of intracavitary gauzes after the surgical procedures is a situation that generates important complications, with serious medico-legal repercussions. The objective of this study is describe the presence of a bladder foreign body as an iatrogenic complication. Two cases are presented, the first is from a 63-year-old man with a history of simple prostatectomy for benign prostatic hyperplasia who presents with episodes of acute urinary retention; and the second is a 65-year-old woman with a history of abdominal hysterectomy due to leiomyomatosis that presents with chronic pelvic pain and recurrent urinary tract infections. A pelvic ecosonogram was performed on the patients who reported a bladder space-occupying lesion, urotac showed an intravesical foreign body with a radiopaque appearance, and intravesical synthetic flotation material was visualized in the urethrocystoscopy. The patient underwent a cystotomy with gas-compatible material extraction and the patient underwent endoscopic extraction, both showing a satisfactory evolution. Surgical site revision and transoperative gauze infection before the final synthesis of tissues is a fundamental step for the success of pelvic surgery(AU)
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Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Hiperplasia Prostática , Retenção Urinária , Corpos Estranhos/complicações , Histerectomia , Dor Pós-Operatória/etiologia , Dor PélvicaRESUMO
Resumen OBJETIVO: Describir las pruebas paraclínicas y los medicamentos indicados para revertir la fiebre en las pacientes que la tuvieron en las siguientes 48 horas posteriores a la histerectomía total abdominal. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo, descrip-tivo, abierto, no controlado consistente en la revisión de los expedientes de pacientes con histerectomía total abdominal. Se incluyeron pacientes programadas en la consulta externa sólo para histerectomía total abdominal con fiebre en las primeras 48 horas posintervención. De acuerdo con la distribución de cada variable se utilizaron estadís-tica paramétrica y no paramétrica, prueba de Wilcoxon y diferencia de proporciones. RESULTADOS: De 181 histerectomías practicadas, 34 pacientes tuvieron fiebre en las primeras 48 horas del posquirúrgico (19%). El tiempo quirúrgico fue de 116.7 ± 29.4 minutos y el sangrado de 498.5 ± 221.4 mL. Los leucocitos se incrementaron en 30% luego de la detección de fiebre con respecto a los valores prequirúrgicos; la hemoglobina disminuyó en 14%. El examen general de orina se reportó alterado en 29%. El primer pico febril alcanzó 38.6 ± 0.5 °C a las 32.8 ± 8.3 horas poscirugía con persistencia de 1.5 ± 0.9 días. El 44% de las pacientes recibió un antibiótico luego de la evidencia de fiebre de causa infecciosa; los más indicados fueron: nitrofurantoína y ciprofloxacina. CONCLUSIONES: Ante la evidencia del primer pico febril es importante efectuar dos pruebas de laboratorio: biometría hemática y examen general de orina y con base en los reportes decidir si es necesaria la prescripción o no de antibiótico.
Abstract OBJECTIVE: To describe the paraclinical tests and the medications indicated to revert the fever in the patients who had it in the following 48 hours after the total abdominal hysterectomy. MATERIALS AND METHODS: Observational, cross-sectional, retrospective, descriptive, open, uncontrolled study consisting of the review of the records of patients with total abdominal hysterectomy. Patients scheduled in the outpatient clinic were included only for total abdominal hysterectomy with fever in the first 48 hours post-intervention. According to the distribution of each variable, parametric and non-parametric statistics, Wilcoxon test and proportional differences were used. RESULTS: Of 181 hysterectomies performed, 34 patients had fever in the first 48 hours after surgery (19%). The surgical time was 116.7 ± 29.4 minutes and the bleeding were 498.5 ± 221.4 mL. The leukocytes were increased by 30% after the detection of fever with respect to the presurgical values; hemoglobin decreased by 14%. The general urine test was reported altered in 29%. The first febrile peak reached 38.6 ± 0.5 °C at 32.8 ± 8.3 hours after surgery with a persistence of 1.5 ± 0.9 days. 44% of patients received an antibiotic after evidence of infectious cause fever; the most indicated were: nitrofurantoin and ciprofloxacin. CONCLUSIONS: Given the evidence of the first febrile peak, it is important to perform two laboratory tests: blood count and urinalysis, and based on the reports, decide whether the prescription of antibiotics is necessary.
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La tetralogía de Fallot es la forma más frecuente de cardiopatía congénita cianótica que se presenta en los neonatos. Los cuatro componentes de la enfermedad son: la alineación anormal de la comunicación interventricular, la obstrucción infundibular del ventrículo derecho, el cabalgamiento aórtico de la comunicación interventricular y la hipertrofia del ventrículo derecho. En este trabajo se trata un caso que se presentó para una cirugía convencional frecuente, la Histerectomía Abdominal Total debido a un mioma uterino, en una paciente que padecía de tetralogía de Fallot, con 43 años de edad, situación poco frecuente en la práctica diaria. El objetivo de este trabajo es exponer la experiencia del caso, que necesitó un manejo cuidadoso y que no aparece en la literatura básica. Habitualmente se aplica anestesia para niños con esta malformación para mejorar la calidad de vida o corregirla definitivamente, y porque precisamente solo el 2 % de los pacientes con esta enfermedad, que no han sido tratados quirúrgicamente, pueden arribar a la cuarta década de vida (AU).
The tetralogy of Fallot is the most frequent form of cyanotic congenital heart diseases presented in newborns. The disease’s four components are: abnormal alignment of intraventricular communication, right ventricle infundibular obstruction, aortic straddling of intraventricular communication, and right ventricle hypertrophy. The case presented is a case of a frequent conventional surgery, the total abdominal hysterectomy due to a uterine myoma, in a patient, aged 43 years, suffering for tetralogy of Fallot, a little frequent situation in the daily practice. The objective is exposing the experience of the case, demanding a careful management, which was not found in the main literature sources. Anesthesia is usually used in children with this malformation to improve their life quality or it is definitively corrected; only 2 % of the patients suffering this disease that have not been surgically treated are still alive in the fourth decade of life (AU).
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Humanos , Feminino , Adulto Jovem , Cirurgia Geral/métodos , Tetralogia de Fallot/cirurgia , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/epidemiologia , Histerectomia/métodos , Anestesia/métodos , Anestesia/normas , Mioma/cirurgia , Mioma/complicaçõesRESUMO
Introducción: la incorporación de la cirugía laparoscopia representa un cambio indiscutible en la especialidad de Ginecología, ya que permite la realización de procedimientos diagnósticos y terapéuticos. Objetivo: evaluar los resultados obtenidos con la implementación de la histerectomía laparoscópica como tratamiento definitivo de las enfermedades ginecológicas quirúrgicas. Métodos: se realizó un trabajo de investigación-desarrollo de tipo explicativo, cuasi experimental. Hubo 140 pacientes con indicación de histerectomía que acudieron al servicio de Cirugía General del Hospital General Docente Comandante Pinares desde enero 2013 hasta diciembre 2014. Se controlaron variables como las operaciones y enfermedades ginecológicas previas, las complicaciones transoperatorias y posoperatorias. Así como: tiempo quirúrgico, pérdidas sanguíneas, estadía y costo hospitalario. Resultados: la cesárea fue la intervención anterior más frecuente y el fibroma uterino la principal enfermedad tratada por este método. Las complicaciones posoperatorias fueron las de mayor incidencia. Disminuyeron variables como pérdidas sanguíneas, tiempo quirúrgico y costos hospitalarios. Conclusiones: queda demostrado que la histerectomía laparoscópica tiene mayores ventajas biológicas, sociales y económicas(AU)
Introduction: The laparoscopic surgery's incorporation represents an indisputable change in the specialty of gynecology, since it permits the realization of diagnostic and therapeutic procedures. Objective: To evaluate the outcomes from the implementation of the laparoscopic hysterectomy as definitive treatment for surgical gynecological diseases. Methods: An explanatory and quasiexperimental development investigation was carried out. There were 140 patients with hysterectomy indications who went to the general surgery service at Comandante Pinares General Teaching Hospital from January 2013 to December 2014. Variables were controlled, like operations and previous gynecological diseases, complications during and after operation, as well as surgical time, blood loss, and in-hospital stay and cost. Results: The cesarean was the most frequent previous operation, and the uterine fibroid was the main disease treated through this method. The postoperative complications were the most common. Variables like blood loss, surgical time and in-hospital cost decreased. Conclusions: The laparoscopic hysterectomy has proved to have more social, economic and biological advantages(AU)
Assuntos
Humanos , Feminino , Técnicas de Diagnóstico Obstétrico e Ginecológico/estatística & dados numéricos , Histerectomia/métodos , Laparoscopia/efeitos adversos , Leiomioma/cirurgiaRESUMO
Introduction: Hysterectomy is a very common surgery and can be performed by abdominal, vaginal or laparoscopic method though the abdominal route is more popular. Vaginal hysterectomy has distinct health and economic benefits. We designed this study to compare the outcomes in TAH and non-descent vaginal hysterectomy and to determine which route of hysterectomy is superior, safe and effective. Aims of the study: To determine the safety and effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy and to compare both in terms of duration of surgery, blood loss, intra operative complications, postoperative complications and duration of hospital stay. Materials and methods: This was a prospective, study done on total of 100 patients were divided randomly into two groups. One group underwent total abdominal hysterectomy and the other underwent vaginal hysterectomy. Both groups were compared for patient demographics, indications for surgery, size of uterus, duration of surgery, blood loss, need for blood transfusions, complications and duration of hospital stay. Results: Fibroid was the most common indication in both the groups. Most of the patients had 6 – 8 weeks size uterus. Mean intra operative blood loss in TAH group was slightly more than NDVH group. The need for blood transfusion was similar. The mean duration of surgery was 100.2 minutes in TAH group and 83 minutes in NDVH group. Fever was the most common complication in both groups. Abdominal wound infection and secondary suturing was seen in TAH group. The mean postoperative stay was 8.1 days in TAH group and 5.8 days in NDVH group. P. Divya Daniel, D. Anupama. To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy. IAIM, 2017; 4(10): 77-86. Page 78 Conclusion: NDVH is associated with less duration of surgery, less blood loss, less postoperative stay than TAH. There was no difference between the need for blood transfusion between the two groups. Therefore, vaginal hysterectomy is safe and feasible in most of the women requiring hysterectomy for benign conditions and should therefore be attempted.
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Objective To investigate the incidence of surgical site infection(SSI)and compliance to bundle inter-vention measures on SSI following total abdominal hysterectomy in patients in department of gynaecology of a tertia-ry first-lass hospital,and evaluate the efficacy of bundle intervention measures in prevention and control of SSI. Methods From March 2014 to October 2015,all gynecology patients undergoing total abdominal hysterectomy were as targeted monitored subjects,March-September 2014 was baseline investigation stage,October 2014 to Oc-tober 2015 was intervention stage(new bundle intervention measures were performed),compliance to bundle inter-vention measures and incidence of SSI before and after intervention were compared.Results A total of 222 episodes of total abdominal hysterectomy were monitored,the incidence of SSI was 5 .86% ,the operation P75 time were 2 hours. Compared with the baseline stage,the compliance to most traditional intervention measures improved after intervention,the largest increase in the compliance to interventions was follow-up after surgery (increased by 64.16% ),followed by preoperative perineal disinfection(increased by 39.07% )and hand hygiene(increased by 21 .34% ). Compliance to new intervention measures was 100.00% . Incidence of SSI following total abdominal hys-terectomy after intervention was significantly lower than before intervention(2.27% [3/132]vs 11.11% [10/90]), difference was significant (χ2= 7.583,P<0.05).Conclusion Targeted monitoring on SSI following total abdomi-nal hysterectomy can improve compliance to bundle intervention measures and decrease incidence of SSI.
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Objective To evaluate the effect of comprehensive intervention measures on preventing and controlling surgical site infection (SSI)in patients undergoing total abdominal hysterectomy.Methods Patients undergoing total abdominal hysterectomy in a hospital between January 2011 and December 2014 were investigated retrospec-tively,patients in 2011 were as control group,from January 2012,a prospective monitoring on SSI was initiated, comprehensive intervention measures were taken,patients between January 2012 and December 2014 were as inter-vention group,SSI before and after the intervention was compared.Results A total of 1 052 patients undergoing to-tal abdominal hysterectomy were investigated,267 cases were monitored before intervention,25 patients (9.36%) developed healthcare-associated infection (HAI),12(4.49%)of whom were with SSI;785 cases were monitored af-ter intervention,13 (1 .66%)of whom were with SSI,incidence of SSI in 2012,2013,and 2014 were 2.31 %, 1 .89%,and 0.77% respectively,there was a decreasing tendency(χ2 =7.30,P <0.01 ).Conclusion Prospective monitoring on SSI and comprehensive intervention can reduce the incidence of SSI in patients undergoing total abdominal hysterectomy.
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Introduction: Hysterectomy is second mostfrequent gynecological operation. Historicallythe uterus has been removed by either theabdominal or vaginal route. The vaginaloperation is preferable when there are nocontraindications because of lower morbidityand quicker recovery. Since it was first reportedby Reich et al in 1989 laparoscopically assistedvaginal hysterectomy (LAVH) has gainedwidespread acceptance. To compare totallaparoscopic hysterectomy (TLH), laparoscopicassistedvaginal hysterectomy(LAVH), vaginalhysterectomy (VH) and total abdominalhysterectomy(TAH).Materials and methods: A prospective,randomized study was performed atGynecologic Surgery Department of NationalCancer Center of Mongolia between March2013 and January 2014. A total of 120 womenindicated to undergo hysterectomy for cervixcancer stage 0-1, uterine myoma, uterinecancer were randomly assigned to fourdifferent groups (30 VH, 30 LAVH,30 TLH and30 TAH). Operating time, blood loss, rate ofcomplications, consumption of analgesics andlength of hospital stay were measured in eachgroup.Results: In our research the groups weresignificantly different for mean intraoperativeblood loss were TLH:119+/-54.7mL, LAVH:127.5+/-52.7 mL, VH; 145+/-57.8 mL andTAH: 210+/-77.4mL (P=.007) and operativetime were TLH 115+/-16.6 minutes LAVH:112.5 +/-18.5 minutes; VH: 51.6 +/-16.9minutes;TAH:69+/-18.2 (P = .001). Theaverage weight of uterine were from 95.1+/-27.6mg (range 58-140) in the VH group ,to 181.2+/-97 (range 76-400g) in the LAVHgroup through to 122.3+/-64 for the TAHgroup. Postoperative pain on day 0 and thetotal abdominal group were 5.5+/-0.7 days ofanalgesic request it was higher than other threegroups (TLH: 3.0+/-0.8days, LAVH: 3.08+/-0.7days, VH: 3.0+/-0.86 days P<.001). LAVHwas associated with a reduced hospital stay(TLH: 3.3+/- 0.7, LAVH: 3.3 +/- 0.6 days;VH: 3.7 +/- 0.6 days;TAH:6.5+/-0.7 P <.001). Total Laparoscopic hysterectomy hadlongest operating time (115+/- 16.6min), a lowcomplication rate, lack of severe post-operativecomplications. Vaginal hysterectomy had theshortest operating time (51.6+/-16.9min).However, there were technical problems withsalpingo-oophorectomy from the vaginalapproach and this group had a significantlyhigher rate of febrile complications (20%)compared to LAVH (2.3%) and TAH (16%).Conclusion: Even though operative timefor VH is less than TLH, there is a technical problem known as salpingo-oophorectomy.TLH and LAVH have number of advantagesincluding less interaoperative blood lose, lesspostoperative analgesic requirement, andshorter duration of postoperative hospitalstays.