Função sexual pós-histerectomia: quais os impactos e aspectos técnicos envolvidos? / Sexual function after hysterectomy: what are the impacts and technical aspects involved?

Objetivo: Identificar o impacto da histerectomia para patologias benignas sobre a sexualidade feminina. Métodos: Revisão de literatura com busca na plataforma PubMed, sendo selecionados 23 artigos em português e inglês publicados entre 2016 e 2021. Resultados: Foi descrita, majoritariamente, melhora na função sexual após histerectomia, semelhante às abordagens totais ou supracervicais e independentemente da via de acesso cirúrgico, apesar de impacto ligeiramente menor com a via laparoscópica. Na laparoscopia, houve melhor desfecho sexual no fechamento da cúpula vaginal, quando comparado ao fechamento via vaginal. Ademais, a ooforectomia concomitante apresentou resultados conflitantes e inconclusivos. Conclusão: A histerectomia afeta positivamente a saúde sexual feminina e aspectos técnicos podem interferir na função sexual, porém os dados são limitados. Devido à importância do tema, necessitam-se de mais estudos com metodologias padronizadas para possibilitar análises mais detalhadas.

Objective: To identify the impact of hysterectomy for benign pathologies on female sexuality. Methods: Literature review with search on PubMed platform, being selected 23 articles in Portuguese and English published between 2016 and 2021. Results: Improvement in sexual function after hysterectomy was mostly described, being similar in total or supracervical approaches and independent of the surgical access route, although it had slightly lower impact when laparoscopic. In the laparoscopic approach, there was better sexual outcome in the vaginal dome closure when compared to vaginal closure. In addition, concomitant oophorectomy showed conflicting and inconclusive results. Conclusion: Hysterectomy positively affects female sexual health and technical aspects may interfere with sexual function, but data are limited. Due to the importance of the theme, more studies with standardized methodologies are needed to enable more detailed analyses.

Cirugía mayor ambulatoria ginecológica en el Hospital San José de Parral / Major outpatient gynecological surgery at the San Jose de Parral Hospital

OBJECTIVE: Evaluate initial results of a ambulatory major surgery program in Gynecology. MATERIAL AND METHODS: Retrospective, descriptive study of the period March 2018 to June 2019. The interventions included were: surgical sterilizations via vaginal, minilap and laparoscopic, diagnostic laparoscopy, laparoscopic cyst or anexectomy, hysteroscopy, TOT, vaginal plasty, biopsy curettage, polypectomy, extraction of IUD under anesthesia, labiaplasty, and removal of transobsturatrix tape. Quality indicators such as suspension, readmissions and systemic and surgical complications have been analyzed. RESULTS: 136 patients were operated by CMA of which 43 were laparoscopic (31.6%), 55 patients vaginally (40.4%), 34 histeroscopy (25%) and 4 patients by minilap (3%)There were 4 minor and late complications (2.9%) that corresponded to operative wound infection in vaginal plasty and nymphoplasty, a dysfunctional TOT tape that had to be removed in a mediated manner and a PIP post surgical sterilization via vaginal route. CONCLUSIONS: Gynecological ambulatory major surgery is feasible to perform in a hospital of medium complexity with a low percentage of minor complications in this study.

Mola hidatiforme como manifestación ginecobstétrica en el curso de las enfermedades reumáticas / Hydatiform mole as a gynecological manifestation in the course of rheumatic diseases

Las enfermedades reumáticas pertenecen a un grupo que provocan manifestaciones clínicas en varios sistemas de órganos de la anatomía humana. Las complicaciones ginecobstétricas no son las que con mayor frecuencia se presentan. La enfermedad trofoblástica gestacional agrupa un conjunto de lesiones benignas como la mola hidatiforme y la neoplasia trofoblástica gestacional. Este trabajo se propone presentar un caso con los elementos clínicos e imagenológicos que permiten llegar al diagnóstico de una mola hidatiforme. Se trata de una paciente de 48 años de edad, con diagnóstico de lupus eritematoso sistémico, que acude con manifestaciones clínicas que permitieron llegar al diagnóstico de enfermedad trofoblástica gestacional con mola hidatiforme completa. Las enfermedades reumáticas, en especial el lupus eritematoso sistémico, provocan complicaciones ginecobstétricas. La enfermedad trofoblástica gestacional con mola hidatiforme completa, a pesar de ser una rara entidad, afecta considerablemente el bienestar biopsicosocial de las pacientes y disminuye su percepción de calidad de vida relacionada con la salud(AU)

Rheumatic diseases fit in a group that cause clinical manifestations in various organ systems of the human anatomy. Gyneco-obstetric complications are those that occur less frequently. Gestational trophoblastic disease groups together benign lesions such as hydatidiform mole and gestational trophoblastic neoplasia. This paper intends to present a case with the clinical and imaging elements that allow the diagnosis of hydatidiform mole. We present a 48-year-old female patient with a diagnosis of systemic lupus erythematosus, who presents with clinical manifestations that led to the diagnosis of gestational trophoblastic disease with complete hydatidiform mole. Rheumatic diseases, especially systemic lupus erythematosus, cause gyneco-obstetric complications. Although being a rare entity, the gestational trophoblastic disease with complete hydatidiform mole greatly affects the biopsychosocial wellbeing of patients and decreases their perception of health-related quality of life(AU)

Comparison of the Kelly's plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions

ABSTRACT Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence, and the daily pad use were recorded. Patients were filled "rinary Distress Inventory-6(UDI-6)", "Incontinence Impact Questionnaire 7(IIQ-7)" and "Index of Female Sexual Function(IFSI)" questionnaire forms at preoperatively, and postoperative 6th month. No usage of pads was accepted as subjective cure rate. Intraoperative, and postoperative complications were noted. Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

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

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

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

Prolapso de cúpula vaginal y su corrección: caso clínico y revisiónde literatura / Vaginal vault prolapse and correction. Case report and review of literature

Introducción. El prolapso de cúpula vaginal es una complicación común después de la histerectomía vaginal con un impacto negativo en la calidad de vida de las mujeres y se considera una condición frecuente que alcanza un 40% en mujeres multíparas.Se asocia con disfunción urinaria, anorrectal y sexual. Una clara comprensión del mecanismo de apoyo del útero y la vagina es importante para tomar la decisión adecuada de procedimiento correctivo. El factor de riesgo más importante suelen ser defectos preexistentes del diafragma pélvico antes de la histerectomía. Caso Clínico: Se presenta el caso de una paciente de 60 años de edad, quien acude por sensación de cuerpo extraño protruyendo de vagina de 30 años de evolución, el cual ha incrementado paulatinamente de tamaño, con antecedentes de histerectomía vaginal realizada hace 12 años, y levantamiento de cúpula hace 10 años. Al examen ginecológico se observa descenso de pared vaginal anterior hasta 4 cms por fuera del introito vaginal, además, descenso del recto por la cara posterior de la vagina. Se realiza levantamiento de cúpula vaginal, con resolución exitosa del problema. Discusión: El riesgo de prolapso de órganos pélvicos aumenta con la paridad y edad avanzada. La cirugía para corregir dichos defectos de apoyo de órganos pélvicos se ha identificado como factor de riesgo para el desarrollo de esta patología. El manejo debe ser individualizado, teniendo en cuenta la experiencia del cirujano, la edad del paciente, sus comorbilidades, antecedentes de cirugía previa y su vida sexual. Conclusión: No hay consenso sobre el mecanismo del prolapso de cúpula, pero lo que es aceptado por todos es la necesidad de evaluar adecuadamente estas pacientes y ponerse de acuerdo sobre el tipo de cirugía que será adecuado para cada circunstancia...(AU)

Vaginal Removal of Non Prolapsed Uterus with Benign Pathology.

Vaginal hysterectomy was the first minimally invasive surgical approach for benign gynecologic conditions, a number of other approaches for hysterectomy have been introduced, yet when compared with vaginal hysterectomy these approaches do not offer significant benefits for similar indications. Objectives : (1) To know the benign gynecological conditions that can be treated by vaginal hysterectomy. (2) To find out the operative difficulties of vaginal hysterectomy done in non-prolapsed uterus. (3) To know the morbidity and mortality of vaginal hysterectomy. Methodology : This is a prospective study conducted at our Hospital from 1st December 2010 to 30th Nov. 2011. Hundred consecutive cases of non-descent vaginal hysterectomy for benign pathology of uterus were studied. Results : In our study maximum hysterectomies were done in the age group 41-50 (49%) followed by 31- 40 (40%) least were in age more than 50 years. Mean parity of the cases undergoing hysterectomy were 2.47. In 77% patients, complaints were menorrhagia. The maximum hysterectomies, 41% for fibroid uterus were done, followed by 39% for DUB. One patient had intraoperative bladder injury. Mean operating time for the hysterectomies was 53.21 minutes. No mortality was seen, 12% post-operative complications were present. The mean post-operative stay in the hospital was 5.95 days. Conclusion : Vaginal hysterectomy is both feasible and optimal for many patients who long have been considered inappropriate candidates for vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic approach for benign conditions of the uterus.

Leiomioma uterino atípico: a propósito de un caso / Atypical uterine leiomyoma: a case report

Los leiomiomas son tumores benignos compuestos principalmente por células musculares lisas, pero con cantidad variable de tejido conectivo fibroso. Son las neoplasias más habituales del tracto genital femenino, estando presentes en 77% de las piezas de histerectomías realizadas por cualquier indicación. Además de los leiomiomas uterinos usuales y los leiomiosarcomas, existe un grupo de tumores intermedios o borderline. Presentar un caso infrecuente. Descripción del caso y revisión bibliográfica. Femenina de 47 años, quien presenta aumento de volumen circunferencia abdominal y dolor pélvico de 2 años de evolución, al examen físico presenta abdomen globoso, ascítico, lesión de ocupación de espacio palpable en hipogastrio que se extiende hasta mesogastrio, al examen ginecológico se palpa lesión que ocupa fondo de saco, altacto rectal tumor que ejerce compresión extrínseca sobre el recto. Tanto al ultrasonido como tomografía se evidencia lesión para uterina izquierda y ascitis sin otras alteraciones. La colonoscopia confirma compresión extrínseca sobre cara anterior del recto, sin infiltración. Es llevada a mesa operatoria encontrando como hallazgos líquido ascítico, tumor de 30 cm x 20 cm que aparenta originarse de la cara posterior del cuerpo uterino e implante peritoneal en parietocólico izquierdo. Se realiza histerectomía total abdominal más ooforosalpingectomía bilateral, muestreo ganglionar pélvico y muestreo peritoneal. Los leiomiomas atípicos son un grupo de neoplasias cuyo diagnóstico y tratamiento representan un reto, debido a su comportamiento y a la poca información que existe publicada.

Leiomyomas are benign tumors composed mainly of smooth muscle cells, but with varying amounts of fibrous connective tissue. They are the most common malignancies of the female genital tract, being present in 77% of the parts of hysterectomies performed for any indication. Besides the usual uterine leiomyomas and leiomyosarcomas, there is a group of intermediate or borderline tumors. In this work we presentan unusual case. Analysis of case report and literature review. We view and examined a patient women’s of 47 years, who presented increased abdominal volume concomitant pelvic pain, physical examination presents abdomen globosely, ascites, a space occupying lesion palpable in the hypogastrium extending to the mesogastrium, the gynecologic examination shows that space occupying for tumor lesion in the fornix, the rectal touch space occupying for tumor and extrinsic compression exerted on the rectum. Both the ultrasound and tomography is evidence of parauterine left space occupying lesion and ascites without other alterations. Colonoscopy confirmed extrinsic compression on anterior rectum without infiltration. Operative finding as ascites fluid findings, tumor side 30 cm x 20 cm, appears to originate from the back of the uterine body and left parietocolic peritoneal implant. Total abdominal hysterectomy is performed more oophorectomy bilateral, pelvic lymph node and peritoneal sampling. The atypical leiomyomas are a group of neoplasms whose diagnosis and treatment represent a challenge because of their behavior and that there is little published information.

effect of a modified surgical technique on the incidence of vault haematomas

To evaluate the effects of a modified incision and closure technique on the incidence of vault haematomas and post operative morbidity after vaginal hysterectomy. This study was conducted in Lady Aitchison Hospital, Lahore from November 2011 to December 2012. 100 patients aged 40 to 70 years having utero-vaginal prolapse undergoing vaginal hysterectomy were included in the study. Vaginal hysterectomy was performed with a modified Incision. Patients were observed for fever, pain and vaginal bleeding. Pelvic ultrasound was carried out for any pelvic collection or haematomas. Patients were followed for one month. Patients with complaints of lower abdominal pain, vaginal spotting, bleeding or fever were readmitted and evaluated. Out of 100 patients, 2% patients developed vault haematomas, 11% developed pain, 5% developed fever. 7% patients stayed at hospital for 5-6 days due to complications. Haematoma was confirmed by ultrasound in 2% cases and those were readmitted. Conservative management was done. No patient required surgical evacuation. Adoption of the modified technique resulted in a significant fall in postoperative morbidity due to haematoma formation.

Total laparoscopic hysterectomy versus vaginal hysterectomy at the University Hospital of the West Indies: a 5-year retrospective study

OBJECTIVE: To compare the outcomes of total laparoscopic hysterectomy (TLH), a relatively new procedure, with vaginal hysterectomy (VH), a wellestablished procedure, in a university teaching hospital. SUBJECTS AND METHODS: A retrospective chart review of all patients who underwent TLH at the University Hospital of the West Indies between January 2007 and December 2011 was conducted. Chart review was also conducted of a group of patients who underwent VH during this time period. The groups were compared with respect to demographic data and intraoperative and postoperative outcomes. Statistical analysis was undertaken using the SPSS software, version 12.0 (SPSS, Chicago, IL). The Student unpaired ttest was used to analyse continuous variables, and the Chi-square test and Fisher exact test for categorical variables, when appropriate. A p-value of < 0.05 was considered statistically significant. RESULTS: Ten patients underwent TLH, and were compared with 22 women who underwent VH. There was no statistically significant difference between groups in uterine weight, estimated blood loss, postoperative analgesic requirement, or length of hospitalization. Total laparoscopic hysterectomy took significantly longer to perform (209.9 vs 145.6 minutes, p = 0.004). One patient in the TLH group had to be brought back to the operating theatre after three months because of bowel prolapse secondary to vault dehiscence. With the exception of one case of bladder injury in the VH group, there were no significant differences between the groups in terms of intraoperative and postoperative complications. CONCLUSION: Total laparoscopic hysterectomy, notwithstanding its learning curve, is as safe as VH. However, TLH was associated with a significantly longer operative time.

Respuesta sexual en mujeres posmenopáusicas / Sexual response in postmenopausal women

Comparar la respuesta sexual en mujeres posmenopáusicas según el tipo de menopausia presentada. Se estudiaron 120 pacientes divididas en dos grupos pareados, las cuales fueron valoradas mediante un cuestionario de 46 ítems a través de una escala de Lickert, validado mediante el juicio de expertos y el coeficiente Alfa-Cronbach (0.94). Maternidad Dr. Armando Castillo Plaza, Maracaibo. Durante la excitación, sus indicadores en las menopáusicas naturales se ubicaron en las categorías alta o moderada; mientras que en las histerectomizadas en moderada o baja. En el orgasmo, los indicadores analizados se encontraron en iguales categorías, salvo el indicador tipos de estimulación que resultó alto en las que presentaron menopausia natural y bajo en las quirúrgicas. Por su parte, en las fases de meseta y resolución los indicadores se mostraron en categorías similares. Existen diferencias significativas en las fases de excitación y orgasmo entre ambos grupos, reflejando en las mujeres que tuvieron una menopausia natural bienestar sexual, vida placentera y salud

To compare the sexual response in postmenopausal women according with the menopause type showed. One thousand twenty patients were studied, divided into two matched groups, which were assessed through a questionnaire comprising 46 items through a Lickert´s scale, validated by expert opinion and the Cronbach alpha coefficient (0.94). “Dr. Armando Castillo Plaza” Maternity Center, Maracaibo. During the arousal phase, all indicators were located in the high or moderate category in natural menopausal, while in the hysterectomized women were moderate or low. In the orgasm phase, analyzed indicators were in same categories, although stimulation type in natural menopausal women was high and low in the hysterectomized. Meanwhile, in plateau and resolution phases, the indicators were showed in similar categories. There are significant differences in arousal and orgasm phases between the two groups reflecting in the natural menopausal sexual wellness, pleasant life and health

Histerectomía vaginal en pacientes sin prolapso uterino / Vaginal hysterectomy in patients with uterus prolapse

INTRODUCCIÓN. En la literatura médica se cita la nuliparidad, la existencia de operaciones anteriores y el tamaño del útero como factores excluyentes a la hora de elegir la técnica de histerectomía. El objetivo de la investigación fue determinar la eficacia y factibilidad de la histerectomía vaginal por la técnica de Heaney, practicada en pacientes sin prolapso uterino, incluso en presencia de los factores antes mencionados. MÉTODOS. Se realizó un estudio observacional descriptivo multivariado, en una muestra de 1 000 pacientes operadas en el servicio de Cirugía General del Hospital Universitario«Martín Chang Puga, en Nuevitas (Camagüey), entre mayo del 1994 y diciembre del 2006. Se diseñó una base datos en Excel, que se importó al paquete estadístico profesional SPSS, con el que se realizaron análisis univariados, bivariados y multivariados, que finalmente se representaron en tablas de frecuencias y porcentajes. Se utilizó una significación de p = 0,05. RESULTADOS. El 6 por ciento de las pacientes eran nulíparas y el 23,5 por ciento tenían cirugías previas en la pelvis. Un 82,6 por ciento de las pacientes tenían úteros que no sobrepasaban un valor aproximado de 12 semanas de gestación, y el fibroma uterino fue el motivo principal (88,5 por ciento) de la intervención. Solamente un 4,1 por ciento de las pacientes necesitó transfusión sanguínea. Las complicaciones peri- y posoperatorias ocuparon el 1,7 por ciento y el 10,3 por ciento respectivamente. El 97,2 por ciento de las pacientes estuvo menos de 48 h en el hospital y el 99,4 por ciento se reincorporó antes de los 30 días. CONCLUSIONES. Se desestiman la nuliparidad, el tamaño del útero y las operaciones anteriores como factores aislados y excluyentes para la vía vaginal. No obstante, el tipo de histerectomía dependerá de la decisión tomada en conjunto por la paciente y su médico tratante, según los costos y beneficios que implique en cada caso(AU)

INTRODUCTION. In the medical literature is quoted the nulliparity, the existence of previous operations and the uterus size as exclusion factors to choice the hysterectomy technique. The aim of present research was to determine the effectiveness and feasibility of vaginal hysterectomy by Heaney's technique, carried out in patients without uterus prolapse even in presence of the above mentioned factors. METHODS. A multivariate, descriptive and observational study was conducted in a sample including 1 000 patients operated on in the General Surgery service of the Martín Chang Puga University Hospital in Nuevitas municipality (Camagüey province, between May, 1994 and December, 2006. A database was designed in Excel transferred to SPSS professional statistical package to carry out univaried, bivaried and multivariate analyses, which finally were represented in frequency and percentages tables. A significance of p = 0.05 was used. RESULTS. The 6 percent of patients were nulliparous and the 23,5 percent had previous surgeries of pelvis. A 82,6 percent of patients had uteri with no more than an approximate value of 12 weeks of pregnancy and the uterine fibroma was the leading cause (88,5 percent) of intervention. Only a 4,1 percent of patients need blood transfusion. The perioperative and postoperative complications accounted for the 1,7 percent and the 19,3 percent, respectively. The 97,2 percent of patients stayed less than 48 hours in the hospital and the 99,4 percent go back to normal life. CONCLUSIONS. The nulliparity, the uterus size and the previous operations were not considered like isolated and excluding factors for the vaginal route. However, the type of hysterectomy will depends of the decision of the attending physician and the patient, according the costs and benefits involved in each case(AU)

Histerectomía radical vaginal en cáncer cérvicouterino de estadio precoz / Radical vaginal hysterectomy in early stage cervical cancer

Objetivo: Comunicar una técnica mínimamente invasiva para el manejo quirúrgico del cáncer cérvicouterino en estadio precoz y sus resultados. Método: 40 pacientes con cáncer cérvicouterino en estadios IA2 y IB1 operadas en un período de 2,5 años. Se les efectúa linfadenectomía pelviana sistemática laparoscópica seguidas de histerectomía vaginal radical, excepto aquellas pacientes que tienen compromiso ganglionar detectado en biopsia contemporánea. Resultados: 40 pacientes son sometidas a esta técnica. Cuatro pacientes son abortadas de su cirugía, 3 por presentar ganglios positivos para carcinoma en biopsia contemporánea y 1 por tener un extenso compromiso cervical al momento de efectuar la histerectomía vaginal radical. Los 36 casos restantes tienen una edad promedio de 43,9 años, ninguna nulípara y 8 tienen el antecedente de cesárea. El IMC promedio fue de 30,49 y 14 conizadas previas. El tiempo operatorio promedio fue de 238 minutos. La estadía postoperatoria promedio fue de 2,9 días. El sangrado estimado fue de 139 cc y ninguna paciente requirió transfusión. Se conservan los anexos en 13 pacientes y en todas se suspenden por vía laparoscópica. El promedio de ganglios obtenidos fue de 30. Cuatro pacientes sufren lesión vesical, 1 fístula vesicovaginal y 3 disfunciones vesicales. Conclusión: El cáncer cérvicouterino en estadio precoz es factible de ser tratado con esta técnica y brinda las ventajas de la cirugía laparoscópica y vaginal con mínimas complicaciones.

Objective: To communicate a minimally invasive technique for surgical handling of early stage cervical cancer and its results. Methods: 40 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 2.5 years, are presented. Laparoscopic systemic pelvic lymphadenectomy with posterior radical vaginal hysterectomy was performed, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: 40 patients were submitted to this technique. 4 patients had their surgery aborted: 3 presented positive nodes for carcinoma in contemporary biopsy and 1 had extensive cervical compromise when performing radical vaginal hysterectomy. Analysis of the remaining 36 cases shows an average age of 43.9 years, all of them had given birth before, 8 of them through Cs-section. BMI averaged 30.49 and 14 had had cone surgery performed previously. Average duration of surgery was of 238 minutes. Postoperative hospitalization averaged 2.9 days. Bleeding volume was estimated at 139 cc and no patient required blood transfusion. 13 uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 30 nodes were obtained. 4 patients suffered bladder injury, one had vesicovaginal fistula and there were 3 bladder dysfunctions. Conclusion: The early stage cervical cancer is likely to be treated with this technique and provides de benefits of laparoscopic and vaginal surgery with minimal complications.

Complicaciones peri-operatorias en histerectomía abdominal, laparoscópica y vaginal / Perioperative complications in abdominal hysterectomy, laparoscopic and vaginal

Estudio descriptivo, restrospectivo en el que se revisaron 442 expedientes de pacientes operadas de histerectomía simple (230 vaginales, 43 laparoscópicas y 169 abdominales) durante el 2007 y 2008 en el Servicio de Ginecología, Departamento de Gineco-obstetricia, Hospital General Doctor Juan José Arévalo Bermejo, Instituto Guatemalteco de Seguridad Social. Se recolectaron datos, sobre método de histerectomía, antecedentes quirúrgicos, volumen uterino, experiencia del cirujano y presencia o no de complicaciones...

Histerectomía por patología benigna: ¿abordaje vaginal, laparoscópico o abdominal? ¿una decisión basada en evidencia? situación actual en Guatemala / Pathology hysterectomy: vaginal approach, laparoscopic or abdominal? A decision based on evidence? current situation in Guatemala

Mucho se ha publicado alrededor del mundo sobre medicina basada en evidencia. Se invita al médico a utilizar la evidencia científica como base para la toma de sus decisiones. Pero, ¿Se está llevando a la práctica clínica toda la evidencia científica? ¿Los objetivos educacionales de los hospitales escuela están apegados a la medicina basada en evidencia?. No existe duda que la histerectomía vaginal es la vía menos invasiva de extirpar el útero, la de recuperación más rápida, con menos morbilidad y la más costo-efectiva...

Prevención del prolapso genital en histerectomía abdominal utilizando los ligamentos redondos: experiencia personal / Prevention of genital prolapse in abdominal hysterectomy using the round ligaments: personal experience

Prevenir el prolapso de la cúpula vaginal, empleando una técnica peroperatoria que consiste en fijar la cúpula vaginal a los ligamentos redondos, en el momento de realizar la intervención. Realizada la histerectomía, se procedió al cierre de la cúpula vaginal con puntos separados en número de 6 a 8 con material no absorbible, dependiendo de la amplitud de la vagina. Los cabos distales son utilizados para anudar horizontalmente los ligamentos redondos. La fijación de las dos paredes del extremo superior de la vagina, garantiza mayor estabilidad de la vagina y menor posibilidad de producir el prolapso de la cúpula y/o de las paredes anterior y posterior de la vagina. Servicio de Ginecología, Hospital Universitario de Caracas. Las 124 pacientes histerectomizadas y controladas anualmente en un lapso entre 2 y 27 años, con un promedio de 7 años, ninguna de ellas presentó prolapso de cúpula vaginal. Las histerectomías se realizaron en el ejercicio privado. En centros asistenciales públicos, es muy difícil hacer seguimiento y evaluar las pacientes, por razones múltiples. La histerectomía ocupa el primer lugar de las intervenciones ginecológicas, esto obliga a realizar la suspensión y fijación de la cúpula vaginal y simultáneamente corregir la patología asociada del aparato genital. El procedimiento que hemos empleado tuvo resultados muy favorables. La calidad de vida de las mujeres intervenidas quirúrgicamente no se desmejoró, como suele suceder cuando se produce el prolapso de la cúpula vaginal

To prevent vaginal vault prolapse, using a preoperative technique to fix the vaginal vault to the round ligaments in total abdominal hysterectomy, and identify associated pathology in the genital area. After hysterectomy, we proceed to the closure of the vaginal vault with interrupted sutures with non-absorbable material, in number of 6-8, depending of the amplitude of the vagina, the distal ends are used to tie horizontally bilateral round ligaments. The setting of the two upper walls of the vagina, ensures greater stability of the vagina and lower possibility of occurrence of prolapse of the dome and/or the anterior and posterior vaginal walls. Servicio de Ginecologia, Hospital Universitario de Caracas The 124 patients undergoing hysterectomy, checked annually over a period of time between 2 and 27 years, with an average of 7 years, neither had vaginal prolapse. Histerectomy is the firstone gynecological operation. It requires making the suspension and fixation of the vaginal vault and simultaneously correct the genital tract associated pathology. The procedure we used had very favorable results. We can not compare our results with other techniques, do to scarse national an international references. The quality of life of women surgically intervened did not deteriorated, as usually happens when there is prolapse of the vaginal vault

Histerectomía de alta complejidad I (vaginal: útero de un Kilo) Presentación de dos casos / I highly complex hysterectomy (vaginal: uterus of a Kilo) Presentation of two cases

La histerectomía laparoscópica se ha convertido en una alternativa a la histerectomía abdominal. Varios estudios han demostrado la viabilidad y seguridad de la histerectomía laparoscópica en úteros de gran tamaño. Aunque existen limitantes para la laparoscopía en estos casos, las mismas pueden ser superadas modificando la colocación habitual de los puertos y reacomodando la técnica habitual...

Histerectomía de alta complejidad II (laparoscopía total: útero de uno y dos kilos) Presentación de dos casos / Highly complex II hysterectomy (laparoscopy total: uterus of one and two kilos) Presentation of two cases

La histerectomía laparoscópica se ha convertido en una alternativa a la histerectomía abdominal. Varios estudios han demostrado la viabilidad y seguridad de la histerectomía laparoscópica en úteros de gran tamaño. Aunque existen limitantes para la laparoscopía en estos casos, las mismas pueden ser superadas modificando la colocación habitual de los puertos y reacomodando la técnica habitual. Una vez resecada la pieza quirúrgica, su extracción puede presentar un desafío importante...

Validez de la prueba de histerectomía vaginal en pacientes con indicación de vía abdominal mandatoria / Validity of test of vaginal hysterectomy in patients with indication of abdominal hysterectomy

Objetivo: Evaluar la histerectomía vaginal en la resolución de patología uterina benigna, en casos que habitualmente se resuelven por histerectomía abdominal. Método: Estudio prospectivo en 68 pacientes sometidas a histerectomía vaginal en el Servicio de Ginecología del Hospital Claudio Vicuña, de San Antonio, entre junio de 2003 a junio de 2009. Son pacientes sin partos vaginales, algunas nuligestas, la mayoría con cicatrices de cesárea o historia de cirugía pélvica previa. Se separan en dos grupos, uno de dificultad moderada (DM) (útero móvil, vagina >2 dedos de diámetro, fondos de saco bien conformados) y otro de dificultad severa (DS) (útero fijo, vagina <2 dedos, o fondos de saco planos). Resultados: No hubo diferencias significativas en edad, número de cesáreas previas, número de cirugías pélvicas previas, tamaño uterino al examen físico, porcentajes de lesión vesical iatrogénica, ni conversión abdominal entre ambos grupos de pacientes. Hubo diferencias significativas en mayor tiempo operatorio y necesidad de morcelación para el grupo DS. Se destaca la ausencia de complicaciones mayores y menores en más del 93 por ciento de las pacientes. Conclusión: Nuestros resultados desmitifican las objeciones a la vía vaginal, incluso en pacientes definidas de dificultad extrema.

Objective: To assess vaginal hysterectomy in benign uterine pathology resolution in cases who are usually resolved by abdominal hysterectomy. Method: We studied, prospectively, 68 patients that were operated by vaginal hysterectomy between june 2003 to june 2009 in the Gynecology Service at Claudio Vicuña Hospital, San Antonio. Most of the patients have history of prior cesarean section or pelvic surgery, but no one has had vaginal deliveries, inclusive, some of them, have no history of previous pregnancies. The patients were separated into two groups, moderate difficulty (MD): composed by patients with uterus conserved motility, vagina >2 fingers diameter, well conserved cul de sac, and severe difficulty (SD): composed by patients with none uterine motility, vagina <2 fingers diameter or fat cul de sac. Results: We did not observed statistically signifcant differences in age, number of prior cesarean sections or pelvic surgeries, estimated uterine size, bladder injury, nor abdominal conversion, but there was significant differences in operative time and need of morcelation, being greater in SD patients. It is important to notice the absent of major and minor complications in 93 percent of the patients. Conclusion: Our results are meant to demystify the objections for vaginal route, including the patients with extreme difficulty.