RESUMEN
OBJECTIVE: To compare the effects of electrical bipolar vessel sealing and conventional suturing on postoperative pain, recovery, costs and micturition symptoms in women undergoing vaginal hysterectomy. DESIGN: Randomised controlled trial. SETTING: Eight teaching hospitals in the Netherlands. POPULATION: One hundred women scheduled to undergo vaginal hysterectomy for benign conditions excluding pelvic organ prolapse. METHODS: Women were randomised to vessel sealing or conventional surgery. The quality of life related to pelvic floor function was assessed using validated questionnaires before surgery and 6 months after surgery. Pain scores and recovery were assessed using a diary, including daily visual analogue scale scores, starting from the day before surgery until 6 weeks after surgery. MAIN OUTCOME MEASURES: Visual analogue scale pain scores, surgery time, blood loss, complications, quality of life related to pelvic floor function and costs. RESULTS: The evening after surgery, women in the vessel-sealing group reported significantly less pain (5.7 versus 4.5 on a scale of 0-10, P = 0.03), but after that pain scores were similar. Operation duration was shorter for vessel sealing (60 versus 71 minutes, P = 0.05). Blood loss and hospital stay did not differ. We observed no major difference in costs between the two interventions (2903 versus 3102 , P = 0.26). Changes in micturition and defecation symptoms were not affected by the surgical technique used. CONCLUSION: Using vessel sealing during vaginal hysterectomy resulted in less pain on the first postoperative day, shorter operating time, similar morbidity and similar pelvic floor function. No major differences in costs were found between the two interventions.
Asunto(s)
Electrocirugia , Histerectomía Vaginal/métodos , Dolor Postoperatorio/prevención & control , Técnicas de Sutura , Adulto , Anciano , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Constricción , Electrocirugia/economía , Femenino , Costos de Hospital , Humanos , Histerectomía Vaginal/economía , Análisis de Intención de Tratar , Tiempo de Internación/estadística & datos numéricos , Persona de Mediana Edad , Países Bajos , Tempo Operativo , Dimensión del Dolor , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiología , Trastornos del Suelo Pélvico/epidemiología , Trastornos del Suelo Pélvico/etiología , Trastornos del Suelo Pélvico/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Calidad de Vida , Encuestas y Cuestionarios , Técnicas de Sutura/economía , Resultado del Tratamiento , Trastornos Urinarios/epidemiología , Trastornos Urinarios/etiología , Trastornos Urinarios/prevención & controlRESUMEN
The incidence of relaxation of the pelvic floor increases with age, and although a relation between prolapse and the decline of estrogens has been suggested, there is no objective evidence. Together with urodynamic measurements, anal manometry is one of the few ways of making an objective assessment of the strength of pelvic structures located in and near the pelvic floor. In order to study the role of estrogens, anal manometry was performed before, during and after estrogen replacement therapy with daily oral use of 0.625 mg conjugated estrogens for 6 months. Five postmenopausal women, who had not used estrogen replacement therapy in the past, were included in the study. None of the manometric parameters, including maximal anal resting pressure, maximal squeeze pressure and internal anal sphincter response, changed. It was concluded that estrogens have no effects on manometric parameters of the external sphincter and that anal manometry may not be the appropriate method to assess the effects of estrogens on the pelvic floor.
