Sample records for abdominal supracervical hysterectomies

  1. Robotic Trachelectomy After Supracervical Hysterectomy for Benign Gynecologic Disease

    Aoun, Joelle; Hanna, Rabbie; Papalekas, Eleni; Schiff, Lauren; Theoharis, Evan; Eisenstein, David


    Background and Objectives: A renewed interest in the supra cervical approach to hysterectomy has created a cohort of patients with a retained cervix at risk of persistent symptoms requiring a subsequent trachelectomy. The objective of this study was to evaluate the efficacy of robotic trachelectomy after a previous supracervical hysterectomy. Methods: This is a retrospective chart review of women who had robotic trachelectomy after supracervical hysterectomy for benign gynecologic disease from January 2009 through October 2014. Results: Eleven patients underwent robotic trachelectomy for benign conditions during the observed period. Prior supracervical hysterectomy had been performed for pelvic pain (8/11, 73%), abnormal uterine bleeding (7/11, 64%), and dysmenorrhea (5/11, 45%). In 10 of 11 patients, the symptoms leading to robotic trachelectomy were the same as those leading to supracervical hysterectomy. The time from hysterectomy to recurrence of symptoms ranged from 0.5 to 26 months (median, 6), whereas the time interval from previous surgery to robotic trachelectomy ranged from 1 to 57 months (median, 26). Mean age and body mass index at robotic trachelectomy were 42 ± 5.4 years and 32 ± 6.1 kg/m2. Mean length of surgery was 218 ± 88 minutes (range, 100–405). There was 1 major postoperative complication involving bladder perforation and subsequent vesicovaginal fistula (VVF). Endometriosis was seen in 27% of pathologic specimens and cervicitis in another 27%; 45% showed normal tissue histology. In 6 (55%) cases, symptoms leading to trachelectomy resolved completely after surgery, and the other 5 (45%) patients reported a significant improvement. Conclusions: Although trachelectomy can be a challenging surgery, our experience suggests that the robotic approach may be a valuable means of achieving safe and reproducible outcomes. PMID:27493470

  2. Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy

    Andersen, Lea Laird; Møller, Lars Mikael Alling; Gimbel, Helga


    INTRODUCTION AND HYPOTHESIS: Lower urinary tract symptoms (LUTS) are common after hysterectomy and increase after menopause. We aimed to compare subtotal with total abdominal hysterectomy regarding LUTS, including urinary incontinence (UI) subtypes, 14 years after hysterectomy. Main results from ...

  3. Total Laparoscopic Hysterectomy Compared with Abdominal Hysterectomy; Clinical Outcomes

    Cem Celik


    Full Text Available Aim: The purpose of this study was to confirm the positive intraoperative and postoperative outcomes of total laparoscopic hysterectomy (TLH and total abdominal hysterectomy (TAH. Material and Method: We presented surgical procedures performed at Namik Kemal University Faculty of Medicine, Department of Obstetrics and Gynecology between September 2010 and December 2012, 47 patients who underwent TLH and 30 patients who underwent TAH  were included in the present study. Results: Operating time in TLH group was significantly longer than in the TAH group (202.56±61.53 vs 138.06±40.52 min. There were no significant differences between the two groups regarding complications, conversion to laparotomy, intraoperative bleeding. We observed no differences in reoperation and transfusion rates between the two groups. Duration of hospital stay was statistically shorter in TLH group compared to the TAH group (3.93±0.70 vs 5.26±1.63 day. Discussion: Laparoscopic hysterectomy, compared to laparotomy regarding equal outcomes and lower perioperative morbidity, improvement of quality of life, shorter hospital stay and faster return to activity.

  4. Parasitic myoma after supracervical laparoscopic histerectomy

    Maurício Paulo Angelo Mieli


    Full Text Available Parasitic myoma is a condition defined as a myoma of extrauterine nourishing. It may occur spontaneously or as a consequence of surgical iatrogeny, after myomectomy or videolaparoscopic supracervical hysterectomy, due to remaining residues of uterine tissue fragments in the pelvic cavity after morcellation. The authors describe two cases in which the patients were submitted to videolaparoscopic supracervical hysterectomy and uterine body removal through morcellation. The sites of development of the parasitic myomas were next to the cervix stump in Case 1, and next to the right round ligament in Case 2. These parasitic myomas were removed by videolaparoscopy. After myomectomies or videolaparoscopic supracervical hysterectomies followed by uterine fragments removal from the pelvic cavity through morcellation, meticulous searching for residues or fragments of uterine tissue is mandatory to prevent the occurrence of parasitic myomas.

  5. Early Feeding After a Total Abdominal Hysterectomy

    Mary Flesher


    Full Text Available Background: Oral fluids and food are traditionally introduced slowly after total abdominal hysterectomy (TAH. This descriptive study examined the effect and tolerance of early oral intake following this surgery. Methods: A retrospective chart review was conducted on 164 patients who had been on a clinical pathway following TAH. Comparisons in initiation of fluids and foods, and gastrointestinal effects were made between the early fed group (n=82 and the traditionally fed group (n=82. Results: Both groups had the similar gastrointestinal symptoms postoperatively, but the early fed group had an earlier bowel movement. The early fed group had a statistically significant shorter length of stay. Similar usage of anti-nausea medication and pain medication usage was noted between the two groups, except for a lower usage of Tylenol #3 (acetaminophen with codeine in the early fed group. Conclusions: This study found that early feeding could be tolerated well in TAH patients, with statistically significant improvements in usage of some pain medication and length of stay were noted in the early fed group.

  6. Experience with irrigation analgesia after abdominal hysterectomy

    R. V. Garyaev


    Full Text Available A prospective randomized clinical trial was performed in 100 patients who underwent abdominal hysterectomy under endotracheal anesthesia based on sevoflurane and fentanyl. Intraoperatively, ketorolac 30 mg was administered intramuscularly after induction of anesthesia and paracetamol 1 g was injected intravenously 30–40 minutes prior to surgical termination in a control group (n = 25. For postoperative anal- gesia, promedol, tramadol, and ketorolac were used intramuscularly and paracetamol was given intravenously. Three study groups (n = 2 in each differed from the control group in that during wound suturing a multiperforated catheter was placed above the peritoneum over a length of 15 cm, through which a 10-ml bolus of 0.75 % ropivacaine was first administered, followed by continuous infusion of 0.2 % ropivacaine at a rate of 8 ml/hour for 36 hours. In one irrigation group, ketorolac 30 mg was injected intramuscularly t.i.d. for 2 days; in another group, the agent was added to a ropivacaine solution calculated with reference to 180 mg for 2 days; in the third group, ketoprofen 100 mg instead of ketorolac was used b.i.d. for 2 days. Pain level (by digital rating scale, 0–10 and the need for analgesics were measured. There was no sta- tistical significant difference in the level of pain and the need for analgesics between the wound irrigation and control groups.

  7. Laparoscopic hysterectomy with morcellation versus abdominal hysterectomy for presumed fibroids in premenopausal women: a decision analysis

    SIEDHOFF, Matthew T.; WHEELER, Stephanie B.; RUTSTEIN, Sarah E.; GELLER, Elizabeth J.; DOLL, Kemi M.; WU, Jennifer M.; CLARKE-PEARSON, Daniel L.


    Objective To model outcomes in laparoscopic hysterectomy with morcellation compared to abdominal hysterectomy for the presumed fibroid uterus, examining short-and long-term complications, as well as mortality. Study Design A decision tree was constructed to compare outcomes for a hypothetical cohort of 100,000 premenopausal women undergoing hysterectomy for presumed fibroids over a 5-year time horizon. Parameter and quality of life utility estimates were determined from published literature for postoperative complications, leiomyosarcoma incidence, death related to leiomyomsarcoma, and procedure-related death. Results The decision analysis predicted fewer overall deaths with laparoscopic hysterectomy compared to abdominal hysterectomy (98 vs. 103 per 100,000). While there were more deaths from leiomyosarcoma following laparoscopic hysterectomy (86 vs. 71 per 100,000), there were more hysterectomy-related deaths with abdominal hysterectomy (32 vs. 12 per 100,000). The laparoscopic group had lower rates of transfusion (2,400 vs. 4,700 per 100,000), wound infection (1,500 vs 6,300 per 100,000), venous thromboembolism (690 vs. 840 per 100,000) and incisional hernia (710 vs. 8,800 per 100,000), but a higher rate of vaginal cuff dehiscence (640 vs. 290 per 100,000). Laparoscopic hysterectomy resulted in more quality-adjusted life years (499,171 vs. 490,711 over five years). Conclusion The risk of leiomyosarcoma morcellation is balanced by procedure-related complications associated with laparotomy, including death. This analysis provides patients and surgeons with estimates of risk and benefit, upon which patient-centered decisions can be made. PMID:25817518

  8. Abdominal versus vaginal hysterectomy in non-descent cases

    Kavitha Gayak


    Full Text Available Background: Hysterectomy is the most frequently performed elective major operation in gynaecology by vaginal and abdominal route. Gynaecologic surgeons worldwide said that two are not competitive procedures but each one has its own place in the operative armamentarium. Present study is done to comparative risks of complications in abdominal route versus vaginal route of hysterectomy in intra operative and post-operative periods. Methods: It's a retrospective study was done from Dec 2013 - Dec 2014 for a period of one year in 82 women who had undergone hysterectomy, divided as group A with abdominal hysterectomies (44 cases and group B with vaginal hysterectomies (38. Information on the indications, operative procedures, and complications were noted and analyzed. Results: Intra-operative blood loss, mean operating time was more in group A than in group B. The mean duration of surgery in group B was 76 +/- 12 min and that of group B was 101 +/- 14 min. The mean blood loss was also more in case of group A than that of group B (219 ml vs. 172 ml. Bladder injury occurred in 1 case in group B (3% and in 3 cases in group B (7%. Ureter injury occurred in 1 (2% case in group A. Postoperative fever (20% and 8%, UTI (13% and 11% and wound infection (10%, 0%. Only one patient underwent relaparotomy for internal bleeding via abdominal route was more common in group A as compared to group B. Only one patient underwent re-laparotomy for internal bleeding via abdominal route. Conclusions: Study results conclude that patients requiring hysterectomy for benign non prolapse cases be offered the option of vaginal route which is quicker recovery, early mobilization, shorter hospitalization, less operative and post-operative morbidity, more economical and effective. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 419-423

  9. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    Carney, John


    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  10. Total abdominal hysterectomy versus minimal-invasive hysterectomy: a systemic review and meta-analysis

    INTRODUCTION. At the present time three types of hysterectomies are used: the vaginal hysterectomy and the minimal-invasive hysterectomy (MIH). The objective of present research was to compare the MIH and the total abdominal hysterectomy (TAH) in women presenting with benign uterine diseases. METHODS. A systemic review was made and a meta-analysis from the following databases: MEDLINE, EBSCO HOST AND The Cochrane Central Register of Controlled Trials. Only the controlled and randomized studies were selected. The data of all studies were combined and also the relative risk (RR) with a 95% CI was used with the Mantel-Haenszel method as an effect measure for dichotomy variables. For the analysis of continuing variables the mean difference was used. In all the comparisons performed the results were obtained with the fix effect and randomized forms. RESULTS. A total of 53 transoperative complications were registered in the MIH hysterectomy versus 17 in the TAH group (RR: 1,78; 95% CI: 1,04-3.05). Postoperative complications evolved in a similar way in both groups without significant differences from the statistical point of view. The blood losses, the hospital stay and the patient's reincorporation to usual and work activities were lesser in the laparoscopy group; however, the operative time is higher when it is compared with TAH (mean difference: 37,36; 95% CI: 34,36-39,93). CONCLUSIONS. Both techniques have advantages and disadvantages. The indication of MIH must to be individualized according to the clinical situation of each patient and these not to be performed in those centers without a properly trained surgical staff and with experience in advanced minimal invasive surgery. (author)

  11. Radical Hysterectomy and Total Abdominal Vaginectomy for Primary Vaginal Cancer.

    Ozgul, Nejat; Basaran, Derman; Boyraz, Gokhan; Salman, Coskun; Yuce, Kunter


    The aim of this surgical video is to demonstrate en bloc radical removal of uterus and vagina in a patient with clinical early-stage vaginal cancer. Surgical treatment was offered to our patient for clinical early-stage primary vaginal cancer. An en bloc radical hysterectomy, systematic pelvic lymphadenectomy, and total abdominal vaginectomy were performed. Postoperative adjuvant radiation or chemotherapy was not recommended for completely resected pathologic stage I disease with no lymph node involvement and negative surgical margins. Radical surgery can be a treatment option for selected patients with primary vaginal cancer. PMID:26825828

  12. Ovarian function and ovarian blood supply following premenopausal abdominal hysterectomy

    Abdelrazak, Khaled M.; Elbiaa, Assem A.M.; Farghali, Mohamed M.; Essam, Amr; Zhurabekova, Gulmira


    Introduction The issue of conserving the ovaries at hysterectomy in premenopausal women with benign gynecologic disease has been the subject of considerable controversy. Some clinicians prefer prophylactic oophorectomy in premenopausal women during hysterectomy to prevent future development of malignant changes in conserved ovaries. Other clinicians prefer to conserve apparently normal ovaries, because bilateral oophorectomy in premenopausal women results in an abrupt imbalance, sudden onset of menopausal symptoms, decreased libido, increased cardiovascular risk and osteoporosis. Material and methods Two hundred and twenty multipara women (who had completed their families), with benign uterine pathology were included in this prospective study for abdominal hysterectomy with bilateral ovarian preservation. Pre-operative vaginal ultrasound, Doppler studies, diagnostic hysteroscopy and endometrial biopsy were done followed by laboratory studies including Anti-mullerian hormone (AMH), follicle stimulating hormone (FSH) and estradiol for all studied women. Doppler studies, AMH, FSH and estradiol were repeated 6 and 12 months post-operative for assessment of the ovarian function and ovarian blood supply after hysterectomy. Results Pre-operative AMH, FSH and estradiol of the studied women were statistically insignificant compared to AMH, FSH and estradiol 6 and 12 months post-operative. Twelve months post-operative right and left ovarian volumes (6.92 ± 0.18 and 6.85 ± 0.19 cm3, respectively) were significantly larger than pre-operative right and left ovarian volumes (6.19 ± 0.22 and 5.86 ± 0.23 cm3, respectively), and, 12 months post-operative right and left ovarian pulsatility indices (2.92 ± 0.15 and 2.96 ± 0.16 cm/s, respectively) were significantly lower than pre-operative right and left ovarian pulsatility indices (3.45 ± 0.19 and 3.36 ± 0.2 cm/s, respectively). Eight (3.6%) cases of the studied women developed an ovarian cyst 6 months after hysterectomy, 3

  13. Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence

    Andersen, Lea L; Alling Møller, Lars M; Gimbel, Helga M


    OBJECTIVE: To compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases. STUDY DESIGN: Long-term follow-up of a randomized clinical trial of subtotal vs. total......, total: 100), the PFDI-20 questionnaire was answered by 140 (46.1%) (subtotal: 68, total: 72). We found no difference between subtotal and total abdominal hysterectomy in the PFDI-20 scores or regarding objectively assessed urinary incontinence or pelvic organ prolapse. In the subtotal hysterectomy group...... (443ml) (P=0.0147) according to the voiding diary. CONCLUSION: Subtotal and total abdominal hysterectomy are comparable regarding long-term objective pelvic organ prolapse and urinary incontinence. The subtotal hysterectomy group had a higher Qmax and voided volume....

  14. Advantages of nerve-sparing intrastromal total abdominal hysterectomy

    Samimi D


    Full Text Available Daryoosh Samimi,1 Afdal Allam,2 Robert Devereaux,2 William Han,2 Mark Monroe21Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 2Department of Obstetrics and Gynecology, Fountain Valley Regional Hospital, Fountain Valley, CA, USABackground: The purpose of the prospective study was to evaluate the effect of the nerve-sparing intrastromal abdominal hysterectomy bilateral salpingo-oophorectomy (ISTAH-BSO on intraoperative, and postoperative complications namely blood loss and length of hospital stay.Methods: Forty female patients were allocated by a block randomization method into a study group and a control group. The study group consisted of 20 patients who underwent ISTAH-BSO over a 2-year period. The control group included 20 patients who underwent conventional hysterectomy by the same surgeon during the same time frame. Both groups were followed for outcomes of interest, which included length of hospital stay, blood loss, and surgical complications. The participants in both groups were as similar as possible with respect to all known or unknown factors that might affect the study outcome.Results: Postoperative hemoglobin levels were higher in the study group (blood loss 1.0 g/dL versus 1.4 g/dL in control group. Average hospital stay was significantly shorter in the study group (2.7 days versus 3.15 days in the control group, P = 0.028. No significant complications such as urinary fistula, vaginal vault prolapse, blood transfusion, or postoperative infections were identified in the study group.Conclusion: The nerve-sparing ISTAH-BSO procedure described in this study has the potential to reduce length of hospital stay after abdominal hysterectomy by reducing blood loss and postoperative complications. Follow-up observations suggest that urinary function and sexual satisfaction are also preserved. Since this research, 175 cases have been performed, with an average of 5 years of

  15. Mini laparotomy versus conventional laparotomy for abdominal hysterectomy: A comparative study

    Sharma Jai


    Full Text Available BACKGROUND: Less traumatizing measures for hysterectomies are searched for to improve the recovery from surgery. AIM: Comparison of minilaparotomy abdominal hysterectomy with conventional abdominal hysterectomy in respect to per-operative and post-operative outcome and complications. SETTING AND DESIGN: In a medical college hospital patients undergoing abdominal hysterectomy were enrolled. It was a concomitant comparative study. METHODS AND MATERIAL: We are presenting our comparative data of 100 cases of minilaparotomy abdominal hysterectomy (group I, incision =< 6 cm performed over last 4 years from January 1998 to December 2002 and comparing the outcome with 99 cases of abdominal hysterectomy (group II, incision > 6 cm done by traditional method over the same duration. STATISTICAL ANALYSIS USED: Chi-square and Fischer test with significance of p value being taken at 0.05 were used for categorical data, while student′s t test was used for continuous data. RESULTS: Mean age and parity of patients were similar in the two groups. Incision was transverse in 100% cases in-group I and 22.2% cases in-group II. Estimated blood loss was significantly higher (354 ml in group II in contrast to group I (240 ml. Blood transfusion was also required more commonly (22.2% in-group II than in-group I (9%. Mean operative time was significantly more in-group II (90 minutes than in group I (41 minutes. Mean hospital stay, day of mobility, starting oral diet and days of injectable analgesics required were higher in group II than in group I. Major complications were rare in both the groups, but minor complications were significantly higher in group II (40.4% than in group I (26%. CONCLUSION: Minilaparotomy abdominal hysterectomy appears to be an attractive alternative to traditional abdominal hysterectomy with fewer complications.

  16. Hysterectomy

    ... such as wound infection, bleeding, blood clots, and nerve and tissue damage, than vaginal or laparoscopic hysterectomy. ... hysterectomy, you still may need pelvic exams and cervical cancer screening. Glossary Adhesions: Scarring that binds together ...

  17. Perioperative use of etoricoxib reduces pain and opioid side-effects after total abdominal hysterectomy

    Viscusi, Eugene R; Frenkl, Tara L; Hartrick, Craig T;


    -blind, placebo-controlled, randomized clinical trial, we evaluated postoperative pain following total abdominal hysterectomy over 5 days in patients receiving placebo or etoricoxib administered 90 min prior to surgery and continuing postoperatively. Patients were randomly assigned to receive either placebo (n...

  18. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M;


    AND METHODS: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare......INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...... professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...

  19. Comparison of ramosetron's and ondansetron's preventive anti-emetic effects in highly susceptible patients undergoing abdominal hysterectomy

    Lee, Jae-Woo; Park, Hye Jin; Choi, Juyoun; Park, So Jin; Kang, Hyoseok; Kim, Eu-Gene


    Background This study compared the preventive effects of ramosetron and ondansetron on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing abdominal hysterectomy. Methods In a prospective, randomized, double-blinded study, a total of 120 highly susceptible women (nonsmokers, those receiving opioid-based IV patient-controlled analgesia [PCA]) undergoing abdominal hysterectomy were included in the study. Patients were divided into 2 groups and each group received ...

  20. Impact of stress coping capacity on recovery from abdominal hysterectomy in a fast-track programme: a prospective longitudinal study

    Kjölhede, Preben; Borendal Wodlin, Ninnie; Nilsson, Lena; Fredrikson, Mats; Wijma, Klaas


    Objective To evaluate the effect of stress coping capacity in combination with mode of anaesthesia on postoperative recovery in fast-track abdominal hysterectomy. Design Prospective longitudinal study. Setting Five hospitals in the south-east of Sweden. Population A cohort of 162 women undergoing fast-track abdominal hysterectomy for benign conditions. Methods Self-administered questionnaires, the Stress Coping Inventory (SCI) and the Swedish Postoperative Symptom Questionnaire (SPSQ), and cl...

  1. Effect of preoperative flupirtine on postoperative morphine sparing in patients undergoing total abdominal hysterectomy

    Thapa, D; Ahuja, V; C Dass; S Gombar; Huria, A.


    Background: Flupirtine is a unique non-opioid, centrally acting analgesic with muscle relaxant properties. So far no study has evaluated, use of preoperative flupirtine on postoperative morphine sparing effect in patients undergoing total abdominal hysterectomy (TAH). Materials and Methods: We performed a prospective, controlled, and randomized study in 50 female patients of American Society of Anesthesiologists physical status I-II, aged between 30 and 60 years scheduled for TAH under ge...

  2. Analgesic effect of ultrasound-guided transversus abdominis plane block after total abdominal hysterectomy

    Røjskjaer, Jesper O; Gade, Erik; Kiel, Louise B;


    OBJECTIVE: To assess the effect of bilateral ultrasound-guided transversus abdominis plane block with ropivacaine compared with placebo as part of a multimodal analgesic regimen. DESIGN: A randomized, double-blind, placebo-controlled trial following the CONSORT criteria. SETTING: Hvidovre...... ultrasound-guided transversus abdominis plane block in women undergoing total abdominal hysterectomy. As part of a multimodal regimen the transversus abdominis plane block showed some effect on pain scores at rest only in the early postoperative period....

  3. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

    Anju Ghai


    Full Text Available Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.

  4. Clinicohistopathological correlation of hysterectomy in rural India: an observational study

    Kumud Gupta


    Full Text Available Background: Hysterectomy - abdominal or vaginal or laparoscopic assisted, hysterectomy is the most commonly performed elective major gynaecological surgery. Rate of hysterectomy has varied between 6.1 and 8.6/1000 women of all ages. The abdominal removal of the uterus is called and lsquo;total abdominal hysterectomy' while the removal of the uterus by the vaginal route is termed as and lsquo;vaginal hysterectomy'. The supracervical removal of the uterus is termed as and lsquo;subtotal hysterectomy'. As compared to a higher frequency of hysterectomy (10-20% in other countries, a lower rate (4-6% has been reported in India. Methods: The study was conducted in the department of obstetrics and gynaecology National Institute of Medical Sciences (NIMS, Jaipur in 2013-2014. 100 patients were undergoing hysterectomy. The patients were diagnosed on the basis of history, clinical examination and ultrasonography report. Results: In our study, maximum number of clinical diagnosis made, were of DUB (with PID and Prolapse which was 35%. This was followed by leiomyoma i.e. 29%, clinically 29 cases were diagnosed of which 24 were histopathologically proven. Adenomyosis (10%, clinically 10 cases were identified but there were 15 cases histopathologically, this can be due to different clinical presentation. Clinically diagnosed cases of carcinoma endometrium and cervical erosions were 1% and 2% respectively. Overall sensitivity for clinical diagnosis in our study was 52%. The most common histopathological finding was leiomyoma (24%, followed by adenomyosis (15% and chronic cervicitis (15%. Other pathologies include combined adenomyosis and leiomyoma (6%, benign ovarian cyst in four cases. Normal histopathological report was obtained in 32 cases. Maximum correlation (100% was found with cancer cervix, cancer ovary and cancer endometrium. Conclusions: Hysterectomy still remains the widely used modality in developing as well as developed countries. Every

  5. Analgesia postoperatoria con tramadol epidural tras histerectomía abdominal Epidural postoperative analgesia with tramadol after abdominal hysterectomy

    E. González-Pérez


    Full Text Available Introducción: El dolor postoperatorio es un tipo especial de dolor agudo cuyo control inadecuado conduce a reacciones fisiopatológicas anormales. Objetivos: Evaluar la utilidad del tramadol por vía epidural en la analgesia postoperatoria de las pacientes a quienes se les practicó histerectomía abdominal. Material y método: Se estudiaron 90 pacientes que conformaron tres grupos: Grupo I: recibió 100 mg de tramadol epidural cada 6 h. Grupo II: recibió 1,2 g de metamizol por vía intramuscular cada 6 h. Grupo III: recibió 100 mg de tramadol por vía intramuscular cada 6 h. Se evaluó el comportamiento de la presión arterial media y la frecuencia cardíaca. Evaluamos la intensidad del dolor por medio de una Escala Visual Analógica. Fue utilizado metamizol sódico, 2 g endovenoso, como analgesia de rescate. Resultados: Se presentaron variaciones significativas de la frecuencia cardíaca y presión arterial media en el grupo I (P0,05, por lo que sólo 2 pacientes requirieron analgesia de rescate, mientras que el grupo II mostró las mayores variaciones (PIntroduction: Postoperative pain is a special type of acute pain whose inadequate control leads to abnormal reactions. Objectives: To evaluate the utility of tramadol by the epidural route in the postoperative analgesia of patients undergoing abdominal hysterectomy. Material and method: 90 patients studied who conformed three groups: Group I: received 100 mg of epidural tramadol every 6 h. Group II: received 1.2 g of intramuscular metamizol every 6 h. Group III: received 100 mg of intramuscular tramadol every 6 h. Blood pressure and heart rate were measured. Pain intensity was evaluated by a visual analogical scale. Metamizol 2 g was used as rescue analgesia. Results: Significant variations of heart rate and mean blood pressure were found in group I (p < 0.05 whereas in group II and III they were very significant (p < 0.01. The intensity of postoperative pain reached lower values in group I

  6. Patient and Staff (doctors and nurses) Experiences of Abdominal Hysterectomy in Accelerated Recovery Programme

    Wagner, Lis; Carlslund, Anne Mette; Møller, Charlotte;


    Introduction: The accelerated recovery programme (ARP) is becoming commonplace in surgical specialties and has also been introduced to hysterectomy patients. Diagnostic, prognostic and other clinical indicators are well described. The aim of this article is to relay knowledge about the ARP, throu...... for purposes of information relay and dialogue between staff and patients/family members. A nursing care ambulatory unit is recommended to support with information for women prior to and following hysterectomy in the ARP....




    Full Text Available BACKGROUND: Various adjuvants are being used with local anaesthetics in spinal anaesthesia for prolongation of intraoperative and post-operative analgesia. Dexmedetomidine, a highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. AIMS: To evaluate the onset and duration of sensory and motor block, hemodynamic effect, post-operative analgesia and adverse effects of dexmedetomidine given intrathecally with hyperbaric 0.5% bupivacaine. METHODOLOGY: A study was carried out in 30 adult female patients aged 18-55 yrs of ASA grade I and II in each group scheduled for Total abdominal hysterectomy under spinal anaesthesia. Group B received 2.5ml of 0.5% hyperbaric bupivacaine with 0.5ml of normal saline. Group D received 2.5ml of 0.5% hyperbaric bupivacaine with 10µg of dexmedetomidine in 0.5ml of normal saline. The onset time to reach peak sensory and motor level, regression time of sensory and motor block, rescue analgesia, hemodynamic changes and side effects were recorded. STATISTICAL ANALYSIS USED: Data obtained were tabulated and analyzed using statistical package for social science (SPSS 16.0 evaluation version to calculate the sample size. Descriptive data are presented as Mean ± SD and Continuous data are analyzed by unpaired’t’ test. P<0.05 was considered statistically significant. RESULTS: Patients in dexmedetomidine group (group D had a significantly longer sensory and motor block than patients in bupivacaine group (group B. The mean time of sensory regression to S1 was (323 ± 31 min in group D and (191 ± 15min in group B. The regression time of motor block to reach Bromage 0 was (314 ± 30 min in group D and (163 ± 15 min in group B. The time to rescue analgesia was significantly longer in group D (383 ± 38 min as compared to group B (228.6 ± 15 min. CONCLUSION: Intrathecal dexmedetomidine as adjuvant to spinal bupivacaine is associated with prolonged sensory and motor block, hemodynamic stability




    Full Text Available Regional anesthesia is widely used for abdominal hysterectomies. It is divided into spinal and epidural anaesthesia. Epidural anesthesia has got the advantage of extending the period of anesthesia to post-operative analgesia. We can use various pharmacological agents as adjuvants, which prolong the duration of action of local anesthetics. They include opiods, alpha 2 agonists like clonidine and dexmedetomidine. In this we studied the efficacy of local anesthetic agent – ropivacaine alone, ropivacaine with clonidine and ropivacaine with dexmedetomidine for epidural block. Present study showed that Epidural Dexmedetomidine and clonidine have synergistic action in combination with epidural ropivacaine resulting in smooth and prolonged postoperative analgesia and sedation. Group RD (Ropivacaine and Dexmedetomidine had significant difference in comparison of postoperative block characteristics, such as time of two segment regression, time to Bromage scale 1, time of regression to S1 dermatome and time of first epidural top up than group RC and R. (Ropivacaine with clonidine and Ropivacaine alone. Thus epidural dexmedetomidine is a better neuraxial adjuvant in combination with epidural ropivacaine in producing prolonged analgesia and better sedation for abdominal hysterectomy

  9. Total laparoscopic hysterectomy versus abdominal hysterectomy in the treatment of patients with early stage endometrial cancer: A randomized multi center study

    Bergsma-Kadijk Johanna A


    Full Text Available Abstract Background Traditionally standard treatment for patients with early stage endometrial cancer (EC is total abdominal hysterectomy and bilateral salpingo oophorectomy (TAH+BSO with or without lymph node dissection through a vertical midline incision. While TAH is an accepted effective treatment, it is highly invasive, visibly scarring and associated with morbidity. An alternative treatment is the same operation by laparoscopy. Though in several studies total laparoscopic hysterectomy (TLH+ BSO seems a safe and feasible alternative approach in early stage endometrial cancer patients, there are no randomized data available yet. Furthermore, a randomized controlled trial with surgeons trained in laparoscopy is warranted in order to implement this technique in a safe manner. The aim of this study is to compare the treatment related morbidity, cost-effectiveness and quality of life in early stage endometrial cancer patients treated by laparoscopy versus the standard open approach. Methods A multi centre randomized clinical phase 3 trial, including 5 university hospitals and 15 regional hospitals in the Netherlands. Only gynecologists trained in performing a TLH are allowed to participate. Inclusion criteria: Patients with a clinical stage I endometrioid adenocarcinoma or complex atypical hyperplasia are randomized in a 2:1 allocation to receive TLH or TAH. The main outcome measure is the rate of major complications, as assessed by an independent clinical review board. In total, 275 patients are required to have 80% power at α-0.05 to detect a significant difference of 15% complication rate. Secondary outcome measures are 1 costs and cost-effectiveness, 2 minor complications, and 3 quality of life. All data from this multi center study are reported using case record forms. Data regarding quality of life, pain, body Image, sexuality and additional homecare are assessed with self reported questionnaires. Discussion A randomized multi center

  10. The effect of Reiki on pain and anxiety in women with abdominal hysterectomies: a quasi-experimental pilot study.

    Vitale, Anne T; O'Connor, Priscilla C


    The purpose of this pilot study was to compare reports of pain and levels of state anxiety in 2 groups of women after abdominal hysterectomy. A quasi-experimental design was used in which the experimental group (n = 10) received traditional nursing care plus three 30-minute sessions of Reiki, while the control group (n = 12) received traditional nursing care. The results indicated that the experimental group reported less pain and requested fewer analgesics than the control group. Also, the experimental group reported less state anxiety than the control group on discharge at 72 hours postoperation. The authors recommend replication of this study with a similar population, such as women who require nonemergency cesarian section deliveries. PMID:17099413

  11. Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial

    Rasmussen, M L; Dierking, G; Lech, K;


    BACKGROUND: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy. METHODS: One hundred and...... sixteen patients were randomly assigned to either group A (paracetamol+placebo x 2), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). According to randomization and preoperatively, patients received paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or...... placebo. General anaesthesia was performed. Postoperative pain treatment was paracetamol 1000 mg x 4 and patient-controlled intravenous morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain score (visual analogue scale) at rest and during mobilization, nausea, sedation...

  12. Tinidazol versus cefazolina na antibioticoprofilaxia de histerectomia vaginal e abdominal Tinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy

    José Antonio Simões


    das mulheres submetidas à histerectomia vaginal sugere que essa infecção deve ser melhor pesquisada e devidamente tratada antes da cirurgia.PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction; Group T (2 g of tinidazole orally, 12 hours before the surgery; or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction. Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12. There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02. BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%, though without statistical significance (p=0.19. CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post

  13. Comparative study of abdominal, vaginal and laparoscopic assisted vaginal hysterectomies with special reference to immediate sequel, late sequel and complications

    Pujitha Devi Suraneni


    Conclusions: Preference for laparoscopic assisted vaginal hysterectomy or vaginal hysterectomy depends on expertise of doctor and selections of patients. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 402-406


    Rakesh Kumar


    Full Text Available BACKGROUND Postoperative nausea and vomiting is (PONV a very distressing complication and preventive measures are justified when the risk of PONV is very high. Ondansetron is the first 5-HT3 antagonist used alone or in combination for prophylaxis of PONV due to its lower cost. Granisetron and palonosetron are recently introduced 5-HT3 antagonists with greater affinity for 5-HT3 receptor and having longer half-life. Aim of the present study is to compare the antiemetic efficacy of ondansetron, granisetron and palonosetron in high-risk patients undergoing abdominal hysterectomy under general anaesthesia. METHODS After obtaining Institutional Ethical Committee approval and written informed consent from all the participants, 150 patients of ASA grade I & II, aged between 20-50 years and weight between 30-60 kg undergoing abdominal hysterectomy under general anaesthesia were assigned randomly in to three groups of 50 patients each using random number table receiving either ondansetron 4 mg (Group O or granisetron 2 mg (Group G or palonosetron 0.75 mg (Group P intravenously just before the induction of anaesthesia. Incidence and severity of nausea and frequency of retching and vomiting were recorded in each group at the end of 2-hour and then at 24-hour and 48-hour intervals. RESULTS The incidence of nausea during first two hours postoperatively was found to be 14(28% in Group O, which was found to be significantly higher than 6(12% in group G and 4(8% in group P (p value = 0.016. The incidence of vomiting was found to be 6(12% in group O, which was found to be significantly higher than 2(4% in both group G and group P (p value = 0.018. Number of complete responders was significantly higher in Group P and group G as compared to group O. Number of patients requiring rescue antiemetic treatment was significantly high in group O{10(20%} as compared to 3(6% in both the group G and group P. CONCLUSIONS Newly introduced 5-HT3 antagonists, granisetron and

  15. Premedication with gabapentin, alprazolam or a placebo for abdominal hysterectomy: Effect on pre-operative anxiety, post-operative pain and morphine consumption

    Tim Thomas Joseph; Handattu Mahabaleswara Krishna; Shyamsunder Kamath


    Background and Aims : Utility of gabapentin for pre-operative anxiolysis as compared to commonly administered alprazolam is not evident. The aim of the present study was to compare the effects of pre-operative oral gabapentin 600 mg, alprazolam 0.5 mg or a placebo on pre-operative anxiety along with post-operative pain and morphine consumption. Methods: Seventy five patients scheduled for abdominal hysterectomy under general anaesthesia were included. Groups gabapentin, alprazolam and placebo...

  16. Fatores de Risco para Infecção Pós-histerectomia Total Abdominal Risk Factors for Infection after Total Abdominal Hysterectomy

    Melania Maria Ramos de Amorim


    with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP. Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414. The frequency of surgical site infection (defined according to the CDC criteria, 1998 was 10% (42 cases. Prevalence risk (PR of infection (dependent variable and its 95% confidence interval (CI were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94, obesity (PR = 3.2, 95% CI = 1.83-5.59, duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21 and diabetes (PR = 6.0, 95% CI = 3.41-10.57. On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68. Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.

  17. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial

    Amany S Ammar


    Full Text Available Purpose: Different adjuvants have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. The current study was aimed to evaluate the effect of adding dexamethasone to bupivacaine on the quality and duration of transversus abdominis plane (TAP block. Methods: Sixty adult patients undergoing elective open abdominal hysterectomy were randomly allocated to receive TAP block using 20 mL of bupivacaine hydrochloride 0.25% + 2 mL saline 0.9% (control group, n=30 or 20 mL of bupivacaine hydrochloride 0.25% + 2 mL dexamethasone "8 mg" (dexamethasone group, n=30. The primary outcome was postoperative pain, as evaluated by visual analog scale (VAS for pain scoring at 1, 2, 4, 12, 24 and 48 h postoperatively, whereas the secondary outcomes were time to first analgesia (TFA, morphine consumption and the occurrence of nausea, vomiting or somnolence. Results: The pain VAS score was significantly lower at the postoperative 2 h (4.9 vs. 28.1, P=0.01, 4 h (12.2 vs. 31.1, P=0.01 and 12 h (15.7 vs. 25.4, P=0.02. Furthermore, TFA was significantly longer in the dexamethasone group (459.8 vs. 325.4 min, P=0.002, with lesser morphine requirements in the postoperative 48 h (4.9 vs. 21.2 mg, P=0.003 and lower incidence of nausea and vomiting (6 vs. 14, P=0.03. No complications attributed to the block were recorded. Conclusion: Addition of dexamethasone to bupivacaine in TAP block prolonged the duration of the block and decreased the incidence of nausea and vomiting.

  18. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... abdominal hysterectomy? Well the vaginal hysterectomy has some limitations. It is somewhat of a blind procedure, as we know, with limited exposure. Inherent with that may be some fear ...

  19. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... taking all that into account, taking experience and skill, for most of us, the abdominal hysterectomy is ... You’ll basically converting that into a two-step procedure, a myomectomy first, and then a hysterectomy. ...

  20. Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: results of a prospective, randomized, double-blind, multicenter clinical trial

    Faiz HR


    Full Text Available Hamid Reza Faiz,1 Poupak Rahimzadeh,1 Ognjen Visnjevac,2 Behzad Behzadi,1 Mohammad Reza Ghodraty,1 Nader D Nader2 1Iran University of Medical Sciences, Tehran, Iran; 2VA Western NY Healthcare System, University at Buffalo, Buffalo, NY, USA Background: In recent years, intravenously (IV administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen's analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This double-blind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy. Methods: Eighty women aged 25–70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance. Results: Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05, and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039. The two groups had no significant differences in terms of adverse effects. Conclusion: Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy. Keywords: intravenous acetaminophen, abdominal hysterectomy, ketamine, analgesia, postoperative pain

  1. An adhesion-related small bowel obstruction occurring within 36 h of a total abdominal hysterectomy and bilateral salpingo-oophorectomy

    Shah, Neha; Shah, Sonya Pratik; Thakrar, Amit; Rozati, Hamoun


    We present a case of adhesion-related small bowel obstruction occurring within only 36 h of a total abdominal hysterectomy and bilateral salpingo-oophorectomy. There has been no previously reported case where there has been such a short interval between surgery and adhesion-related small bowel obstruction. This is important to note, as it ensures that adhesion-related small bowel obstruction is on the list of differential diagnoses for patients who present very soon after surgery with symptom...

  2. Comparison of the short-term and long-term outcomes of laparoscopic hysterectomies and of abdominal hysterectomies: a case study of 4,895 patients in the Guangxi Zhuang Autonomous Region, China

    He, Hongying; Yang, Zhijun; Zeng, Dingyuan; Fan, Jiangtao; Hu, Xiaoxia; Ye, Yuan; Bai, Hua; Jiang, Yanming; Lin, Zhong; Lei, Zhiying; Li, Xinlin; Li, Lian; Gan, Jinghua; Lan, Ying; Tang, Xiongzhi; Wang, Danxia; Jiang, Junsong; Wu, Xiaoyan; Li, Meiying; Ren, Xiaoqing; Yang, Xiaomin; Liu, Mei; Wang, Qinmei; Jiang, Fuyan; Li, Li


    Background: To evaluate the short-term and long-term outcomes after laparoscopic hysterectomy (LH) compared with abdominal hysterectomy (AH) in case of benign gynecological disease. Methods: A multi-center cohort retrospective comparative study of population among 4,895 hysterectomies (3,539 LH vs.1,356 AH) between 2007 and 2013 was involved. Operative time (OT), estimated blood loss (EBL), intra-operative and post-operative complications, passing flatus; days with indwelling catheter, questionnaires covering pelvic floor functions and sexual functions were assessed. Results: The EBL (174.1±157.4 vs. 263.1±183.2 cc, LH and AH groups, respectively), passing flatus (38.7±14.1 vs. 48.1±13.2 hours), days with indwelling catheter (1.5±0.6 vs. 2.2±0.8 days), use of analgesics (6.5% vs. 73.1%), intra-operative complication rate (2.4% vs. 4.1%), post-operative complication rate (2.3% vs. 5.7%), post-operative constipation (12.1% vs. 24.6%), mild and serious stress urinary incontinence (SUI) post-operative (PSexual Functioning Index (FSFI) total score <26.55 post-operative (P<0.001) of the LH group were significantly less than those of AH group. There were no significant differences in OT (106.5±34.5 vs. 106.2±40.3 min) between the two groups. Conclusions: LH is a safe and efficient operation for improving patients?long-term quality of life (QoL), and LH is a cost-effectiveness procedure for treating benign gynecological disease. LH is superior to AH due to reduced EBL, reduced post-operative pain and earlier passing flatus. PMID:27199516

  3. Decrease in symptoms, blood loss and uterine size with nafarelin acetate before abdominal hysterectomy: a placebo-controlled, double-blind study.

    Ylikorkala, O; Tiitinen, A; Hulkko, S; Kivinen, S; Nummi, S


    To evaluate the efficacy and safety of nafarelin before hysterectomy in a prospective placebo-controlled trial, we randomized 188 pre-menopausal women with uterine fibroids (n = 111), menometrorrhagia (n = 58) or pelvic pain (n = 19) to receive either nafarelin (200 micrograms twice daily as a nasal spray) or a placebo for 3 months before abdominal hysterectomy. The data analysis could be performed in 166 women, of whom 107 received nafarelin and 59 a placebo. Nafarelin led to a rise in blood haemoglobin (5.5 g/l) and to a decrease in uterine volume (23.7%). This, however, gave no objective benefit during surgery (similar operative durations and blood losses). The uteri from patients treated with nafarelin (255.5 +/- 12.6 g, mean +/- SD) were significantly lighter (P = 0.029) than those from patients treated with a placebo (346.2 +/- 35.7 g). Histological examination of the fibroids or uteri revealed changes typical for hypo-oestrogenism, but no specific histological pattern could be established. The endometrium was proliferative in 56% and showed mild hyperplastic features in 10% of patients given nafarelin, whereas the respective figures for the placebo group were 41 and 0%. Hot flushes were the most common side-effects, being reported by 61% in the nafarelin group and 35% in the placebo group. Nafarelin can be useful as a pre-surgical adjunct in a patient scheduled for abdominal hysterectomy if there is a need to raise the haemoglobin concentration or to reduce the size of the uterus. PMID:7593517

  4. Infusion of hypertonic saline (7.5%) does not change neutrophil oxidative burst or expression of endothelial adhesion molecules after abdominal hysterectomy

    Kølsen-Petersen, Jens Aage; Rasmussen, Torsten Bøgh; Krog, Jan; Hokland, Marianne; Tønnesen, Else Kirstine


    surgery. METHODS: Fifteen women scheduled for open abdominal hysterectomy were randomized double-blindly to infusion of 4 mL/kg 7.5% NaCl, 4 mL/kg 0.9% NaCl, or 32 mL/kg 0.9% NaCl over 20 minutes. Blood was collected at baseline, after infusion, 1, 4, and 24 hours postoperatively for the determination of...... the expression of adhesion molecules, and halved the superoxide production unrelated to the tonicity or volume of the infused fluids. CONCLUSION: Infusion of a clinically relevant dose of hypertonic saline has no detectable effect on the membrane expression of endothelial adhesion molecules or O2...

  5. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... majority of our hysterectomies as an abdominal procedure, meaning with sort of the larger abdominal incision. In ... less blood loss and a quicker recovery. We should also recognize that there have been technological advances ...

  6. Total versus subtotal hysterectomy

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Anna Birthe; Gluud, Christian; Ottesen, Bent S; Tabor, Ann


    The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF-36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1-year postoperative. Eighty...

  7. Comparison of the effect of laparoscopic hysterectomy and abdominal hysterectomy on ovarian function%腹腔镜与开腹全子宫切除术对女性卵巢功能影响的比较

    姜琦; 朱福梅


    目的:探讨腹腔镜下与开腹全子宫切除术对中青年女性卵巢功能的影响。方法选择60例未绝经的子宫良性疾病并需行子宫切除术的中青年患者,随机分为腹腔镜组和开腹组,每组各30例,比较两组患者围手术期指标、性激素水平及围绝经期综合征情况。结果腹腔镜组术中出血量、术后肛门排气时间均显著少于开腹组,差异有统计学意义( t值分别为4.27和3.11,P<0.05);术后6个月,两组患者卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)水平相比,差异均无统计学意义(t值分别为0.69、0.95、0.67、-0.33,均P>0.05);术后12个月两组患者FSH、LH、E2、P水平差异也均无统计学意义(t值分别为0.88、-0.21、1.65、0.20,均P>0.05);两组患者术后围绝经期综合征发生率比较差异无统计学意义(χ2=0.10,P>0.05)。结论腹腔镜子宫切除术具有对机体创伤小、术后恢复快的优点,与传统子宫切除术相比不会增加对卵巢功能的损伤。%Objective To investigate the effect of laparoscopic hysterectomy ( LH) and abdominal hysterectomy ( AH) on ovarian function of young and middle-aged women.Methods Totally 60 young and middle-aged premenopausal patients with benign uterine disease were going to undergo hysterectomy .They were randomly divided into LH group and AH group with 30 cases in each .The perioperative indexes , sexual hormone level and perimenopausal syndrome were compared between two groups .Results The blood loss and postoperative flatus in LH group were significantly less than AH group , and the differences were significant (t value was 4.27 and 3.11, respectively, both P0.05).There were not significant differences in the serum levels of FSH , LH, E2 and P in 12 months after surgery ( t value was 0.88, -0.21, 1.65 and 0.20, respectively, all P >0.05 ).The incidence of

  8. The decline of hysterectomy for benign disease.

    Horgan, R P


    Hysterectomy is one of the most common gynaecological surgical procedures performed but there appears to be a decline in the performance of this procedure in Ireland in recent times. We set out to establish the extent of the decline of hysterectomy and to explore possible explanations. Data for hysterectomy for benign disease from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2006. The total number of hysterectomies performed for benign disease showed a consistent decline during this time. There was a 36% reduction in the number of abdominal hysterectomy procedures performed.

  9. Anesthetic management of an elderly patient with kyphoscoliosis and dilated cardiomyopathy posted for abdominal hysterectomy and salpingo-oophorectomy

    Suvidha Sood


    Full Text Available A 76-year-old kyphoscoliotic female patient presented with severe pain and sudden acute abdominal distension for 1-week and was diagnosed to have right-sided massive twisted ovarian cyst. The patient was a known case of hypertension, dilated cardiomyopathy with low 20% cardiac ejection fraction. Though very few incidences of multiple co-morbid conditions existing together in a single elderly patient have been reported in the past, it is important to titrate the dosage, type of anesthetic agents and their routes of administration in high risk patients.




    Full Text Available BACKGROUND: Bupivacaine is the most commonly used drug for spinal anesthesia . To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenoreceptor agonist with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Low doses of clonidine and buprenorphine have shown effectiveness in i ntensifying spinal anesthesia. AIM: This study is designed to evaluate the effectiveness of spinal blockade by adding 50μgm clonidine to bupivacaine. SET TINGS AND DESIGN: This a prospective, randomized , comparative clinical study involved 60 ASA grade Ι/ΙΙ patients aged 18 - 55 years undergoing elective hysterectomy under spinal anesthesia after approval from hospital ethics committee with written an d inform ed consent of patients. MATERIALS AND METHODS: 60 ASA grade Ι/ΙΙ patients aged 18 - 55 years selected for the study are divided in two groups of 30 each. Group B (Bupivacaine group patients will receive intrathecally 0.5% hyperbaric bupivacaine 4 ml (Total 4 ml whereas Group C (Clonidine group patient will receive intrathecally 0.5% hyperbaric bupivacaine 3. 5 ml + 50μg (Total 4 ml. The onset time to reach peak sensory and motor level, post - operative analgesia , hem odynamic changes, and side effects were recorded. RESULTS: The onset of sensory and motor blockade was faster in the group C compared to group B [137.60 seconds and 112.22 seconds] (p<0.001, [231.80 seconds and 165.1 seconds] (p<0.001. Duration of sensor y block, motor block and postoperative analgesia [221.4 minutes in group B vs. 362.84 minutes in group C] (P<0.001, was significantly prolonged in group C. There were no significant hemodynamic changes in both the groups. CONCLUSION: Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without significant hemodynamic side

  11. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... t know if I feel comfortable doing that.” Well I believe our presentation will be different. I’m confident that after this evening ... this? Why do OB-GYNs prefer abdominal hysterectomy? Well the vaginal hysterectomy ... Inherent with that may be some fear that will have some injury to ...

  12. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... taking all that into account, taking experience and skill, for most of us, the abdominal hysterectomy is ... approach. If you do not have vaginal surgery skills, again, this is not -- that’s not something you ...

  13. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... is large; that’s not something we want as far to enter into. We are very comfortable as ... not things that are new to us as far as doing abdominal hysterectomy, C-sections, myomectomies, multiple ...

  14. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... be resolved. I believe we can achieve ACOG’s goals by using the familiar abdominal hysterectomy, and using ... sealing device that can help us achieve these goals an also use what we’ve learned from ...

  15. Preoperative teaching and hysterectomy outcomes.

    Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia; Ryan, Marian; Gale, Nancy; Parker, Carla


    This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies. PMID:12817743

  16. Plexopatia lombar após histerectomia abdominal: relato de caso Plexopatía lumbar después de la histerectomía abdominal: relato de caso Lumbar plexopathy after abdominal hysterectomy: case report

    Elizabeth Vaz da Silva


    anesthesia, but they can also be secondary to the surgery itself. The aim of this report was to present the case of a patient who underwent a pelvic surgery and developed lumbar plexopathy, and to discuss the possible causes. CASE REPORT: A woman patient, 38 years old, 58 kg, 1.63 m, physical status ASA I, was admitted to undergo a total abdominal hysterectomy for treatment of uterine leiomyomatosis. Initial monitoring included pulse oxymetry, non-invasive blood pressure, electrocardioscope, and urine output. After venous cannulation in the left upper limb with an 18G catheter, cefazoline (2 g, dypirone (2 g, dexamethasone (10 mg, and metochlopramide (10 mg were administered. With the patient in left lateral decubitus, a 16G Tuohy needle was inserted in the L3-L4 space, in the median line, for the epidural block. Fifteen milliliters of 0.75% ropivacaine and 2 mg of morphine were administered, followed by placement of the catheter for postoperative analgesia. The surgery was uneventful, and the patient's cardiovascular parameters were stable. Eight hours after the procedure, at the postanesthetic follow-up, the patient could not walk and presented monoparesis in the left lower limb. The hypothesis of radicular syndrome was ruled out after clinical and radiological evaluation. Since symptoms did not resolve, an electroneuromyography was done 30 days later, and was compatible with lumbar plexopathy, which was possibly caused by trauma. CONCLUSIONS: The anesthesiologist must be aware of the postoperative neurological complications and should be part of the efforts to diagnose their causes, of the treatment, and its evolution.

  17. Premedication with gabapentin, alprazolam or a placebo for abdominal hysterectomy: Effect on pre-operative anxiety, post-operative pain and morphine consumption

    Tim Thomas Joseph


    Full Text Available Background and Aims : Utility of gabapentin for pre-operative anxiolysis as compared to commonly administered alprazolam is not evident. The aim of the present study was to compare the effects of pre-operative oral gabapentin 600 mg, alprazolam 0.5 mg or a placebo on pre-operative anxiety along with post-operative pain and morphine consumption. Methods: Seventy five patients scheduled for abdominal hysterectomy under general anaesthesia were included. Groups gabapentin, alprazolam and placebo, received oral gabapentin 600 mg, alprazolam 0.5 mg and one capsule of oral B-complex forte with Vitamin C respectively, on the night prior to surgery and 2 h prior to surgery. Visual analogue scale (VAS was used to measure the anxiety and post-operative pain. All patients received patient-controlled analgesia. Statistical tests used were Kruskal-Wallis test, Wilcoxon signed rank test and one-way ANOVA. Results: Alprazolam provided significant anxiolysis (median [interquartile range] baseline VAS score 35 [15.5, 52] to 20 [6.5, 34.5] after drug administration; P = 0.007. Gabapentin did not provide significant decrease in anxiety (median [interquartile range] VAS score 21 [7.5, 41] to 20 [6.5, 34.5]; P = 0.782. First analgesic request time (median [interquartile range in minutes] was longer in group gabapentin (17.5 [10, 41.25] compared to group placebo (10 [5, 15] (P = 0.019 but comparable to that in group alprazolam (15 [10, 30]. Cumulative morphine consumption at different time periods and total morphine consumption (mean [standard deviation] at the end of study period (38.65 [18.04], 39.91 [15.73], 44.29 [16.02] mg in group gabapentin, alprazolam and placebo respectively were comparable. Conclusion: Gabapentin 600 mg does not have significant anxiolytic effect compared to alprazolam 0.5 mg. Alprazolam 0.5 mg was found to be an effective anxiolytic in the pre-operative period. Neither alprazolam nor gabapentin, when compared to placebo showed any opioid

  18. A comparison between intrathecal clonidine and neostigmine as an adjuvant to bupivacaine in the subarachnoid block for elective abdominal hysterectomy operations: A prospective, double-blind and randomized controlled study

    D Bhar


    Full Text Available Background and Aims: Adjuvant to the local anesthetic agent has proven benefits when used intrathecally. With regards to intrathecal bupivacaine as control, we have compared in this study the effects of clonidine and neostigmine when co-administered intrathecally with hyperbaric (0.5% bupivacaine for abdominal hysterectomy. Materials and Methods: This prospective, randomized, double-blind study was conducted from May 2009 to June 2011. A total of 150 patients of American Society of Anaesthesiology grades I and II scheduled for abdominal hysterectomy under spinal anesthesia were randomly allocated into three groups. A volume of 3 ml of 0.5% hyperbaric bupivacaine was respectively added 1 ml solution containing 5% dextrose and 75 mcg of neostigmine in Group N, 1 ml containing 5% dextrose and 30 mcg of clonidine in Group C and 1 ml of 5% dextrose in Group D (control. We compared the sensory and motor block, the surgical condition, the duration of spinal analgesia and the side-effect profile. Results and Observations: Sensory and motor blocks and duration of spinal analgesia were significantly increased in both Group C and Group N compared to Group D. More incidences of Nausea and vomiting were observed in Group N compared to other groups. The surgical condition was poorer in Group N compared to Group C. Conclusion: Both intrathecal clonidine and neostigmine increase the bupivacaine-induced spinal block. However, clonidine provides better surgical condition and fewer incidences of nausea and vomiting.

  19. Subtotal versus total abdominal hysterectomy

    Andersen, Lea Laird; Ottesen, Bent; Alling Møller, Lars Mikael;


    from discharge summaries from all public hospitals in Denmark. The results were analyzed as intention to treat and per protocol. Possible bias caused by missing data was handled by multiple imputation. The primary outcome was urinary incontinence; the secondary outcomes were pelvic organ prolapse...

  20. Abdominal Hysterectomy (Beyond the Basics)

    ... reverse engineered or included in other software. UpToDate electronically monitors compliance with this Agreement, and reserves the ... Any access to the Licensed Materials provided under contract to the Government are provided with limited rights. ...

  1. Nonmalignant Sequelae of Unconfined Morcellation at Laparoscopic Hysterectomy or Myomectomy.

    Tulandi, Togas; Leung, Annie; Jan, Noran


    The objective of this study was to evaluate nonmalignant sequelae of unconfined morcellation at hysterectomy and myomectomy. We performed a systematic review following the PRISMA statement key words of "morcellation, uterine leiomyoma, uterine fibroid, laparoscopic myomectomy, laparoscopic total hysterectomy, and laparoscopic supracervical hysterectomy" and their combination. Fifty-one articles met the inclusion criteria: 11 articles were related to endometriosis, adenomyosis, and endometrial hyperplasia; 30 articles parasitic myoma; and 9 disseminated peritoneal leiomyomatosis (DPL) and 1 DPL and endometriosis. We found that laparoscopic hysterectomy or myomectomy with unconfined morcellation is associated with the risk of iatrogenic endometriosis (1.4%), adenomyosis (0.57%), parasitic myoma (0.9%), and rarely DPL. Our study showed that benign sequelae of uterine or myoma morcellation could be found in up to 1% of cases. This is much higher than the prevalence of uterine sarcoma after morcellation. Benign conditions have less consequences than malignancy, yet they are more common and might require another operation. Accordingly, if morcellation is required, confined morcellation should be considered. PMID:26802909

  2. Clinicopathological review of gynaecological hysterectomies local experience

    share clinicopathological spectrum of hysterectomies performed at CMH Rawalpindi. Study Design: A cross sectional descriptive study. Place and duration of the study : This study was carried out at Obstetrics and Gynaecology department CMH Rawalpindi, from October 2010 to June 2012. Material and Methods: Total of 54 patients who underwent hysterectomy were selected for the study. Detailed history and examination of the patient pre and post-operatively were carried out to observe the indications and complications of hysterectomy. Results: In total 54 hysterectomies were carried out; all of which with the exception of one were total abdominal. The patients who underwent hysterectomies were in the 4th decade of life. The most common (48%) indication of hysterectomy in our study was found to be menstrual irregularities like menorrheagia, irregular vaginal bleeding, DUB and post-menopausal bleeding give frequently of complication as well. Delayed wound healing was the most common complaint (7%). Histopathology carried out on the uterine specimen showed adenomyosis 17(31%) being the most common finding. Conclusion: Abdominal hysterectomies carried out in our setup are most commonly done for menstrual irregularities and complication rate is low. (author)

  3. The diagnosis and treatment of intra-abdominal bleeding after peripartum hysterectomy%围产期子宫切除术后腹腔内出血的诊断及治疗

    戴满花; 刘慧姝; 陈敦金; 苏向辉; 黄天晴


    Objective To analyze the diagnosis and treatment of intra-abdominal bleeding after peripartum hysterectomy in postpartum hemorrhage. Methods A retrospective clinical data was analyzed involving 112cases critically ill obstetric patients performed peripartum hysterectomy for postpartum hemorrhage in Obstetric Critical Care Center of Guangzhou between January 1999 and June 2010, which divided to intra-abdominal bleeding group 37 cases and non-intra-abdominal bleeding group 75 cases depending on whether the patient was underwent intra-abdominal bleeding after peripartum hysterectomy. Main demographic data and clinical details including diagnosis and treatment of intra-abdominal bleeding, and postoperative outcomes were analyzed and compared between two groups. Results Intra-abdominal bleeding was identified in 37 patients (37/112, 33. 0% ) after peripartum hysterectomy. Of these, 22 (59. 5% ) cases were diagnosed by elevated bloody output from the drains. Fifteen cases (40. 5% ) were diagnosed by integrated approaches. The 22 cases took shorter time to diagnose intra-abdominal bleeding by the sanguinous output from the drain in comparison to the comprehensive approaches(P =0. 033). Of the 37 patients treated, 17 patients were re-explored, and the others were treated non-operatively. There were 11 cases maternal deaths, including 5 complicated with hepatic failure and 5 complicated with amniotic fluid embolism. The group of patients who were re-explored > 12 h in comparison to ≤12 h group had more total blood loss, total blood transfusion ( P = 0. 008; P = 0. 015 ) , longer duration of mechanical ventilation (P = 0. 022 ) . There were 3 cases maternal deaths in re-explored > 12 h group. Conclusions An integrated monitoring is critical measures of determinant of intra-abdominal bleeding after peripartum hysterectomy, in spite of drains allowed early diagnosis of intra-abdominal bleeding. It is necessary to perform surgical hemostasis without hesitation when short time

  4. Endoluminal release of ureteral ligature after hysterectomy.

    Wang, Chih-Jen; Lin, Victor Chia-Hsiang; Huang, Ching-Yu


    Iatrogenic ureteral injury is a well-recognized complication of abdominal total hysterectomy. We report a case of a 57-year-old female who underwent abdominal total hysterectomy for a uterine myoma and experienced severe right flank pain postoperatively. The imaging study displayed an obstruction of the right distal ureter. Under ureteroscopy, an extraluminal ligature was released with a holmium:yttrium-aluminum-garnet laser. The stenotic segment was immediately relieved. Two months later, the intravenous urogram illustrated patency of the distal ureter with regression of right hydronephrosis. There was no recurrent hydronephrosis during 1 year of follow-up. PMID:25241286

  5. Total Vaginal NOTES Hysterectomy: A New Approach to Hysterectomy.

    Baekelandt, Jan


    The aim of this study was to demonstrate the feasibility of a total hysterectomy performed entirely by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Conventional, reusable laparoscopic instruments were used, inserted through an inexpensive, self-constructed single-port device. Ten total vaginal NOTES hysterectomies (TVNHs) were performed by a single surgeon. The self-constructed single-port device was made by assembling a surgical glove, a wound protector or modified laryngeal mask airway, 1 reusable 10-mm trocar, and 4 reusable 5-mm trocars. This gloveport was inserted into the vagina to create a pneumovagina. The conventional steps of a vaginal hysterectomy were followed, but performed endoscopically with standard reusable endoscopic instruments. The patient and perioperative data were analyzed. No conversion to standard laparoscopy or laparotomy was necessary in any of the 10 patients who underwent a TVNH. Mean operation time was 97 min (range: 60-120); mean drop in hemoglobin level was 1.5 g/dL (range: 0.5-2.4). There were no operative complications, and postoperative pain scores were very low. This first report on a small number of patients demonstrates that TVNH is possible. By incorporating the advantages of endoscopic surgery, TVNH broadens the indications for vaginal hysterectomy and helps overcome its limitations. At the same time, the NOTES approach avoids abdominal wall wounds and trocar-related complications. TVNH is feasible, even when performed with reusable, conventional laparoscopic instruments. This frugally innovative technique also enables surgeons to perform hysterectomies by vNOTES in low resource settings. PMID:26009278

  6. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... to us as far as doing abdominal hysterectomy, C-sections, myomectomies, multiple other procedures. This is the ... standard if you use Alexis O retractors in C-sections, and they’re self-retaining. The good ...

  7. Current Issues with Hysterectomy.

    Barker, Matthew A


    Hysterectomy is one of the most common gynecologic surgeries. Early adoption of surgical advancements in hysterectomies has raised concerns over safety, quality, and costs. The risk of potential leiomyosarcoma in women undergoing minimally invasive hysterectomy led the US Food and Drug Administration to discourage the use of electronic power morcellator. Minimally invasive hysterectomies have increased substantially despite lack of data supporting its use over other forms of hysterectomy and increased costs. Health care reform is incentivizing providers to improve quality, improve safety, and decrease costs through standardized outcomes and process measures. PMID:27521886

  8. Effect of Two Different Doses ofDexmedetomidine as Adjuvant in BupivacaineInduced Subarachnoid Block for ElectiveAbdominal Hysterectomy Operations: A Prospective, Double-blind, RandomizedControlled Study

    Anjan Das


    Full Text Available Objectives: Improvements in perioperative pain management for lower abdominal operations has been shown to reduce morbidity, induce early ambulation, and improve patients’ long-term outcomes. Dexmedetomidine, a selective alpha-2 agonist, has recently been used intrathecally as adjuvant to spinal anesthesia to prolong its efficacy. We compared two different doses of dexmedetomidine added to hyperbaric bupivacaine for spinal anesthesia. The primary endpoints were the onset and duration of sensory and motor block, and duration of analgesia.  Methods: A total of 100 patients, aged 35–60 years old, assigned to have elective abdominal hysterectomy under spinal anesthesia were divided into two equally sized groups (D5 and D10 in a randomized, double-blind fashion. The D5 group was intrathecally administered 3ml 0.5% hyperbaric bupivacaine with 5µg dexmedetomidine in 0.5ml of normal saline and the D10 group 3ml 0.5% bupivacaine with 10µg dexmedetomidine in 0.5ml of normal saline. For each patient, sensory and motor block onset times, block durations, time to first analgesic use, total analgesic need, postoperative visual analogue scale (VAS scores, hemodynamics, and side effects were recorded.  Results: Although both groups had a similar demographic profile, sensory and motor block in the D10 group (p0.050 without any appreciable side effects.  Conclusion: Spinal dexmedetomidine increases the sensory and motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.

  9. Chronic pain after hysterectomy

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;


    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  10. [Peripartal hysterectomy - review].

    Pálová, E; Borovsky, M


    Peripartal hysterectomy is one of the life - threatening procedures needed to be performed in an urgent situation. Women at highest risk of peripartal hysterectomy are multiparas, women who had a caesarian delivery in either previous or present pregnancy or women who had an abnormal placentation. This report presents the basic issues and brief review of the major indications of peripartal hysterectomy. It also compares the effectiveness of the selected types of operation. PMID:22779724

  11. Analgesia preemptiva com S(+cetamina e bupivacaína peridural em histerectomia abdominal Analgesia preemptiva con S(+cetamina y bupivacaína peridural en histerectomía abdominal Preemptive analgesia with epidural bupivacaine and S(+ketamine in abdominal hysterectomy

    Ferdinand Edson de Castro


    fue posible demostrar efecto preemptivo con la utilización peridural de S(+cetamina y bupivacaína en las dosis utilizadas en histerectomía abdominal.BACKGROUND AND OBJECTIVES: This study investigates the ability of epidural S(+ketamine, NMDA receptor antagonist, plus local anesthetic (bupivacaine injection to promote preemptive analgesia in patients undergoing total abdominal hysterectomy, when this solution is administered before surgical incision. METHODS: Participated in this prospective double-blind study 30 patients were randomly assigned in two equal groups. Epidural injection and catheter insertion were performed at L1-L2 interspace. Group 1 (G1 patients received 17 mL bupivacaine 0.25% plus 3 mL S(+ketamine (30 mg, 30 min before surgical incision, followed by 20 mL saline 30 min after incision. Group 2 (G2 patients received 20 mL saline 30 min before surgical incision, followed by 17 mL bupivacaine 0.25% plus 3 mL S(+ketamine (30 mg 30 min after incision. General anesthesia was induced with propofol, pancuronium, O2 and isoflurane. Postoperative analgesia consisted of epidural fentanyl plus bupivacaine bolus with 4h minimal interval. If necessary, IV dipyrone supplementation was administered. Patients were evaluated for analgesia by a verbal and numeric scale (at recovery and every six hours until 24 postoperative hours. Time to first analgesic request and total analgesic requirements were recorded. RESULTS: There were no significant differences between groups in time to first analgesic request, total analgesic consumption and numeric or verbal scale pain scores. CONCLUSIONS: This study failed to demonstrate a preemptive effect of epidural administration of bupivacaine and S(+ketamine in the doses tested for abdominal hysterectomy.

  12. Total laparoscopic hysterectomy via suture and ligation technique

    Kang, Hye Won; Lee, Ji Won; Ho Yeon KIM; Kim, Bo Wook; Moon, Chong Soo


    Objective The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and oper...

  13. Complications of vaginal hysterectomy - (Analysis of 1105 cases

    Bhattacharya Menna


    Full Text Available Eleven hundred and five cases of vaginal hysterectomy are analysed and their complications discussed. More than 90% of the patients were between the ages of 31 to 60 years. The common indications for hysterectomy were prolapse (51% and dysfunctional uterine bleeding (34.9%. In four cases abdominal approach was necessary to complete the operation. The overall incidence of major complications was 4% and the corrected mortality rate was 0.18%. The complications of vaginal hysterec-tomy by other authors are discussed.

  14. Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome

    Lovina S.M. Machado


    Full Text Available Background: Peripartum hysterectomy is a major operation and is invariably performed in the presence of life threatening hemorrhage during or immediately after abdominal or vaginal deliveries. Material and Methods: A Medline search was conducted to review the recent relevant articles in English literature on emergency peripartum hysterectomy. The incidence, indications, risk factors and outcome of emergency peripartum hysterectomy were reviewed. Results: The incidence of emergency peripartum hysterectomy ranged from 0.24 to 8.7 per 1000 deliveries. Emergency peripartum hysterectomy was found to be more common following cesarean section than vaginal deliveries. The predominant indication for emergency peripartum hysterectomy was abnormal placentation (placenta previa/accreta which was noted in 45 to 73.3%, uterine atony in 20.6 to 43% and uterine rupture in 11.4 to 45.5 %. The risk factors included previous cesarean section, scarred uterus, multiparity, older age group. The maternal morbidity ranged from 26.5 to 31.5% and the mortality from 0 to 12.5% with a mean of 4.8%. The decision of performing total or subtotal hysterectomy was influenced by the patient′s condition. Conclusion: Emergency peripartum hysterectomy is a most demanding obstetric surgery performed in very trying circumstances of life threatening hemorrhage. The indication for emergency peripartum hysterectomy in recent years has changed from traditional uterine atony to abnormal placentation. Antenatal anticipation of the risk factors, involvement of an experienced obstetrician at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in reducing morbidity and mortality.




    Full Text Available BACKGROUND: Hysterectomy is the most common gynec operation worldwide. It leads to significant morbidity and mortality hence there must be justifiable indication before procedure is undertaken. There is a lack of comprehensive data and too much variability from place to place, even in India. OBJECTIVE: To analyze the changing trends in hysterectomy in past 6 years. METHOD: A retrospective study of all women undergoing hysterectomy that were done in Dr. B.R.A.M. Hospital, Medical College, Raipur for 6yrs from 2009 to 2014. RESULTS: A total of 1032 hysterectomies were done during the study period. Most common age group was from 41-50 years. The commonest indication was symptomatic fibroid (33.52%. Vaginal and abdominal hysterectomy were done equally. A declining trend of incidence of hysterectomy was observed over the years from 14.9 to 9.61 per 1000 women per year, which is significant (p value- 0.008. CONCLUSION: This study shows changing scenario of hysterectomy in terms of age, oophorectomy and rate. A shift towards minimal invasive techniques is also evident

  16. Histopathological Analysis of 422 Nononcological Hysterectomies in a University Hospital

    Seda Ates


    Full Text Available Aim: The aim of the study was to evaluate the surgical indications, routes of surgery and the correlation between preoperative diagnosis and histopathological examination of hysterectomy specimens. Material and Method: Medical records and histopathological findings were reviewed and analyzed retrospectively, in 422 consecutive women who underwent hysterectomy over a two-year period from 2011 to 2014. Those with confirmed malignancy before operation were excluded. Cohen kappa statistics were used to measure agreement between preoperative clinical and postoperative histopathological diagnosis which was found to be fair with %u043A value being 0.4. Results: The mean age of our patients was 51.5 ± 8 years. The abdominal route was used in 378 cases (85.5%, the vaginal route in 55 patients (12.4% and the laparoscopic-assisted vaginal hysterectomy in 9 cases (2%. Abnormal uterine bleeding (28.9 % was the most common indication for hysterectomy. The histopathology of the endometrium prior to hysterectomy was reported in 75% of the cases and the most common finding was a secretory or proliferative endometrium. Leiomyomatous uterus was the most frequently encountered pathology (43.7% followed by coexistence of leiomyoma and adenomyosis (17.4% in hysterectomy specimens. Hysterectomy specimens may be unremarkable histopathologically, most of which are vaginal hysterectomies done for uterine prolapsed (kappa=0,407. Discussion: The correlation between the preoperative clinical and the pathological diagnosis were poor in cases with abdominal pain, abnormal uterine bleeding and fibroids. But there was a high correlation in cases with adnexial mass.

  17. An audit of indications and complications associated with elective hysterectomy at SVMCH and RC, Ariyur, Pondicherry

    Nidhi Bansal, Hiremath PB, Meenal C, Vishnu Prasad


    Full Text Available Background: Hysterectomy is the most common gynaecological surgery performed worldwide Menorrhagia secondary to uterine fibroids and abnormal menstrual bleeding are the two most common indications for hysterectomy. An important factor impacting on the incidence of complications of hysterectomy, apart from the indication for surgery, is the surgical approach. Most surgeons perform up to 80% of procedures by the abdominal route. The incidence of LAVH performed for benign lesions has progressively increased in recent years. Methods : Surgical indications and details, histological findings, and postoperative course were reviewed and analysed for 340 patients who underwent hysterectomy in 2011 and 2012.Results : In our study, fibroid uterus (27.9 % was the leading indication for performing hysterectomies followed by a DUB (22.9% and uterovaginal prolapse (UVP-21.8%. During the study period (2011-2012, most hysterectomies were performed abdominally (54.4%. Overall post operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the vaginal and laparoscopic group ( p value= 0.001 . Conclusion: We need to ensure that trainees acquire competency in performing hysterectomies vaginally, which is clearly safer than the abdominal approach.

  18. Emergency peripartum hysterectomy

    Jakobsson, Maija; Tapper, Anna-Maija; Colmorn, Lotte Berdiin;


    OBJECTIVE: To assess the prevalence and risk factors of emergency peripartum hysterectomy. DESIGN: Nordic collaborative study. POPULATION: 605 362 deliveries across the five Nordic countries. METHODS: We collected data prospectively from patients undergoing emergency peripartum hysterectomy within...... 7 days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period. MAIN OUTCOME MEASURES: Emergency peripartum hysterectomy rate. RESULTS: The total number of emergency.......7%), uterine rupture (n = 31, 14.7%), other bleeding disorders (n = 12, 5.7%), and other indications (n = 8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post-term birth increased the risk for emergency peripartum...

  19. Fallopian tube prolapse after hysterectomy: a systematic review.

    Lobna Ouldamer

    Full Text Available BACKGROUND: Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this disregarded complication when dealing with post-hysterectomy vaginal bleeding. OBJECTIVES: We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcome of fallopian tube prolapse occurring after hysterectomy. SEARCH STRATEGY: A systematic search of MEDLINE and EMBASE references from January 1980 to December 2010 was performed. We included articles that reported cases of fallopian tube prolapse after hysterectomy. Data from eligible studies were independently extracted onto standardized forms by two reviewers. RESULTS: Twenty-eight articles including 51 cases of fallopian tube prolapse after hysterectomy were included in this systematic review. Clinical presentations included abdominal pain, dyspareunia, post- coital bleeding, and/or vaginal discharge. Two cases were asymptomatic and diagnosed at routine checkup. The surgical management reported comprised partial or total salpingectomy, with vaginal repair in some cases combined with oophorectomy using different approaches (vaginal approach, combined vaginal-laparoscopic approach, laparoscopic approach, or laparotomy. Six patients were initially treated by silver nitrate application without success. CONCLUSIONS: This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with fallopian tube prolapse following hysterectomy published in the past 30 years. We anticipate that these results will help inform current investigations and treatment.

  20. Emergency peripartum hysterectomy

    Mehmet Sıddık Evsen


    Full Text Available The aim of the present study was to determine the incidence, indications and maternal characteristics of emergency peripartum hysterectomy (EPH.Medical records belong to 49 patients, that undergone EPH at Diyarbakır Gynecology and Obstetrics Hospital, between September 2005 and August 2008 were retrospectively reviewed. During three years, from 63463 deliveries, hysterectomy was performed to 49 patients (0.77/1000 due to obstetrical hemorrhage. Indications for EPH were uterine atony (49.6%, uterine rupture (42.9% and placenta accreata (8.2%. The mean age of patients was 34.6±5.7 years, and mean gravida was 5.5±2.4. Subtotal hysterectomy was performed to 31 (63.3% patients and total hysterectomy to 18 (36.7% of them. Bilateral hypogastric artery ligation was performed to 8 (16.3% and unilateral ooferectomy to 7 (14.3%. Two of our patients died secondary to uncontrolled uterine bleeding.In conclusion, uterine atony and uterine rupture were the most frequent causes of EPH. Emergent and appropriate management of these patients is the most important life saving procedure.

  1. The effect of hysterectomy on ano-rectal physiology.

    Kelly, J L


    Hysterectomy is associated with severe constipation in a subgroup of patients, and an adverse effect on colonic motility has been described in the literature. The onset of irritable bowel syndrome and urinary bladder dysfunction has also been reported after hysterectomy. In this prospective study, we investigated the effect of simple hysterectomy on ano-rectal physiology and bowel function. Thirty consecutive patients were assessed before and 16 weeks after operation. An abdominal hysterectomy was performed in 16 patients, and a vaginal procedure was performed in 14. The parameters measured included the mean resting, and maximal forced voluntary contraction anal pressures, the recto-anal inhibitory reflex, and rectal sensation to distension. In 8 patients, the terminal motor latency of the pudendal nerve was assessed bilaterally. Pre-operatively, 8 patients were constipated. This improved following hysterectomy in 4, worsened in 2, and was unchanged in 2. Symptomatology did not correlate with changes in manometry. Although, the mean resting pressure was reduced after hysterectomy (57 mmHg-53 mmHg, P = 0.0541), the maximal forced voluntary contraction pressure was significantly decreased (115 mmHg-105 mmHg, P = 0.029). This effect was more pronounced in those with five or more previous vaginal deliveries (P = 0.0244, n = 9). There was no significant change in the number of patients with an intact ano-rectal inhibitory reflex after hysterectomy. There was no change in rectal sensation to distension, and the right and left pudendal nerve terminal motor latencies were unaltered at follow-up. Our results demonstrate that hysterectomy causes a decrease in the maximal forced voluntary contraction and pressure, and this appears to be due to a large decrease in a small group of patients with previous multiple vaginal deliveries.




    Full Text Available OBJECTIVE: To determine the incidence , indications , maternal and perinatal outcome of emergency peripartum hysterectomy. METHOD: A prospective observational study of all patients who underwent peripartum hysterectomy was conducted from June 2011 to November 2012 in the Department of Obstetrics and Gynecology , Lalla Ded Hospital , an associated hospital of Government Medical College , Srinagar , Kashmir. Data , specifically on the incidence of emergency peripartum hysterectomy , the total number of deliveries , the maternal parameters , the indications of peripartum hysterectomy and associated maternal morbidity and mortality were recorded on a proforma. RESULTS: There were 87 cases of peripartum hysterectom y ( 75 caesarean hysterectomies , 86.2% and 12 postpartum hysterectomies , 13.8% , making an incidence of 2.56/1000 deliveries. Most of the patients were para 3 , 32 ( 36.8% , were mostly in age group of 35 - 39 years 38 ( 43.7% and belonged to rural areas . Overa ll , the most common indication for emergency peripartum hysterectomy was morbidly adherent placenta with placenta previa 39( 44.8% followed by uterine rupture 24 ( 27.6 % , uterine atony 13 (14.9% and accidental haemorrhage 6 (6.9%. In 38 (43.7% patients total abdominal hysterectomy was performed while 49 (56.3% patients required subtotal hysterectomy. There were 9 (10.3% maternal and 40 (46% perinatal deaths; all were due to severity of conditions necessitating hysterectomy. CONCLUSION: Emergency perip artum hysterectomy is potentially a lifesaving procedure associated with significant maternal morbidity and mortality. Morbidly adherent placenta with placenta previa was the commonest indication for emergency peripartum hysterectomy. Previous scar , multip arity and abnormal placentation were the significant risk factors.

  3. Learning curve analysis of laparoscopic radical hysterectomy for gynecologic oncologists without open counterpart experience

    Kong, Tae-Wook; Chang, Suk-Joon; Paek, Jiheum; Park, Hyogyeong; Kang, Seong Woo; Ryu, Hee-Sug


    Objective To evaluate the learning curve of laparoscopic radical hysterectomy (LRH) for gynecologic oncologists who underwent residency- and fellowship-training on laparoscopic surgery without previous experience in performing abdominal radical hysterectomy (ARH). Methods We retrospectively reviewed 84 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB cervical cancer who underwent LRH (Piver type III) between April 2006 and March 2014. The patients were divid...

  4. Salpingectomy as standard at hysterectomy?

    Guldberg, Rikke; Wehberg, Sonja; Skovlund, Charlotte Wessel; Mogensen, Ole; Lidegaard, Ojvind


    To assess if the risk of first-time salpingectomy was affected by prior hysterectomy with retained fallopian tubes and by prior sterilisation.......To assess if the risk of first-time salpingectomy was affected by prior hysterectomy with retained fallopian tubes and by prior sterilisation....

  5. Lower urinary tract symptoms after total and subtotal hysterectomy

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Birthe Jakobsen; Sørensen, Helle Christina; Toftager-Larsen, Kim; Sidenius, Katrine; Møller, Nini; Madsen, Ellen Merete; Vejtorp, Mogens; Clausen, Helle; Rosgaard, Annie; Villumsen, John; Gluud, Christian; Ottesen, Bent S; Tabor, Ann


    The aim of this Danish multicenter trial was to compare the proportion of women with lower urinary tract symptoms after total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (SAH) for benign uterine disorders. A total of 319 women were randomized to TAH (n = 158) or SAH (n = 161......). Women were followed up for 1 year by strict data collection procedures, including postal questionnaires. Results were analyzed by intention-to-treat analyses. Urinary incontinence was found less often among TAH women than among SAH women. This was due to a larger reduction of the number of women with...... stress and urinary incontinence in the TAH group. No other differences were found between the two operation methods. The number of women with urinary incontinence and frequency was reduced from study entry for follow-up, while double/triple voiding was increased. Incontinent women had significantly lower...

  6. Sexuality after total vs. subtotal hysterectomy

    Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe;


    The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....




    Full Text Available OBJECTIVE: To evaluate the role of non - descent vaginal hysterectomy in advancing gynaecological practice and to study the safety and feasibility of performing vaginal hysterectomy for non - prolapsed uterus as primary route in benign gynaecological condition . METHODS: A prospective study of 120 cases was conducted at the department of obstetrics and g ynaecology of PES institute of medical sciences and research from January 2012 to December 2014 120 patients planned for hysterectomy for a wide range of benign indications like fibroid uterus, AUB, adenomyosis were chosen for non - descent vaginal hysterect omy. Data regarding age, parity, uterine size, and estimated blood loss, length of operation, intra - operative and post - operative complications and hospital stay were recorded. RESULTS: A total of 120 cases were selected for non - descent vaginal hysterectomy . Among them 113(94.16% cases successfully underwent non - descent vaginal hysterectomy. Majority were aged 40 - 45 years (53.33% with 8 nullipara and 21primipara. Commonest indication was fibroid (58% and largest uterine size was 16 weeks. Different morc ellation techniques were used in more than 10weeks sized uterus. Adnexal surgeries were performed in 11 cases without much difficulty. In uncomplicated cases average blood loss was 200 ml and operating time was 60minutes. Most of the patients were discharg ed by 4 th post - operative day, 7 patients were converted to abdominal route due to various difficulties, 3 patients had bladder injury and 1 patient was subjected to laparotomy due to hemoperitoneum post operatively. CONCLUSION: Proper training and proper c ase selection can lead a gynecologist to consider the vaginal approach as the standard route for hysterectomy and good patient compliance

  8. Hysterectomy at a Canadian tertiary care facility: results of a one year retrospective review

    Gorwill R Hugh


    Full Text Available Abstract Background The purpose of this study was to investigate the indications for and approach to hysterectomy at Kingston General Hospital (KGH, a teaching hospital affiliated with Queen's University at Kingston, Ontario. In particular, in light of current literature and government standards suggesting the superiority of vaginal versus abdominal approaches and a high number of concurrent oophorectomies, the aim was to examine the circumstances in which concurrent oophorectomies were performed and to compare abdominal and vaginal hysterectomy outcomes. Methods A retrospective chart audit of 372 consecutive hysterectomies performed in 2001 was completed. Data regarding patient characteristics, process of care and outcomes were collected. Data were analyzed using descriptive statistics, t-tests and linear and logistic regression. Results Average age was 48.5 years, mean body mass index (BMI was 28.6, the mean length of stay (LOS was 5.2 days using an abdominal approach and 3.0 days using a vaginal approach without laparoscopy. 14% of hysterectomies were performed vaginally, 5.9% were laparoscopically assisted vaginal hysterectomies and the rest were abdominal hysterectomies. The most common indication was dysfunctional or abnormal uterine bleeding (37%. The average age of those that had an oophorectomy (removal of both ovaries was 50.8 years versus 44.3 years for those that did not (p Conclusions A significant reduction in LOS was found using the vaginal approach. Both the patient and the health care system may benefit from the tendency towards an increased use of vaginal hysterectomies. The audit process demonstrated the usefulness of an on-going review mechanism to examine trends associated with common surgical procedures.

  9. Review article: late post-hysterectomy ectopic pregnancy.

    Saad Aldin, Ehab; Saadeh, Joanna; Ghulmiyyah, Labib; Hitti, Eveline


    Ectopic pregnancy after hysterectomy is a rare but potentially life-threatening condition requiring prompt diagnosis to prevent the increased mortality associated with rupture. Twenty-seven cases of late post-hysterectomy ectopic pregnancy reported in the English literature since 1918 were reviewed and analysed for presenting symptoms, missed diagnosis rate at initial presentation, location of ectopic and rupture rate at diagnosis. The presenting symptoms were found to be non-specific. The diagnosis in this population is twice more likely to be missed than in women with intact uteri. The rupture rate is 63%, compared with 37% in women with intact uteri. The majority of late post-hysterectomy ectopic pregnancies (62%) were located in the fallopian tubes. Because of the potential risk of mortality, emergency physicians should always consider the possibility of ectopic pregnancy in childbearing women whose surgical history includes hysterectomy without oophorectomy. Evaluation of abdominal pain in this population should include a pregnancy test to ensure prompt diagnosis when the possibility of pregnancy exists clinically. PMID:22672163

  10. Histopathological Distribution of Ovarian Masses Occurring After Hysterectomy: A Five-Year Assay in Iranian Patients



    Full Text Available Background Ovarian cancer, the third most important genital cancer and fifth cause of cancer-related death in women, is diagnosed at terminal stages in 70% of cases. Therefore, it is imperative to know the possible risk factors associated with ovarian cancer. Only a few studies have discussed the histopathological features of ovarian masses occurring after hysterectomy. Objectives The study aimed to investigate the five-year prevalence and histopathological distribution of ovarian masses after hysterectomy in Iranian patients and to determine the need for prophylactic salpingo-oophorectomy. Patients and Methods This descriptive cross-sectional study enrolled all patients with ovarian masses and a history of hysterectomy for benign conditions who were visiting the gynecology clinic of Baqiyatallah Hospital, Tehran, between May 2009 and May 2014. Demographic information, pathological features of ovarian masses, family history, the time between hysterectomy and ovarian mass surgery, and method of hysterectomy were recorded in a predesigned checklist. The level of tumor markers such as CA125 and alpha-fetoprotein (α-FP were measured. Results Of the 1052 patients with ovarian masses, 45patients (mean age, 53.11 ± 9.56 years who had undergone abdominal hysterectomy underwent analysis. The study participants had a mean age of 47.92 ± 1.58 years at the time of hysterectomy. The mean time interval between hysterectomy and diagnosis of ovarian mass was 5.38 ± 4.15 years. Based on pathological reports, serous cystadenoma was the most frequent (43.2% pathological diagnosis, followed by mucinous cystadenoma (17.5%. Conclusions A majority of ovarian masses, especially those diagnosed within a short duration after hysterectomy, are benign. Iranian patients with such ovarian masses when asymptomatic and associated with negative tumor markers could be followed up, and prophylactic oophorectomy may not be necessary.

  11. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... as follows: I’ll begin with some historical information regarding hysterectomy, and then we’ll show a ... perform the hysterectomy procedure; however I believe the information that we present and discuss tonight will be ...

  12. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... discuss an innovative approach to do a hysterectomy. It’s called the “minilap hysterectomy.” I’m very excited ... settle for large incisions and prolonged recoveries when it comes time to have your hysterectomy. With that, ...

  13. Peripartum hysterectomy: an evolving picture.

    Turner, Michael J


    Peripartum hysterectomy (PH) is one of the obstetric catastrophes. Evidence is emerging that the role of PH in modern obstetrics is evolving. Improving management of postpartum hemorrhage and newer surgical techniques should decrease PH for uterine atony. Rising levels of repeat elective cesarean deliveries should decrease PH following uterine scar rupture in labor. Increasing cesarean rates, however, have led to an increase in the number of PHs for morbidly adherent placenta. In the case of uterine atony or rupture where PH is required, a subtotal PH is often sufficient. In the case of pathological placental localization involving the cervix, however, a total hysterectomy is required. Furthermore, the involvement of other pelvic structures may prospectively make the diagnosis difficult and the surgery challenging. If resources permit, PH for pathological placental localization merits a multidisciplinary approach. Despite advances in clinical practice, it is likely that peripartum hysterectomy will be more challenging for obstetricians in the future.

  14. 腹式子宫切除术中0.6%甲磺酸罗哌卡因脊髓麻醉的有效剂量*%Effective dose of 0.6% Ropivacaine mesylate for spinal block of combined spinal-epidural anesthesia of abdominal hysterectomy

    时利荣; 崔成立; 王静; 祁风灵; 葛华; 郭俊利; 陈军妹


    目的:观察研究0.6%甲磺酸罗哌卡因在腹式子宫切除术腰麻联合硬膜外麻醉中蛛网膜下腔阻滞的有效剂量。方法随机选取妇科腹式子宫切除术患者80例,按随机数字表法分为4组,每组20例。单因素设计,采用序贯试验的Robbins- Monro法,监测血压、心电图、术中恶心、呕吐,观察感觉神经和运动神经阻滞、术后并发症及追踪1个月后肝、肾功能是否发生变化,记录达到有效剂量标准、超过有效剂量标准、未达到有效剂量标准的情况,并据此分析研究。结果在腹式子宫切除术腰麻联合硬膜外麻醉中,应用0.6%甲磺酸罗哌卡因使蛛网膜下腔阻滞达到有效标准者的生命体征平稳,心电图未见明显变化,术中偶有恶心,无呕吐。其半数有效剂量(ED50)为15.33 mg,95%可信区间为13.56,16.76。结论0.6%甲磺酸罗哌卡因可以安全有效地应用于腰麻联合硬膜外麻醉蛛网膜下腔阻滞,ED50为15.33 mg,无明显毒副作用,对循环影响较轻。%Objective To study the effective dose of 0.6% Ropivacaine mesylate for spinal block of com-bined spinal-epidural anesthesia in abdominal hysterectomy. Methods Eighty patients of elective abdominal hysterectomy were selected randomly, given serial number and divided into four groups (20 in each group) ac-cording to the random number table. Single factor design was carried out for Robbins-Monro's procedure of sequential trials. The level of anesthesia plane of sensory nerve block and motor nerve block was observed. Blood pressure, electrocardiogram, nausea and vomiting were monitored, and postoperative side effects, changes in liver and kidney function one month after operation were tracked. Some criteria such as the effective-dose standard, the standard of over effective-dose and suboptimal dose standard were evaluated and recorded. The results were analyzed by statistic software 19.0. Results When the optimal

  15. Case series of abdominal sacral colpopexy

    Vandana Dhama


    Conclusions: Abdominal sacral colpopexy with polypropylene mesh is a safe, effective treatment in patients having post hysterectomy vaginal vault proplase. When done by experienced gynecologist, major post-operative complications seem to be very few in patients having normal BMI and no major systemic illnesses. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1992-1995




    Full Text Available Urinary bladder injury or injury to ureter is a recognized complication of lower abdominal surgery and it is the most common organ injured during gynecological procedures. We report here, history of a 48 year old female developing ascites and respiratory distress on 3 rd postoperative day of abdominal hysterectomy for fibroid ut e rus. Ultrasound guided abdominal tap showed urine. Computed tomography of abdomen revealed double ureter and injury to one of the left ureters. It was re implanted and bladder site repaired throug h emergency lap a rotomy. The key to the diagnosis of ureter injury is awareness of this clinical entity.




    Full Text Available OBJECTIVE: This study was designed to identify various factors affecting women’s decision to undergo hysterectomy, to know the reasons for preference of hysterectomy over medical and surgical conservative management and observe occurrence of various uterine pathologies in relation to age. METHODS: A prospective observational study of 600 patients who underwent hysterectomy for various etiologies by different routes at Sola Civil Hospital, Ahmedabad over a period of 1 year (from jan-13 to Dec 13 was carried out. RESULT: percentage of patients undergoing hysterectomy in prolapse and adenomyosis group patients are 100% and 96.29% In DUB 64.39% and the fibroid group 68.10-% patients preferred hysterectomy as a first line of treatment. CONCLUSION: DUB was recognized as the most common indication for hysterectomy amongst reproductive age women whereas prolapse was the commonest indication in women over 50 years of age. A considerable number of patients with PID preferred medical management Patients with DUB and fibroid preferred conservative surgical and medical management before finally opting for hysterectomy but more than 64% patients in both group opted hysterectomy as first-line treatment.. Cost of medical management and affection of quality of life were identified as major reasons for diverting to permanent cure (hysterectomy in DUB patients. Belief of uterus as a vestigial organ after completion of childbearing was reason for hysterectomy in PID and prolapse patients.

  18. Anti-hemorrhagic effect of prophylactic tranexamic acid in benign hysterectomy - a double-blinded randomized placebo-controlled trial

    Fink Topsøe, Märte; Bergholt, Thomas; Ravn, Pernille;


    to benign hysterectomy is still missing. OBJECTIVE: To investigate the anti-hemorrhagic effect of prophylactic tranexamic acid in elective benign hysterectomy. STUDY DESIGN: A double-blinded randomized placebo-controlled trial was conducted at four Gynecological departments in Denmark from April 2013...... in 2004, 8% of all women in Denmark undergoing benign hysterectomy experienced a bleeding complication. Tranexamic acid is an anti-fibrinolytic agent that has shown to effectively reduce bleeding complications within other surgical and medical areas. However, knowledge on the drugs effect in relation...... to October 2014. A total of 332 women undergoing benign abdominal, laparoscopic or vaginal hysterectomy were included in the trial, and randomized to either 1 g of intravenous tranexamic acid or placebo at start of surgery. Chi-test and Student T-test statistical analyses were applied. RESULTS: The...

  19. Transformation of Abdominal Wall Endometriosis to Clear Cell Carcinoma

    Maria Paula Ruiz; Darryl Lewis Wallace; Matthew Thomas Connell


    Clear cell carcinoma is the least common of the malignant transformations reported in nonpelvic sites of endometriosis. Two cases with clear cell carcinoma transformation arising from endometriosis in abdominal wall scars are presented. These patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic washings, and abdominal wall lesion resection. The first case had initial treatment with chemotherapy, while chemotherapy and radiation therapy were given for th...

  20. Role of non-descent vaginal hysterectomy in previous cesarean section scar women

    Naina Kumar


    Results: Total ten cases were selected for NDVH with history of one, two/ three cesarean sections. All successfully underwent NDVH, except one in which bladder injury occurred which was repaired at same time from below. Five patients had previous one Lower Segment Cesarean Section (LSCS, four had two LSCS and one had three LSCS. Commonest indication was leiomyoma of uterus followed by abnormal uterine bleeding. Mean duration of surgery was 50 +/- 20.5 min. Mean blood loss was 150 +/- 65 ml. Post-operative complications were minimal with no scar, patient mobility, resumption of daily activities was fast. Mean hospital stay was 4-5 days. Conclusions: Vaginal hysterectomy appears to be safe, cost effective alternative to abdominal hysterectomy in women with previous cesarean section scar requiring hysterectomy for benign conditions with fewer complications, shorter hospital stay. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 785-789

  1. Histopathological Study of Hysterectomy Operations in A University Clinic in Tehran From 2005 to 2009

    Mahmoud Khaniki


    Full Text Available Objective: We intended to determine causes and histological pattern of hysterectomies in an Iranianpopulation.Materials and methods: Archived reports of pathology department of a university hospital dated March2005 to March 2009 were retrospectively reviewed. Age, chief complaint, type of operation includingabdominal, vaginal and subtotal hysterectomy, the indication of the operation and the pathology of thespecimen were retrieved from the records.Results: The average rate of hysterectomy was 219 per year. The average age of the patients was49.6±11.3. About 40% of cases aged 45-54 years. The main chief compliant was abnormal uterinebleeding (62.2%. The leading preoperative indication for hysterectomy operations were uterineleiomyoma (24.8% and then abnormal uterine bleeding and abdominal/pelvic mass. The most frequentpathologic findings were leiomyoma (22.0% and adenomyosis (12.1%. In 11.8% of hysterectomyspecimens no pathologic lesion was found.Conclusion: The hysterectomy is rather common in Iran with age dependent pattern of indications andcorresponding pathologies.

  2. Total laparoscopic hysterectomy versus vaginal hysterectomy: a retrospective study

    Jayashree S.


    Full Text Available Background: Total laparoscopic hysterectomy (TLH is now emerging as a safe procedure even in patients suitable for vaginal hysterectomy (VH due to its advantages like better visualisation, less post-operative pain and shorter hospital stay. This study was done to compare the duration of surgery, intra-operative and postoperative complications, hospital stay and post-operative analgesia requirement in TLH and VH. Methods: A retrospective study of women undergoing TLH and VH between June 2013 and September 2014 in JSS Hospital, Mysore was done. Patients with suspected genital malignancy and uterine prolapse were excluded. Baseline characteristics like age, BMI, parity, indication for hysterectomy, uterine size and previous pelvic surgeries were noted. Intra-operative and post-operative parameters like duration of surgery, complications, post-operative analgesic dosage and hospital stay were compared between the two surgeries and the results were analysed using Chi square test and independent t test. Results: The mean time taken to perform TLH was significantly longer, i.e. 113.46 minutes compared with VH, i.e. 61.18 minutes ( p <0.0001. But the duration of stay in the hospital was shorter for the women undergoing TLH, mean duration being 3.74 days as opposed to 5.85 days in women undergoing VH (p<0.0001. Also, women undergoing VH required more analgesic doses (mean 1.79 than those undergoing TLH (mean 1.36. When we studied the rate of complications in both the groups, we found no statistically significant difference. Conclusions: TLH was as safe as VH and had advantages like shorter hospital stay and reduced analgesia dose. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1499-1504

  3. Urological complications after radical hysterectomy: Incidence rates and predisposing factors

    Likić-Lađević Ivana


    Full Text Available Bacground/Aim. Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy. Methods. The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient’s age; the International Federation of Ginecology and Obstetrics (FIGO stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection. Results. The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentioned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal

  4. Depression Following Hysterectomy and the Influencing Factors

    Bahri, Narjes; Tohidinik, Hamid Reza; Fathi Najafi, Tahereh; Larki, Mona; Amini, Thoraya; Askari Sartavosi, Zahra


    Background Hysterectomy is one of the most common gynecological surgeries performed worldwide. However, women undergoing this surgery often experience negative emotional reactions. Objectives This study was done with the aim of investigating the relationship between hysterectomy and postoperative depression, three months after the procedure. Materials and Methods This longitudinal study was conducted in the province of Khorasan-Razavi in Iran, using multistage sampling. At first, three cities were selected from the province by cluster sampling; then, five hospitals were randomly selected from these cities. The participants included 53 women who were hysterectomy candidates in one of the five selected hospitals. The participants’ demographics and hysterectomy procedure information were entered into two separate questionnaires, and the Beck depression inventory (BDI) was employed to measure their severity of depression before and three months after the surgery. The statistical package for the social sciences (SPSS) version 16 was used for the statistical analysis, and a P value of < 0.05 was considered to be statistically significant. Results The means and standard deviations of the participants’ depression scores before and three months after their hysterectomies were 13.01 ± 10.1 and 11.02 ± 10.3, respectively. Although the mean score of depression decreased three months after the hysterectomy, the difference was not statistically significant. However, a significant relationship was found between the satisfaction with the outcome of the hysterectomy and the postoperative depression score (P = 0.04). Conclusions In this study, undergoing a hysterectomy did not show a relationship with postoperative depression three months after the surgery. Moreover, the only factor related to depression following a hysterectomy was satisfaction with the surgery. PMID:27066267

  5. Laparoscopic hysterectomy in the treatment of endometrial cancer: NCI experience

    The standard treatment for women with endometrial cancer is total abdominal hysterectomy and pelvic lymphadenectomy for surgical staging. Total laparoscopic radical hysterectomy (TLH) is an alternative approach providing surgical and patient related advantages to laparoscopy. Methods: Twenty female patients with early stage endometrial cancer were operated upon by TLH and pelvic lymphadenectomy, aiming to assess the safety and efficacy of TLH. Results: The mean operative time was 296.8 min conversion to laparotomy was done in one patient due to bleeding from the uterine vessels. The mean blood loss was 517.5 cc. The uterus was removed transvaginally in 18 patients (90%) and via a small Pfannenstiel incision in two patients (10%). The mean number of pelvic lymph nodes retrieval was 21.2. Postoperative bleeding occurred in one patient (5%) which necessitated exploration. One patient (5%) suffered a pulmonary embolism. Four patients (20%) developed pyrexia, and one patient (5%) suffered from a chest infection. One patient (5%) had wound infection. The mean hospital stay was 4.5 days (range 3-10). Conclusion: TLH with pelvic lymphadenectomy is a safe and effective approach in the treatment of early endometrial carcinoma.

  6. Hysterectomy

    ... in the pelvic area). You may still get pregnant after myolysis. Treatments to shrink fibroids without surgery. These treatments include uterine artery embolization (UAE) and magnetic resonance (MR)-guided focused ultrasound (MR[f]US). UAE puts ...

  7. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... Illinois. I practice with North Shore University Health Systems at Highland Park Hospital. I’m joined tonight ... as follows: I’ll begin with some historical information regarding hysterectomy, and then we’ll show a ...

  8. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... recently issued an opinion to the OB-GYN community. They state that the vaginal hysterectomy is the ... this conflict out there in the OB-GYN community. The American College of OB-GYN wishes that ...

  9. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... 600,000 procedures being performed annually. By the age of 60, one in three women will have ... hysterectomy (INAUDIBLE) myomectomy, adnexal masses, pretty common standard age. Most people going through this procedures are in ...

  10. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... this evening you will feel very encouraged to offer the minilap hysterectomy to your patients, and if ... that’s what you want to be able to offer your patients. You can offer them something that ...

  11. Expanding Patient Options: Minilaparotomy for Hysterectomy

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  12. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... know that all the patients in this particular analysis had supercervical hysterectomies. So back to that slide, ... patient recovery. I would say that, again, statistical analysis tells us that we’re not comfortable doing ...

  13. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... This is something that I can do.” Many times I would have attended conferences and seminars where ... large incisions and prolonged recoveries when it comes time to have your hysterectomy. With that, let me ...

  14. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... hysterectomy summer of 2009, and it was my doctor that recommended the surgery. I had this procedure ... that’s gone. My expectations were really high. My doctor, Dr. Fillmore, said it was going to be ...

  15. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... to be a question of asking, what’s the comparison of this procedure with other hysterectomies? In my ... an approach because it has many benefits. In comparison to the laparoscopy, I do a lot of ...

  16. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... is as follows: I’ll begin with some historical information regarding hysterectomy, and then we’ll show ... if feasibly possible. It does have the best historical data in terms of outcome and patient recovery. ...

  17. Expanding Patient Options: Minilaparotomy for Hysterectomy

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  18. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... women will have had a hysterectomy. The American College of OB-GYN recently issued an opinion to ... something new. About 20 years ago, the American College of OB-GYN or ACOG issued a similar ...

  19. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... By the age of 60, one in three women will have had a hysterectomy. The American College ... Alexis O, please make sure you get the right retractor. It will make all the difference in ...

  20. The Effect of Abdominal Radical Trachelectomy on Ovarian Reserve: Serial Changes in Serum Anti-Müllerian Hormone Levels

    Miho Muraji, Tamotsu Sudo, Shinichi Iwasaki, Sayaka Ueno, Senn Wakahashi, Satoshi Yamaguchi, Kiyoshi Fujiwara, Ryuichiro Nishimura


    Full Text Available Aim: To evaluate the effect of abdominal radical trachelectomy on ovarian reserve and compare it with abdominal radical hysterectomy and a control group that did not have surgery.Method: We enrolled eighteen women who had abdominal radical trachelectomy with pelvic lymphadenectomy and sixteen patients who had abdominal radical hysterectomy for this study. Ten thousand one hundred eighty-six women were also included as a control group for comparison. The Mann-Whitney U test was used for comparison of patient characteristics and comparison of serum anti-Müllerian hormone levels between the three groups.Results: Serum anti-Müllerian hormone levels in patients with abdominal radical trachelectomy were significantly higher than those of patients with abdominal radical hysterectomy (P<0.05. Serum anti-Müllerian hormone levels in the abdominal radical hysterectomy group were significantly lower than those in the control group (P=0.02, with no significant difference between the abdominal radical trachelectomy and control groups. These data indicated that abdominal radical trachelectomy did not affect ovarian function with respect to ovarian reserve and the response to ovarian stimulation.Conclusions: Serum anti-Müllerian hormone levels could be useful as a marker of ovarian reserve after abdominal radical trachelectomy. It is important to avoid postoperative complications causing a reduction in ovarian function to accomplish fertility-sparing surgery.

  1. Women's Hysterectomy Experiences and Decision-Making

    Uskul, Ayse K.; Ahmad, Farah; Leyland, Nicholas A.; Stewart, Donna E.


    The goal of the study was to examine women's experiences with gynaecologic symptoms and how they decided to undergo hysterectomy. For this purpose, twenty-nine women were interviewed in hospital within three days of undergoing hysterectomy. The interviews elicited information about the nature of the problem that caused the women to seek medical help, actions taken to solve their problem, their relationship with their gynaecologist, information seeking patterns and decision-making about hyster...

  2. Diagnostic Neglect Regarding Ureter Ligation After Hysterectomy

    BİLGE, Yaşar


    Complications following cesarean and hysterectomy operations can occur, one of which is ureter ligation. Aims: Urological injuries that occur during hysterectomy are rare but important causes of morbidity. It was aimed to investigate in this case report whether there was any evidence to support malpractice in Court. Case Report: The patient was a woman in her 343 week of pregnancy with familial Mediterranean fever (FMF) and nephrotic syndrome with renal amyloidosis. Preterm operational di...

  3. Single-port access laparoscopic hysterectomy: a new dimension of minimally invasive surgery.

    Liliana, Mereu; Alessandro, Pontis; Giada, Carri; Luca, Mencaglia


    The fundamental idea is to have all of the laparoscopic working ports entering the abdominal wall through the same incision. Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus and reduces morbidity of minimally invasive surgery. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. This review summarizes the history of SPAL hysterectomy (single-port access laparoscopy), and emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific gynecological applications of single-port hysterectomy to date are summarized. Using the PubMed database, the English-language literature was reviewed for the past 40 years. Keyword searches included scarless, scar free, single-port/trocar/incision, single-port access laparoscopic hysterectomy. Within the bibliography of selected references, additional sources were retrieved. The purpose of the present article was to review the development and current status of SPAL hysterectomy and highlight important advances associated with this innovative approach. PMID:22442528

  4. Abdominal Ultrasound

    ... It is used to help diagnose pain or distention and evaluate the kidneys, liver, gallbladder, pancreas, spleen ... variety of conditions, such as: abdominal pain or distention. abnormal liver function. enlarged abdominal organ. stones in ...

  5. Abdominal Adhesions

    ... adhesions? Abdominal adhesions can cause intestinal obstruction and female infertility—the inability to become pregnant after a year of trying. Abdominal adhesions can lead to female infertility by preventing fertilized eggs from reaching the uterus, ...

  6. Morbidity and mortality associated with obstetric hysterectomy

    Background: Obstetric hysterectomy still complicates a substantial number of pregnancies in third world countries and is a significant cause of obstetric morbidity and mortality. This study was carried out to evaluate in our setup the frequency of obstetric hysterectomy, its indication, risk factors, complication, morbidity, mortality and avoidable factors. Methods: A descriptive study of all patients who under went obstetric hysterectomy was conducted from May 1, 2004 to October 31, 2005 at Gynaecology and Obstetric Unit-II, III of Liaquat University of Medical and Health Science Hospital, Hyderabad. After collecting the data on pre-designed proforma the data was fed to SPSS in the form of frequency distribution tables and percentages were calculated. Statistical analysis of data was performed by using Chi-square test. The level of significance was taken as p<0.05. Results: During the study time period there were total 6495 deliveries and 41 cases of obstetric hysterectomy were identified, giving a frequency of 0.63% or 1 in 158 deliveries. Most of patients were from rural areas (82.92%), un-booked 73.17%), uneducated (95%), lower socio economical class (92.69%), 25-29 years age (48.78%) multiparae (56.10%), have to travel a distance of <100 km to reach hospital and referred late (51%) by health care providers (doctors). Majority of hysterectomies were performed due to ruptured uteri (51.21%). There were 5 maternal and 26 perinatal deaths; all were due to severity of conditions necessitating hysterectomy. Conclusion: Incidence of obstetric hysterectomy in our woman is very high. The reason being many avoidable factors such as high parity, inadequate maternity and family planning services, lack of proper referral system, un-booked status, mismanaged labour, illiteracy on the part of woman herself, family and health care providers are not taken care of during pregnancy, labour and puerperium. (author)

  7. Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy

    Torup, H; Bøgeskov, M; Hansen, E G;


    on top of paracetamol and ibuprofen or diclofenac. For the first 24 post-operative hours, we monitored PCA morphine consumption and pain scores with visual analogue scale (VAS) at rest and while coughing. Post-operative nausea and number of vomits (PONV) were recorded. RESULTS: Sixty-five patients......BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS: In a...... and Nonsteroidal anti-inflammatory drugs (NSAID) treatment, had no effect on morphine consumption, VAS pain scores, or frequency of nausea and vomiting after robot-assisted laparoscopic hysterectomy compared with paracetamol and NSAID alone....

  8. Abdominal Assessment.

    Fritz, Deborah; Weilitz, Pamela Becker


    Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care. PMID:26925941

  9. Classical radical hysterectomy and nerve-sparing radical hysterectomy in the treatment of cervical cancer

    Marcin Makowski; Marek Nowak; Marian Szpakowski; Jacek Władziński; Anna Serwach-Nowińska; Łukasz Janas; Jacek R. Wilczyński


    Aim of the study: To compare Piver III radical hysterectomy (RH) with nerve-sparing radical hysterectomy (NSRH) for cervical cancer patients in terms of postoperative physiology of pelvic autonomic nerves and perioperative complications. Material and methods : Seventy-three consecutive patients with invasive cervical cancer underwent RH (53 cases) or NSRH (20 cases) from 2001 to 2012 at the Department of Gynecology and Gynecologic Oncology of Polish Mother’s Memorial Hospital – Research...

  10. Low adherence to cervical cancer screening after subtotal hysterectomy

    Andersen, Lea Laird; Møller, Lars Mikael Alling; Gimbel, Helga Margrethe


    INTRODUCTION: A reason for not recommending subtotal hysterectomy is the risk of cervical pathology. We aimed to evaluate cervical cancer screening and to describe cervical pathology after subtotal and total hysterectomy for benign indications. METHODS: Data regarding adherence to screening.......7% were not screened. We found a minimum of one abnormal test in 28 (10.8%) after subtotal hysterectomy and one after total hysterectomy. No cervical cancers were found. CONCLUSIONS: Adherence to cervical cancer screening after subtotal hysterectomy in a Danish population is suboptimal and some patients...... have unnecessary tests performed after total hysterectomy. Clarification of the use of cervical/vaginal smears after hysterectomy is needed to identify women at risk of cervical dysplasia or cancer. FUNDING: Research Foundation of Region Zealand, University of Southern Denmark, Nykøbing Falster...

  11. Transmural penetration of sigmoid colon and rectum by retained surgical sponge after hysterectomy.

    Shin, Woo Young; Im, Chan Hyuk; Choi, Sun Keun; Choe, Yun-Mee; Kim, Kyung Rae


    Gossypiboma is a surgical sponge that is retained in the body after the operation. A 39-year-old female presented with vague lower abdominal pain, fever, and rectal discharge 15 mo after hysterectomy. The sponge remaining in the abdomen had no radiopaque marker. Therefore a series of radiographic evaluations was fruitless. The surgical sponge was found in the rectosigmoid colon on colonoscopy. The sponge penetrated the sigmoid colon and rectum transmurally, forming an opening on both sides. The patient underwent low anterior resection and was discharged without postoperative complications. PMID:26973401

  12. Abdominal trauma

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  13. Abdominal trauma

    The potential for multiple intraperitoneal and retroperitoneal organ injuries often makes accurate clinical evaluation of abdominal trauma patients difficult. Additionally, patients may be unresponsive, have unreliable abdominal physical examinations, or have concurrent serious head and cervical spine injuries which delay diagnosis of and attention to abdominal problems. In these situations radiologic abdominal imaging is often requested. To expedite patient evaluation, close cooperation between the emergency physician and the radiologist is essential. It is the clinical stability of the traumatized patient that dictates the extent of radiologic imaging. Life-threatening hypotension, positive peritoneal signs, or clear evidence of penetrating abdominal injury are indications for immediate surgery. Stable patients with signs suggesting intra-abdominal injury will benefit by further radiologic evaluation with appropriate imaging modalities. The selection of an appropriate modality in any one clinical situation depends upon many criteria including accessibility to diagnostic equipment, the sensitivity and specificity of each technique, and the expertise and preference of the attending radiologist. A suggested scheme for evaluating abdominal trauma patients is presented. Most aspects of this evaluation scheme will be discussed in depth

  14. Development of Transvaginal Uterus Amputation Device for Laparoscopic Hysterectomies in Gynecologic Surgeries

    Serkan DİKİCİ


    Full Text Available Hysterectomy, that is removal of uterus, is one of the most common major operations in gynecologic surgeries. Laparoscopy technique is preferred in hysterectomy because of its advantages such as lower intra-operative blood loss, decreased surrounding tissue/organ damage, less operating time, lower postoperative infection and frequency of fever, shorter duration of hospitalization and post-operative returning time to normal activity. During total laparoscopic hysterectomy, first uterine vessels and ligaments are cauterized respectively, and then cervicovaginal connections are cauterized and coagulated to remove uterus completely. Uterine manipulators are used during laparoscopy to maximize the endoscopic vision of surgeons by moving related organs. However, conventional uterine manipulators have important drawbacks particularly to move uterus in three dimensions and to show cervicovaginal landmark during laparoscopic circular cauterization and amputation of the uterine cervix. A new transvaginal uterine manipulator may overcome these two important drawbacks of these currently available devices. For this reason, a3D scanned technique was used to get uterus sizes and computer aided design software is used in designing of the new manipulator and then 3D printer was used in prototyping. Special light emitting diodes (LEDs were mounted on the cervical cap of the manipulator to guide light beams from inside of cervicovaginal tissue to abdominal cavity to facilitate the visualization of tissue landmarks. Moreover, performances of different caps and LED systems will be evaluated. Furthermore, after integration of self-cutting and self-suturing mechanisms into our system, final prototype will be produced by using titanium which is biologically and mechanically appropriate. Therefore, aim of this study was to design and produce a new uterine manipulator with three dimensional movements, LED illumination, self-cutting and self-suturing systems to facilitate

  15. Abdominal sounds

    ... during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation. Increased ( hyperactive ) bowel sounds ...


    Vyas, J.N.; R. S. Rathore; P.Sharma; Singhal, A.K.


    SUMMARY Thirty women patients who were hysterectomized for non-malignant pathologies were compared with thirty comparable patients who underwent other gynaecological operations. Each patient was subjected to semistructured psychiatric interview, standardised Hindi version of G.H.Q., Hindi version of PEN, I.P.I.S. and BDRI. The diagnosis was made according to I.C.D. - 9. It was observed that patients undergoing hysterectomy do suffer significantly higher psychiatric morbidity (60%), had higher...


    Abha; Smrity; Anchala


    BACKGROUND: Hysterectomy is the most common gynec operation worldwide. It leads to significant morbidity and mortality hence there must be justifiable indication before procedure is undertaken. There is a lack of comprehensive data and too much variability from place to place, even in India. OBJECTIVE: To analyze the changing trends in hysterectomy in past 6 years. METHOD: A retrospective study of all women undergoing hysterectomy that were done in Dr. B.R.A.M. Hospital, Medic...

  18. A 26-Year-Old Retained Demised Abdominal Pregnancy Presenting with Umbilical Fistula

    Nnadi Daniel


    Full Text Available This is a report on a 72-year-old postmenopausal woman who presented with passage of fetal bones through an umbilical fistula. She was diagnosed as a case of demised abdominal pregnancy, which had been retained for 26 years. She subsequently had exploratory laparotomy, evacuation of the abdominal pregnancy, hysterectomy, and bowel resection. The patient’s condition remained unstable throughout the postoperative period and she died from septicemia on the eleventh day.

  19. Abdominal Sepsis.

    De Waele, Jan J


    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy. PMID:27363829

  20. Abdominal Pain

    ... relaxation. Guided imagery for abdominal pain About self-hypnosis and kids See YourChild : Pain and Your Child or Teen for more detail ... how to help your baby cope with the pain of medical procedures, circumcision, and teething. ... Helping Kids YourChild : A Look at Biofeedback YourChild : ...

  1. Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

    Osako MT


    Full Text Available Claudio Sergio Batista,1 Takasi Osako,2 Eliana Mara Clemente,2 Fernanda Carvalhido Antonio Batista,3 Maurício Takeshi Janiques Osako41Department of Gynecology and Obstetrics of Faculty of Medicine of Petropolis, Petropolis, Rio de Janeiro, Brazil; 2Gynecology and Obstetrics, Casa Providencia Hospital, Petropolis, Rio de Janeiro, Brazil; 3School of Medicine of Technical Educational Foundation Souza Marques, Rio de Janeiro, Brazil; 4School of Medicine of University Gama Filho, Rio de Janeiro, BrazilBackground: Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse.Methods: A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse.Results: The age range of the women was 33–59 years, uterine volume was 300–900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%, with a surgery time of 30–60 minutes in 55 (59.82% and 19 (15.98% cases, respectively. Uterine volume reduction was performed in 41 (35.05% cases, salpingectomy was the most common associated surgery (81.19%, and anesthesia was subdural (68.37%. Common intraoperative complications included bladder lesions (8.54%, with conversion to the abdominal route being necessary in one case (1.28%, and the most common postoperative complication being vaginal

  2. Establishment of a national Danish hysterectomy database: preliminary report on the first 13,425 hysterectomies

    Hansen, Charlotte T; Møller, Charlotte; Daugbjerg, Signe;


    2%, the rate of bleeding complications from 8 to 6%, the reoperation rate from 5 to 4%, and the readmission rate from 7 to 5%. CONCLUSIONS: Clinical performance indicators, audit meetings and nationwide collaboration are useful in monitoring and improving outcome after hysterectomy on a national...

  3. A new approach to simplify surgical colpotomy in laparoscopic hysterectomy

    Van den Haak, L.; Rhemrev, J.P.; Bikkendaal, M.D.; Luteijn, A.C.; Van den Dobbelsteen, J.J.; Driessen, S.R.; Jansen, F.W.


    New surgical techniques and technology have simplified laparoscopic hysterectomy and have enhanced the safety of this procedure. However, the surgical colpotomy step has not been addressed. This study evaluates the surgical colpotomy step in laparoscopic hysterectomy with respect to difficulty and d

  4. 42 CFR 50.207 - Sterilization by hysterectomy.


    ... 42 Public Health 1 2010-10-01 2010-10-01 false Sterilization by hysterectomy. 50.207 Section 50... GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207 Sterilization by hysterectomy. (a) Programs or projects to which this subpart applies shall not perform...

  5. 42 CFR 441.255 - Sterilization by hysterectomy.


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Sterilization by hysterectomy. 441.255 Section 441.255 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Sterilizations § 441.255 Sterilization by hysterectomy. (a) FFP is not available in expenditures for...

  6. Histerectomias: estudo retrospectivo de 554 casos Hysterectomies: a retrospective study of 554 cases

    Eddie Fernando Cândido Murta


    Full Text Available OBJETIVO: A histerectomia é uma operação muito realizada, entretanto há poucos trabalhos na literatura nacional sobre suas indicações, técnica e complicações. O objetivo deste trabalho é avaliar estes procedimentos realizados na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicina do Triângulo Mineiro. MÉTODO: Estudo retrospectivo de 470 histerectomias abdominais e 84 vaginais foi conduzido analisando as indicações, tempo de cirurgia e internação, tipo de incisão e morbidez. RESULTADOS: As principais indicações foram o mioma uterino e o prolapso uterino para as histerectomias abdominais e vaginais, respectivamente. As complicações intra-operatórias aconteceram em 3,4% e as pós-operatórias em 2,4% do total de casos. Nenhuma diferença estatística foi encontrada no número de complicações em relação ao tipo de incisão (vertical ou transversal. O tempo de cirurgia e o de hospitalização foram estatisticamente maiores nas incisões verticais. A hemorragia foi a mais freqüente complicação intra-operatória e a infecção da incisão operatória foi a mais freqüente no pós-operatório. CONCLUSÕES: A histerectomia é um procedimento de baixo risco, no entanto, a realização de revisões sobre indicações e complicações, e a pesquisa de melhores técnicas cirúrgicas são necessárias para torná-la cada vez mais segura.OBJECTIVE: Hysterectomy is a frequently performed surgery, but national literature gives limited information regarding indications, technique and complications. The aim of this study is to evaluate our results with this operation performed by the Discipline of Gynecology and Obstetrics of the Faculty of Medicine of "Triângulo Mineiro". METHODS: A retrospective study of 470 abdominal and 84 vaginal hysterectomies was conducted in which the indications, operation time, abdominal approach, hospitalization time, and morbidity were analyzed. RESULTS: Uterine myoma and uterine prolapse

  7. Are hysterectomies necessary? Racial-ethnic differences in women's attitudes.

    Dillaway, Heather E


    There is a dearth of comparative information about how women from diverse social locations think about, talk about, and experience the various types of reproductive aging. In this article I analyze racial-ethnic differences in attitudes toward surgically induced menopause (hysterectomy) utilizing data from an interview study of 130 menopausal women. African American women in this study were more suspect of doctors' initial offers of hysterectomies than European American women, with the former group of interviewees still fearing a legacy of racial-ethnic discrimination within medical institutions. Only after seeking a second opinion or finding a trustworthy doctor did African American women feel comfortable accepting a hysterectomy. European American interviewees were not as wary as their African American counterparts and sometimes reported wishing for a hysterectomy. I argue that attitudes toward hysterectomy must be contextualized within women's experiences of racial-ethnic oppression and privilege to be fully understood. PMID:27045199

  8. Effect of socioeconomic position on patient outcome after hysterectomy

    Daugbjerg, Signe B; Cesaroni, Giulia; Ottesen, Bent;


    OBJECTIVE: To investigate the association between socioeconomic position (assessed by education, employment and income) and complications following hysterectomy and assess the role of lifestyle, co-morbidity and clinical conditions on the relationship. DESIGN: Register-based cohort study. SETTING...... AND POPULATION: The study included nearly all Danish women (n = 22 150) registered with a benign elective hysterectomy in the Danish Hysterectomy Database in 2004-2008. METHODS: Data were analyzed using logistic regression models estimating the odds ratio with 95% confidence intervals. MAIN OUTCOME...... MEASURES: Complications following hysterectomy. RESULTS: Seventeen percent of the women experienced complications in relation to the hysterectomy. Women with less than high school education and unemployed women had higher odds of infection, complications and readmission than women with more than high...

  9. Surgeon volume and outcomes in benign hysterectomy.

    Doll, Kemi M; Milad, Magdy P; Gossett, Dana R


    Annual surgeon case volume has been linked to patient outcome in a variety of surgical fields, although limited data focus on gynecologic surgery performed by general gynecologists. Herein we review the literature addressing the associations between intraoperative injury, postoperative morbidity, and resource use among surgeons performing a low vs high volume of hysterectomies. Although study design and populations differ, individual and composite morbidity outcomes consistently favored high-volume surgeons. Given the growing emphasis on competency-based evaluation in surgery, gynecology departments may soon consider volume requirements a component of privileging. PMID:23622760

  10. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... the inability to see other abdominal or pelvic pathology because of our limited visibility, as well as our inability to maybe treat ovarian pathology, and especially when the uterus is large; that’s ...

  11. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... the abdominal approach. You do not need to learn a new procedure. But instead of using traditional ... loss. We have another question. “What is the learning curve with the minilap procedure? How many cases ...

  12. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... approach of choice when feasible. They cite certain advantages of the vaginal approach over the abdominal, such ... fewer complications such as fewer fibril episodes, and advantages of OR time, as well as costs. This ...

  13. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... to choose a large abdominal incision with prolonged healing time, so you do have the option to seek ways to get it done with quicker healing and better cosmesis. And to the doctors out ...

  14. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... re trying to emphasize that we’re not teaching you a new technique, just use the smaller abdominal incision and use what technology has afforded us, which is a device that ...

  15. Classical radical hysterectomy and nerve-sparing radical hysterectomy in the treatment of cervical cancer

    Marcin Makowski


    Full Text Available Aim of the study: To compare Piver III radical hysterectomy (RH with nerve-sparing radical hysterectomy (NSRH for cervical cancer patients in terms of postoperative physiology of pelvic autonomic nerves and perioperative complications. Material and methods : Seventy-three consecutive patients with invasive cervical cancer underwent RH (53 cases or NSRH (20 cases from 2001 to 2012 at the Department of Gynecology and Gynecologic Oncology of Polish Mother’s Memorial Hospital – Research Institute in Łódź. Results : Compared with patients treated with RH, patients who underwent NSRH presented no significant difference in terms of operative time (146 vs. 143 minutes, p > 0.05, blood loss and hospital stay (9.2 vs. 7.5 days, p > 0.05. A positive surgical margin was found in 6 cases of RH. No serious surgical complications were found in the NSRH group, while there were 4 cases in the RH group. Conclusions : Nerve-sparing radical hysterectomy is safe and feasible surgical management for cervical cancer patients, which should improve the physiology of the pelvic autonomic nerve system postoperatively. The technique is relatively new and its oncologic efficiency has not been fully established yet, moreover it requires sophisticated anatomical knowledge and high operative skills.

  16. Gender and power: the Irish hysterectomy scandal.

    McCarthy, Joan; Murphy, Sharon; Loughrey, Mark


    In April 2004 the Irish Government commissioned Judge Maureen Harding Clark to compile a report to ascertain the rate of caesarean hysterectomies at Our Lady of Lourdes Hospital in Drogheda, Republic of Ireland. The report came about as a result of complaints by midwives into questionable practices that were mainly (but not solely) attributed to one particular obstetrician. In this article we examine the findings of this Report through a feminist lens in order to explore what a feminist reading of the Report and the events that led to the inquiry will bring to light. We consider how sex and gender feature in the Lourdes case, draw attention to the deeply gendered asymmetries of power and privilege that existed between the men and women at the centre of this inquiry, and explore the impact such asymmetries had on this particular situation. PMID:18687818

  17. Single-incision total laparoscopic hysterectomy

    Sinha Rakesh


    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  18. Metastatic low-grade endometrial stromal sarcoma of the sigmoid colon three years after hysterectomy

    Yuki Asada; Hajime Isomoto; Fumitaka Akama; Noriko Nomura; Chun-Yang Wen; Haruhiko Nakao; Ikuo Murata; Kan Toriyama; Shigeru Kohno


    A 49-year-old woman, who had undergone hysterectomy for low-grade endometrial stromal sarcoma (ESS) 3 years ago, presented with a 2-wk history of lower abdominal pain. Barium enema and sigmoidoscopy disclosed a polypoid submucosal tumor. Histopathologic features of biopsy specimens from the lesion were similar to those of the resected uterine ESS. Under the diagnosis of metastatic ESS of the sigmoid colon, sigmoidectomy was performed. Microscopic examination demonstrated dense proliferation of spindle cells with little nuclear atypia, which were sometimes arranged in whorled pattern around abundant arterioles. Mitotic count is below 1 in 10 highpower fields. Immunohi-stochemically, the neoplastic cells were strongly positive for vimentin, estrogen receptor and progesterone receptor but negative for α-smooth muscle actin, S-100 protein and CD34. Thus, a final diagnosis of low-grade ESS metastasis to the sigmoid colon was made.Her postoperative course was uneventful and hormonal therapy with progestational agents is entertained.

  19. Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D; Guldager, H; Kehlet, H


    Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1 or...... continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P < 0.01) but...... significantly lower pain scores during rest (P < 0.05) and mobilization (P < 0.01). More patients undergoing general anaesthesia received antiemetics (13 vs five; P < 0.05), but fewer received supplementary opioids on the ward (eight vs 16; P < 0.05). We conclude that opioid-free epidural-spinal anaesthesia for...

  20. Comparison between Preoperative Rectal Diclofenac Plus Paracetamol and Diclofenac Alone for PostoperativePain of Hysterectomy.

    Saghar Samimi Sede


    Full Text Available To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy.Ninety female patients (American Society of Anesthesiologists (ASA physical status I-II, scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS was used to assess pain intensity at rest.In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg compared to diclofenac group (16.8± 2.8 mg and placebo group (20.1 ± 3.6 mg (p<0.05. VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p<0.05. There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p<0.05.According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone.

  1. Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent;


    INTRODUCTION AND HYPOTHESIS: The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy and to...

  2. Frequency of adenomyosis in hysterectomy specimens performed for benign indications

    Çakmak, Bülent; özsoy, zeki; nacar, mehmet; aysal, tülay; hısım, yeliz; Demirtürk, Fazlı


    Objective: The aim of this study is to determine the frequency of adenomyosis in hysterectomy specimens performed for benign indications. Methods: Adenomyosis frequency was retrospectively evaluated hystopathologically in hysterectomy specimens performed for benign indications on 149 patients between January 2009 and January 2012 in Gaziosmanpaşa University Medical School, Obstetric and Gynecology Clinic. Results: Adenomyosis frequency was determined as 11.7% (17) of 149 patients received f...

  3. The prevelance of adenomyosis at hysterectomy and associated factors

    Şentürk, Mehmet Baki; BUDAK, Mehmet Şükrü; Çakmak, Yusuf; DURUKAN, Ömer Birol; Polat, Mesut


    Objective: Adenomyosis is a entity characterized by the presence of endometrial glands and stroma embedded within the myometrium without apparent contact with the endo-myometrial junction. As the diagnosis of adenomyosis is based on histological examination, the condition is best described in women at the time of hysterectomy.Material and Methods: We evaluated results of 109 hysterectomized patients retrospectively. Age, parity, menopausal status and indication of hysterectomy were compared b...

  4. Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

    Abasiattai, Aniekan Monday; Umoiyoho, Aniefiok Jackson; Utuk, Ntiense Maurice; Inyang-Etoh, Emmanuel Columba; Asuquo, Otobong Peter


    Introduction Emergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman's life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria. Methods The case records of all women who underwent emergen...

  5. Cervical removal at hysterectomy for benign disease. Risks and benefits.

    Hasson, H M


    An assessment of the risks and benefits of total and subtotal hysterectomy for benign disease was performed using the published literature, including a MEDLINE search, on all studies dealing with hysterectomy and related topics from 1946 to 1992. The shift from subtotal to total hysterectomy occurred before cytologic screening was accepted. Currently, SIL is diagnosed by cytology, evaluated by colposcopy and treated preferentially with cone biopsy. Prophylactic removal of the cervix does not eliminate the risk of cancer: it may shift the risk to the vaginal epithelium. The cervix has a role in sexual arousal and orgasm, probably due to stimulation of the Frankenhauser uterovaginal plexus. Bladder and bowel dysfunction following total hysterectomy may be related to loss of nerve ganglia closely associated with the cervix. Increased operative and postoperative morbidity, vaginal shortening, vault prolapse, abnormal cuff granulations and oviductal prolapse are other disadvantages of total hysterectomy. The cervix is not a useless organ and should not be removed during hysterectomy without a proper indication. PMID:8263867

  6. Abdominal Aortic Aneurysms: Treatments

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  7. Expanding Patient Options: Minilaparotomy for Hysterectomy

    Full Text Available ... is, and if you’re going to have problems with bleeding after the surgery or damage to the organs, you need to feel comfortable with the energy source primarily. So if you’re using that already, it’s a very short learning curve. I was using it on traditional abdominal ...

  8. Abdominal trauma

    Radiologic evaluation of abdominal trauma must provide a quick and accurate assessment of the lesions in order to improve the management of the patient. The technique used varies depending on the mechanism of the trauma (blunt trauma or stab wounds) and the hemodynamic status. Radiologic evaluation is usually performed in blunt trauma whereas stab wound trauma is usually explored surgically. The various techniques available are standard radiographs, ultrasonography, computed tomography and arteriography. The role of magnetic resonance imaging in the immediate evaluation is still not well defined. It appears to be useful method in the delayed evaluation of diaphragmatic trauma. Computed tomography is the method most commonly performed in trauma patients. This technique is accurate and allows correct assessment of the lesions. The disadvantages are the radiation induced and the need for a hemo-dynamically stable patient. The aim of the radiologic evaluation is to provide the clinicians with an accurate description of the lesions. It can help in the management of the patient usually in association with clinical and laboratory data. It can also guide interventional procedures (drainage, embolization...). Finally, it allows radiographic follow-up when conservative treatment is performed. (authors). 26 refs., 11 figs., 1 tab

  9. Mirena as an alternative to hysterectomy in cases of Dub

    Introduction: Dysfunctional uterine bleeding is the leading cause of hysterectomy due to conventional treatment failure. Levonorgestrel releasing intra uterine device (Mirena) is found to solve this issue by better control of bleeding and thus reducing hysterectomy rate. Objective: To measure the efficacy of Mirena as compared to OCP's in control of DUB and to deter-mine that it is an alternative to hysterectomy. Study Design: It was an interventional (experimental) type of study. Setting: Department of Obstetrics and gynecology Unit 11 Lady Willingdon Hospital, Lahore. Duration with Dates: In a total of 60 patients presenting with DUB in out patient department from 7th April 2004 to 31st December 2005. Subjects and Methods: In a total of 60 patients selected were randomly allocated to Group A and B to receive Mirena and OCP's respectively. Both groups were followed at 6 months and 1 year of treatment. Main outcome measures were patient satisfaction with current treatment and their decision to continue or opt for hysterectomy. 80.7% women receiving Mirena were satisfied with their treatment, while only 30% in the OCP's group (p-value < 0.05) at the end of study. 7.69% was the discontinuation rate of treatment in Mirena group while it was 50% in the control group (p-value < 0.05). Conclusion: Mirena is a better option in the treatment of DUB and it can prove to be an alternative to hysterectomy, while we want a more conservative type of treatment. (author)

  10. Analysis of 46 Hysterectomies Performed for Obstetric Indications

    Mahmut Erdemoğlu


    Full Text Available We analyzed retrospectively 52 cases of emergency peripartum hysterectomy that were performed at our clinic from January 1998 to December 2004. Fifty two patients of emergency peripartum hysterectomy were identified amoung 11098 deliveries.The mean age was 32.66±6.74, gravida 7.09±3.37, parity 6.12±3.11 , gestational weeks. 84.61% patients were underwent subtotal hysterectomy. The emergency peripartum hysterectomy was done 51.92% of the cases during cesarean section or later. The indications of hysterectomy were identified as (55.76% uterine atony, uterine rupture (15.38%, pelviperitonitis and acute abdomen (9.61%, anormal placentation (15.38%, uterine myoma (1.92%, and cervical cancer (1.92% respectively. The overall (23.07% patients developed disseminated intravascular coagulopathy (DIC, two cases had ureter injury,one case had bladder injury. Bilateral hypogastric artery ligation were performed in 30.76% of the patients and relaparatomy was performed in 5 (9.61% patients due to the intraabdominal hemorrhage. Maternal mortality occured in four cases.

  11. Extrafascial hysterectomy in IB2 cervical cancer after radio chemotherapy

    Aim: To evaluate overall and disease free survival in cervical cancer IB2 patients with concomitant chemoradiotherapy and posterior extrafascial hysterectomy treatment. Methods: Between July 2005 to December 2009, a total of 31 eligible patients with IB2 cervical cancer were treated with chemoradiotherapy and posterior hysterectomy in the Carlos Van Buren Hospital Oncology Unit. Radiotherapy consisted in external pelvic radiation and a utero-vaginal brachytherapy with low rate doses to get preoperatory doses between 70 and 75 Gy to the A point and a concomitant Cisplatin based chemotherapy. After this treatment, the patients received extrafascial hysterectomy 4 to 6 weeks completed chemoradiotherapy. Results: The mean age was 41 ± 8 years. 81% of the patients had an spinocelular carcinoma. The extrafascial hysterectomy was made between 4 to 6 weeks post-radiation in 85% of the patients. 79% and 13% of the patients received 5 and 4 chemotherapy cycles respectively. The median follow up was 38 months. The 5 years overall survival and disease free survival estimates were 86% and 79% respectively. There was a significant difference between subgroups of patients with and without macroscopic residual disease in the operatory specimen (p<0.001). Conclusion: Our survival is similar to published results with the same treatment. The presence of macroscopic residual disease in the hysterectomy specimen could be a factor of prognostic value

  12. The indication for hysterectomy as a risk factor for subsequent pelvic organ prolapse repair

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent;


    INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate whether the indication for hysterectomy was itself a risk factor for subsequent pelvic organ prolapse (POP) in Danish women who underwent hysterectomy from 1977 to 2009. METHODS: Data from 154,882 women who underwent hysterectomy...

  13. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates

    Hammer, Anne; Rositch, Anne; Kahlert, Johnny Abildgaard; Blaakær, Jan; Gravitt, Patti; Søgaard, Mette


    Despite the fact that hysterectomy is the most common surgical procedure worldwide in gynecology, national reporting of the incidence rate of gynecological cancers rarely removes the proportion no longer at risk of the disease from the population-at-risk-denominator (ie. women who have had a...... hysterectomy). The incidence rate of gynecological cancers is thus likely underestimated. Since hysterectomy, as well as oophorectomy, incidence varies across countries, age, and over time, meaningful comparison of gynecological cancer incidence rates may be compromised. Without accurate estimates of...... gynecological cancer incidence rates, performed via removing the proportion of hysterectomized or oophorectomized women from the population-at-risk-denominator, the impact of prevention strategies may be masked or misinterpreted. Furthermore, since national cervical cancer screening guidelines are at least in...

  14. Hysterectomy with ovarian conservation: effect on bone mineral density

    Full text: There are conflicting data on the long-term effects of hysterectomy with ovarian conservation on bone mineral density (BMD). Accordingly, we performed a cross-sectional study on 58 women with premenopausal hysterectomy and ovarian conservation (group 1) and 59 women with natural menopause (group 2). No subjects had disorders or medications known to interfere with bone metabolism. Patients underwent bone densitometry of the lumbar spine and hip using a Norland XR-36. By chi-squared and one-way ANOVA, there were no differences in age: 55.4± 11.0 y (1)v 57.6± 9.8 y (2); exercise, alcohol or smoking consumption, family history of osteoporosis, height: 1.61 ± 0.08m (1) v 1.61 ± 0.08m (2); weight 67.7 ± 11.3kg (1) v 68.3 kg ± 12.5 kg (2); body mass index: 30.95 (1 ) v 26.26 (2). Lumbar spine BMD was also similar for the two groups [0.95 ± 0.18g/cm2 (1) v 0.94± 0.21 g/cm2 (2)]. However, hysterectomy patients had a significantly lower hip BMD: 0.63 ± 0.16 g/cm2 v 0.76 ± 0.18 g/cm2 (p>0.001). Multivariate logistic regression showed that spine BMD was influenced by age, family history, height and weight (R2 = 0.37), but not prior hysterectomy. Hip BMD was related to age, hysterectomy, smoking and weight (R2 = o 45). We conclude that prior hysterectomy with ovarian conservation has an adverse effect on hip but not spine BMD




    Full Text Available Incidence of missing IUCD iy is 0.5% - 2%. U s ually the cause is either expulsion or perforation of uterus. Sometimes the perforated IUCD remains asymptomatic for years together and found incidentally later on. We hereby presenting a case of 55 yrs female presenting with prolapsed uterus , planned for vaginal hysterectomy. During vaginal hysterectomy asymptomatic missing IUCD was detected which was found on the anterior surface of body of uterus with omentum adherent to it. KEY WORDS: M issing Cu T , IUCD , O mentum , P erforation .

  16. The Essential Elements of a Robotic-Assisted Laparoscopic Hysterectomy.

    Simpson, Khara M; Advincula, Arnold P


    Robotic-assisted laparoscopic hysterectomies are being performed at higher rates since the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) received US Food and Drug Administration approval in 2005 for gynecologic procedures. Despite the technological advancements over traditional laparoscopy, a discrepancy exists between what the literature states and what the benefits are as seen through the eyes of the end-user. There remains a significant learning curve in the adoption of safe and efficient robotic skills. The authors present important considerations when choosing to perform a robotic hysterectomy and a step-by-step technique. The literature on perioperative outcomes is also reviewed. PMID:27521880

  17. Adnexectomy Versus Ovarian Conservation During Total Hysterectomy for Benign Conditions. A Difficult Dilemma

    Ion Păun


    Full Text Available Introduction: Bilateral adnexectomy is a surgical procedure that is frequently associated with total hysterectomy performed for benign uterine conditions. Given the relatively wide range of indications for the aforementioned type of salpingo-ooforectomy which in it self is not devoid of potential risks the patients' and physicians' decision-making should take into account several parameters (most helpful to individualize treatment such as published ratio of removal versus conservation of uterine adnexae, patients' age, pre/postmenopausal status at the time of surgery, relevant family and personal history including current use of hormonal replacement therapy. Material and Method: This retrospective cohort study was conducted among 457 women aged 18 years or older who underwent abdominal total hysterectomies for benign uterine conditions between 2000 and 2011. The study patients were stratified by age for better characterization and according to recent publications. Results: Uni- or bilateral oophorectomy was performed in 50% of the subgroup of hysterectomized women younger than 35 years old whereas in the other half of the same age category of patients the uterine adnexas were conserved. Among the study patients aged between 35 and 45 years in 50.5% of the cases the unilateral type of oophorectomy was undertaken while for the other 49.5% of women the bilateral adnexectomy was the rule. Finally, in all patients older than age 45 years the bilateral salpingo-oophorectomy was the procedure of choice. Moreover, out of the 55 study patients in which at least one ovary was preserved, 30.9% of cases underwent the removal of the remaining adnexa when affected de novo by malignant (n=3 or benign (n=14 pathology. Last but not least, in order to reduce both cancer risks and early menopause hazards, our analysis based on recent literature attempted to identify patient characteristics (relevant factors associated with or without bilateral oophorectomy at the

  18. Risk factors associated with emergency peripartum hysterectomy

    Jin Rong; Guo Yuna; Chen Yan


    Background Use of an emergency peripartum hysterectomy (EPH) as a lifesaving measure to manage intractable postpartum hemorrhage (PPH) appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine (IPMCH).The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P<0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was (5 060.7±3 032.6)ml,and that of the control group was (2 040.8±723.5) ml.There was a significant difference of PHH between the EHP group and the control group (P=0.001).Independent risk factors for EPH from a logistic regression model were:disseminated intravascular coagulation (DIC) (OR:9.9,95% CI 2.8-34,P=0.003),previous cesarean section (OR:5.27;95% CI:1.48-17.9,P=0.009),placenta previa (OR:6.9; 95% CI 1.6-2.9,P=0.008),the loss of PPH (OR:1.001; 95% CI 1.001-1.002,P=0.002),placenta accreta (OR:68; 95% CI 10-456,P=0.004),the use of tocolytic agents prenatally (OR:6.55,95%CI 1.34-32.1,P=0.049),and fetal macrosomia (OR:6.9,95% CI 1.25-38,P=0.049).Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.

  19. Abdominal Pain or Cramping

    ... Body & lifestyle changes > Abdominal pain or cramping Abdominal pain or cramping E-mail to a friend Please ... signs of severe pain. What causes mild belly pain in pregnancy? There are different causes for mild ...

  20. Postoperative recovery profile after elective abdominal hysterectomy: a prospective, observational study of a multimodal anaesthetic regime

    Jensen, Kenneth; Kehlet, Henrik; Lund, Claus M


    insufficiency and time of discharge readiness. RESULTS: The structured regime consisting of total intravenous anaesthesia (propofol-remifentanil), well defined fluid administration, prophylactic antiemetics (dexamethasone, ondansetron, droperidol), weak analgesics (celecoxib, paracetamol) and intraoperative...

  1. Transdermal nitroglycerine enhances postoperative analgesia of intrathecal neostigmine following abdominal hysterectomies

    Fareed Ahmed


    Full Text Available This study was carried out to assess the effect of nitroglycerine (transdermal on intrathecal neostigmine with bupivacaine on postoperative analgesia and note the incidence of adverse effects, if any. After taking informed consent, 120 patients of ASA Grade I and II were systematically randomised into four groups of 30 each. Patients were premedicated with midazolam 0.05 mg/kg intravenously and hydration with Ringer′s lactate solution 10ml/kg preoperatively in the holding room. Group I patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline and transdermal placebo patch. Group II patients received Intrathecal injection of 15 mg bupivacaine with 5 mcg of neostigmine and transdermal placebo patch. Group III patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline with transdermal nitroglycerine patch (5 mg/24 hours. Group IV patients received Intrathecal injection of 15 mg bupivacaine with 5mcg of neostigmine and transdermal nitroglycerine patch (5 mg/24 hours, applied on a non anaesthetised area after 20 minutes. Groups were demographically similar and did not differ in intraoperative characteristics like sensory block, motor block, haemodynamic parameters and SpO 2 . The mean duration of analgesia was 202.17 minutes, 407.20 minutes, 207.53 minutes and 581.63 minutes in control group (I, neostigmine group (II, nitroglycerine group (III and nitroglycerine neostigmine group (IV respectively (P< 0.01. To conclude, our results show that transdermal nitroglycerine itself does not show any analgesic potential but it enhances the analgesic potential of intrathecal neostigmine.

  2. Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy

    Andersen, L L; Zobbe, V; Ottesen, B; Gluud, C; Tabor, A; Gimbel, H


    MEASURES: The primary outcome was UI. Secondary outcomes included constipation, prolapse of the vaginal vault or cervical stump, satisfaction with sexual life, pelvic pain, postoperative complications and vaginal bleeding. RESULTS: The response rate was 234/319 (73.4%). A significantly higher proportion of...

  3. Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormonesTumor necrosis factor-alpha binding capacity and anti-infliximab antibodies measured by fluid-phase radioimmunoassays as predictors of clinical efficacy of infliximab in Crohn's disease

    Kolsen-Petersen, J.A.; Bendtzen, K.; Tonnesen, E.


    BACKGROUND: Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery. METHODS: Sixty-two women undergoing abdominal hysterectomy were randomized in a...... with the other groups (P<0.05). No other differences were found between the groups. CONCLUSIONS: Infusion of a clinically relevant dose of hypertonic saline before hysterectomy appears to have limited effect on the postoperative concentration of selected plasma cytokines and the hormonal stress...

  4. Application of ovarian transposition during hysterectomy

    郭毅; 沈文静; 姜艳明; 刘伟; 李秀芬


    Objective To study the optimal position and method for ovarian transposition and its benefits and indications.Methods We performed ovarian transposition in 34 patients from August 1989 to December 2000. Twelve patients were diagnosed with stage Ⅰb to Ⅱa cervical cancer, 4 had stage Ⅰa endometrial carcinoma, 12 had stage Ⅲ to Ⅳ endometriosis, 4 had myoma of uterus, 1 had dysfunctional uterine bleeding, and 1 had an ovarian granulosa cell tumor. Surgery went as follows: the ovary was dissociated by clamp, the skin was incised and a tunnel was made, then the ovary was translocated to the subcutaneous site. In the cases of benign lesions, the ovarian vessel pedicel went in through the abdominal cavity, but in malignant tumors, it went out through the peritoneum. Results In both cases (benign lesions or malignant tumors), the short-term and long-term endocrine function of the translocated ovary remained normal. Furthermore, patients could supervise their translocated ovary themselves.Conclusions Subcutaneous ovary transposition might prevent not only implantation of gastrointestinal cancer but also the extension of pelvic carcinoma to the ovary. Because of the shallow transposition and the incision scar, it is easy for patients to supervise themselves. Moreover, the site of the ovary is easy to locate for ultrasound examinations. Thus, it can obtain the goal of early prevention for cancer. Subcutaneous ovarian transposition with skin incision is the optimal selection and suitable for all patients with various gynecologic diseases in which ovary removal is not necessary.

  5. Safe vaginal uterine morcellation following total laparoscopic hysterectomy.

    Günthert, Andreas R; Christmann, Corina; Kostov, Plamen; Mueller, Michael D


    The minimally invasive approach for hysterectomy with proven benefits and lower morbidity has become the gold standard, even in women with large uterine masses. Most women with a malignant condition present with abnormal vaginal bleeding and/or suspicious imaging such that few are diagnosed by final histopathology after surgery. However, if a malignancy is not diagnosed preoperatively, intraabdominal morcellation for uterus extraction has an increased risk for potential tumor spread and peritoneal metastases, especially in cases of unexpected leiomyosarcoma. We describe a simple method to wrap the uterus in a contained environment with a plastic bag through the posterior vaginal fornix prior to conventional coring morcellation for vaginal extraction in total laparoscopic hysterectomy. We further describe our experience with a risk stratification and treatment algorithm to implement this procedure in daily routine. A video and an illustrating sketch demonstrate the simplicity and safety of the procedure. PMID:25460836

  6. Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

    Kelly L. Pieh-Holder


    Full Text Available Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function.

  7. Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormones

    Kølsen-Petersen, Jens Aage; Bendtzen, Klaus; Tønnesen, Else Kirstine


    BACKGROUND: Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery. METHODS: Sixty-two women undergoing abdominal hysterectomy were randomized in a...... double-blind study to infusion of NaCl 7.5% (HS), NaCl 0.9% (NS4), both 4 ml kg(-1), or NaCl 0.9% 32 ml kg(-1) (NS32) over 20 min. Blood was collected at baseline, 1, 4, and 24 h after surgery (n=34) for the determination of interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12, IL-1ra, and tumour necrosis...... factor-alpha. Serum cortisol and vasopressin were measured at these time points and 48 h after operation. Epinephrine and norepinephrine (n=26) were quantified at baseline, after infusion, 25 min after incision, 1, and 4 h after surgery. Finally, C-reactive protein was measured at baseline, 24, and 48 h...

  8. Abdominal MRI in childhood

    MRI provides diagnostic information in multiple abdominal diseases in childhood. Additional information to sonographic findings can be achieved in the diagnosis of abdominal malformation as well as in several inflammatory processes. In childhood cancer imaging MRI is essential at the beginning as well as during therapy to assess response to therapy. Because of radiation protection MRI has to replace CT in abdominal imaging in children. Some technical details have to be considered when children are examined. (orig.)

  9. Influence of alcohol intake on postoperative morbidity after hysterectomy

    Felding, C; Jensen, L M; Tønnesen, H


    Postoperative morbidity after hysterectomy was prospectively studied in 229 consecutive patients in our departments. The incidence of alcohol abuse (greater than 60 gm of alcohol daily) and social drinking (between 25 and 60 gm of alcohol daily) was 6.5% for each. When compared with the social...... drinkers and the control group, the alcohol abuse group had significantly more complications (80% vs 27% and 80% vs 13%, respectively)....

  10. Clinical study of emergency peripartum hysterectomy for postpartum hemorrhage

    Amudha S.


    Conclusions: PPH is unpredictable in onset, duration and etiology and it remains a major life threatening complication of any delivery. The most common causes of hemorrhage in these women are placental abnormalities and uterine atony. When conservative treatment is not feasible or has failed, prompt peripartum hysterectomy is performed failing which the delay would contribute to the maternal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1171-1173

  11. Obstetric Hysterectomy: Retrospective analytical study at P D U Medical College, Rajkot

    Parmar, Prakash; Goswami, K. D.; Dudhrejiya, Kavita M; Jain, Mahima


    Objective: To find out indications of obstetrics hysterectomy, related complications and associated maternal morbidity and mortality.Methods:  A Retrospective Analytical Study was performed at Dept of obs & gynec P D U Medical College, Rajkot over a period of 3 yrs during 2011-2013.Evaluation of Maternal age, parity, SE status, booking status, obstetric risk factors, duration of hospital stay, indications of hysterectomy, type of hysterectomy, intra-op and post-operative complications, bl...

  12. Analysis of Risk Factors for Post-Hysterectomy Vaginal Vault Prolapse

    Mahmut Kuntay kuntay Kokanali


    Conclusions: Vault prolapse after hysterectomy is a relatively rare complication. Elderly age, obesity, chronic obstructive lung diseases, prior genital prolapse sugery, vaginal hysterectomy, genital prolapse as indication of hysterectomy and the number of vaginal delivery and #8805;2 increase vault prolapse risk. Identification of these risk factors is important to prevent this complication. [Cukurova Med J 2015; 40(1.000: 63-71




    Full Text Available Emergency peripartum hysterectomy is performed as a life saving measure in uncontrolled PPH. OBJECTIVES: T o examine incidence, risk factors, indications, outcome and complications of emergency peripartum hysterectomy in a teaching hospital. METHODS: A 5 ye ar prospective study conducted between January 2010 to December 2014. Demographic data, detailed history, clinical examination and relevant investigations obtained. RESULTS: The incidence of EPH in present study was 0.6 per 1000 deliveries. Most of these p atients were young, mean age of 22.67 years, para 1 and 2, 84.21% were unbooked with no antenatal visits and delivered outside. Rupture of uterus was the commonest indication (42.10% for EPH, followed by uterine atony (26.32% and abnormal placentation (2 6.32%. Both total or subtotal hysterectomy were performed as a life saving measure after conservative measures failed. Maternal mortality in this study was 15.79%. Other complications noted were febrile illness, anaemia, coagulopathy, renal failure, wound infection. CONCLUSION: EPH performed for uncontrolled PPH is associated with significant mortality and morbidity. Its incidence can be reduced by regular antenatal check - ups, early detection and referral of high risk patients and updating knowledge and skill of doctors working in peripheral centres.

  14. Laparoscopic pelvic anatomy of nerve-sparing radical hysterectomy.

    Park, Nae Yoon; Cho, Young Lae; Park, Il Soo; Lee, Yoon Soon


    Many reports regarding nerve-sparing radical hysterectomy have been published. However, most reports have been based on systematic descriptions via laparotomy or cadaver dissection. The aim of this work was to describe the pelvic anatomy of nerve-sparing radical hysterectomy via laparoscopy, with specific focus on the inferior hypogastric plexus. This study is based on 125 patients with FIGO stage IB cervical cancer who had undergone laparoscopic nerve-sparing radical hysterectomies since 1999. The inferior hypogastric plexus was demonstrated via laparoscopy and was comprised of afferent fibers from the sacral root (S2, S3, and S4), sacral sympathetic ganglion, and hypogastric nerve, and efferent fibers forming its vesical, uterovaginal, and rectal branches. During the dissection of the posterior leaf of the vesicouterine ligament, various vesical veins were identified. If the cut edge of an inferior vesical vein was pulled medially with upward traction, the vesical branches of the inferior hypogastric plexus were exposed and these were divided into medial and lateral branches. The magnified view of laparoscopy made it possible to dissect nerves and vessels meticulously and to secure a clear resection margin during the dissection of the deep part of the cardinal ligament, uterosacral ligament, and posterior leaf of the vesicouterine ligament. PMID:20108355

  15. [Abdominal pregnancy, institutional experience].

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q


    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy. PMID:9737070

  16. Imaging in abdominal trauma

    Imaging in abdominal trauma with special regard to the value of abdominal X-ray, ultrasound and computed tomography is described. The introduction to each organ focusses on the clinical situation, special mechanism of trauma, symptoms and the pathological staging of trauma. (orig.)

  17. Long-term cancer risk after hysterectomy on benign indications: Population-based cohort study.

    Altman, Daniel; Yin, Li; Falconer, Henrik


    Hysterectomy on benign indications is associated with an increased risk for adverse health effects. However, little is known about the association between hysterectomy and subsequent cancer occurrence later in life. The purpose of this study was to assess the effect of hysterectomy on the incidence of cancer. In this population-based cohort study, we used data on 111,595 hysterectomized and 537,9843 nonhysterectomized women from nationwide Swedish Health Care registers including the Inpatient Register, the Cancer Register and the Cause of Death Register between 1973 and 2009. Hysterectomy with or without concomitant bilateral salpingo-ophorectomy (BSO) performed on benign indications was considered as exposure and incidence of primary cancers was used as outcome measure. Rare primary cancers (cancer was observed for women with previous hysterectomy and for those with hysterectomy and concurrent BSO (HR 0.93, 95% CI 0.91-0.95 and HR 0.92, 95% CI 0.87-0.96, respectively). Compared to nonhysterectomized women, significant risks were observed for thyroid cancer (HR 1.76, 95% CI 1.45-2.14). For both hysterectomy and hysterectomy with BSO, an association with brain cancer was observed (HR 1.48, 95% CI 1.32-1.65 and HR 1.45, 95% CI 1.15-1.83, respectively). Hysterectomy, with or without BSO, was not associated with breast, lung or gastrointestinal cancer. We conclude that hysterectomy on benign indications is associated with an increased risk for thyroid and brain cancer later in life. Further research efforts are needed to identify patient groups at risk of malignancy following hysterectomy. PMID:26800386

  18. Histerectomia vaginal: o laparoscópico é necessário? Vaginal hysterectomy: is the laparoscope necessary?

    Octacílio Figueiredo Netto


    pode ser realizada na grande maioria dos casos.Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2% were nulliparous, and 104 (26.0% had never delivered vaginally. Three hundred and three patients (75.7% had a history of previous pelvic surgery, the most common being cesarean section (48.7%. The most frequent indication was leiomyoma (61.2%, and the mean uterine volume was 239.9 cm³ (30-1228 cm³. Vaginal hysterectomy was successfully performed in 396 patients (99.0%, and 73 surgeries (18.2% were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%. Intraoperative complications included 6 cystotomies (1.5% and one rectal laceration (0.2%. There were four conversions (1.0% to the abdominal route. Postoperative complications occurred in 24 patients (6.0%. Two hundred and eighty-one patients (70.2% were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.

  19. Age at hysterectomy as a predictor for subsequent pelvic organ prolapse repair

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent;


    INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate the association between patient age at the time of hysterectomy and subsequent pelvic organ prolapse (POP) surgery. METHODS: We gathered data on all benign hysterectomies and POP surgeries performed in Denmark on Danish women...

  20. Optimization of subarachanoid block by oral pregabalin for hysterectomy

    Monica Kohli


    Full Text Available Background: 80% of patients undergoing surgical procedures experience postoperative pain 1 and requires adequate pain relief. Nowadays drugs like COX2 inhibitors and calcium channel modulators (Pregabalin and Gabapentin are been increasingly used for postoperative pain management effectively. We conducted this study to find whether preoperative pregabalin has any effect in postoperative analgesic requirement in patients undergoing hysterectomy under spinal anaesthesia. Patients & Methods: This randomized, double-blind, placebo-controlled trial was conducted in 150 patients undergoing hysterectomy under spinal anaesthesia, divided in three groups - Group I (PO - Control group, Group II (P150 received 150 mg pregabalin and Group III (P300 received 300 mg pregabalin. We used VAS for anxiety, Ramsay sedation scale and VAS for patient satisfaction regarding pain relief. Results: There was significant reduction in anxiety in groups P (150 and P (300 than placebo group P (0 during intraoperative and postoperative period than preoperative period. There was significant sedation seen in groups P (150 and P (300 than placebo group P (0. First rescue analgesia in group P (300 was202.42±6.77 and in group P (150 was176.38±4.80on average, group P (0 was131.38±5.15. Dizziness was 44.44% in group P (300, 36.11% in group P (150, and 19.44% in group P (0. Patient satisfaction was better in P (300 group than other two groups. Conclusions: Pregabalin being an oral drug which would be easy for the patients to take and also its prolongation of the neuraxial block helps in immediate postoperative analgesia and further reduction of other parentral analgesics. Pregabalin 150mg would be the optimal preemptive dose for hysterectomy under spinal anaesthesia.

  1. Physiological FDG uptake in the ovaries after hysterectomy

    It is known that focal 18F-fluorodeoxyglucose (FDG) uptake is physiologically seen in the ovaries and uterus of premenopausal women in correlation with the menstrual cycle, which may cause false-positive diagnoses on the images of FDG positron emission tomography (PET). The objective of this study was to clarify whether women of reproductive age after hysterectomy whose ovaries were preserved, also showed physiological ovarian FDG uptake. We reviewed 26 women after hysterectomy (age 51.1±5.0 years), who underwent annual cancer screening, including FDG-PET and pelvic magnetic resonance (MR) imaging, three times. Seven women (age 45.9±5.8 years, range 34-52 years) had at least one ovary, showing changes in its appearance including the size and number of follicles on MR images each year, which suggested that the ovary was functioning. Four of the seven women showed focal FDG uptake (standardized uptake value 4.2±1.1) that corresponded to the normal ovaries on five PET examinations. Another group of 19 women (age 53.1±3.1 years, range 47-59 years) who had small ovaries without changes on MR images each year did not show FDG uptake in the ovaries. Physiological FDG uptake observed in the ovaries of women of reproductive age even after hysterectomy is reasonably common. As it is not easy to determine the hormonal cycle in these women, it is essential to correlate focal FDG uptake in the pelvis with anatomical and morphological findings on MR images to avoid false-positive diagnoses. (author)

  2. Hysterectomy as a Management Option for Morbidly Adherent Placenta

    Objective: To determine the outcome of interval (delayed) hysterectomy as compared to cesarean (immediate) hysterectomy in cases of placental invasion in previous cesarean sections. Study Design: Comparative study. Place and Duration of Study: Department of Obstetrics and Gynecology, Unit II, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January 2008 to June 2011. Methodology: The study subjects included 28 women with history of previous cesarean section who had low lying as well as morbidly adherent placenta (MAP) of variable degree. Patients were classified into two groups (group A and B) according to whether cesarean or interval hysterectomy was needed at time of delivery. Demographic data, obstetrical risk factors such as parity and number of previous cesarean sections were compared as well as radiological and histopathological findings, and details of the management. Chi-square, Fisher's exact and t-tests were used to compare proportions and mean values. Results: The frequency of MAP in previous cesarean sections turned out to be 1.83/1000 (28/15,340) deliveries. Mean maternal age (26.54 vs. 29.13 years, p=0.05), mean gestational age (33.8 vs. 36 weeks, p=0.05), estimated blood loss (2615.38 vs. 1506.6 mL, p=0.001), volume of blood transfused (9.76 vs. 2.9 pints, p=0.001) and the duration of hospital stay (10.69 vs. 32.86 days, p=0.001) differed significantly between group A and group B. One maternal death occurred in each group. Eight patients had other complications in group A compared to 3 patients in group B. Three neonatal deaths occurred in group A compared to nil in group B. Conclusion: The frequency of morbidly adherent placenta was 1.83/1000 deliveries. The management and outcome differed markedly according to emergency and scheduled antenatal diagnosis. Counselling and antenatal radiological screening can reduce the high morbidity and mortality associated with it. (author)

  3. Abdominal ultrasound (image)

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X- ... use high frequency sound waves to produce an image and do not expose the individual to radiation. ...

  4. Abdominal CT scan

    Computed tomography scan - abdomen; CT scan - abdomen; CAT scan - abdomen; CT abdomen and pelvis ... An abdominal CT scan makes detailed pictures of the structures inside your belly (abdomen) very quickly. This test may be used to ...

  5. Abdominal Pain Syndrome

    ... inspection of a drop of urine), and urine culture for bacterial infection. Stools can be analyzed for ... Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity Digestive Health Topics Abdominal Pain Syndrome Belching, Bloating, ...

  6. Abdominal tuberculosis: Imaging features

    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis

  7. Imaging in Tuberculosis abdominal

    In this article we illustrate and discuss imaging features resulting from Tuberculosis abdominal affectation. We present patients evaluated with several imaging modalities who had abdominal symptoms and findings suggestive of granulomatous disease. Diagnosis was confirm including hystopatology and clinical outgoing. Cases involved presented many affected organs such as lymphatic system, peritoneum, liver, spleen, pancreas, kidneys, ureters, adrenal glands and pelvic organs Tuberculosis, Tuberculosis renal, Tuberculosis hepatic, Tuberculosis splenic Tomography, x-ray, computed



    Objective.To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor.Methods.We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985~1997 at PUMC hospital. Thirty-eight cases were diagnosed of choriocarcinoma and 30 were invasive mole.Results.Twenty-three elder patients who didn't desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95.6%), the total aver-age courses of chemotherapy was 4.2. Of twenty-seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74.1%), the total average courses of chemotherapy were 9.4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life-threatening hemorrhage, 17 cases had a complete remission(94.4%), the total average courses of chemotherapy were 7.6.Conclusion.Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it's better to perform extended hysterectomy for the indicated patients.

  9. Can radical parametrectomy be omitted inoccult cervical cancer afterextrafascial hysterectomy?

    Huai-WuLu,; JingLi,; Yun-YunLiu,; Chang-HaoLiu,; Guo-CaiXu,; Ling-LingXie,; Miao-FangWu; Zhong-QiuLin


    Background:Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame‑trectomy (RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early‑stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP. Methods:A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early‑stage cervical cancer were analyzed. Results:Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9mm; only one patient had more than 50% stromal invasion, and four patients had lymph‑vascular space invasion (LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico‑vaginal ifstula, and ileus (1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence. Conclusions:Perioperative complications following RP were common, whereas the incidence of parametrial involve‑ment was very low

  10. Childhood abdominal cystic lymphangioma

    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two. Conclusions: US

  11. Childhood abdominal cystic lymphangioma

    Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)


    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two

  12. Abdominal Dual Energy Imaging

    Sommer, F. Graham; Brody, William R.; Cassel, Douglas M.; Macovski, Albert


    Dual energy scanned projection radiography of the abdomen has been performed using an experimental line-scanned radiographic system. Digital images simultaneously obtained at 85 and 135 kVp are combined, using photoelectric/Compton decomposition algorithms to create images from which selected materials are cancelled. Soft tissue cancellation images have proved most useful in various abdominal imaging applications, largely due to the elimination of obscuring high-contrast bowel gas shadows. These techniques have been successfully applied to intravenous pyelography, oral cholecystography, intravenous abdominal arteriog-raphy and the imaging of renal calculi.

  13. Abdominal Vascular Catastrophes.

    Singh, Manpreet; Koyfman, Alex; Martinez, Joseph P


    Abdominal vascular catastrophes are among the most challenging and time sensitive for emergency practitioners to recognize. Mesenteric ischemia remains a highly lethal entity for which the history and physical examination can be misleading. Laboratory tests are often unhelpful, and appropriate imaging must be quickly obtained. A multidisciplinary approach is required to have a positive impact on mortality rates. Ruptured abdominal aortic aneurysm likewise may present in a cryptic fashion. A specific type of ruptured aneurysm, the aortoenteric fistula, often masquerades as the more common routine gastrointestinal bleed. The astute clinician recognizes that this is a more lethal variant of gastrointestinal hemorrhage. PMID:27133247

  14. Endometriosis Abdominal wall

    Endometriosis of abdominal wall is a rare entity wi ch frequently appears after gynecological surgery. Case history includes three cases of parietal endometriosis wi ch were treated in Maciel Hospital of Montevideo. The report refers to etiological diagnostic aspects and highlights the importance of total resection in order to achieve definitive healing

  15. Adult abdominal hernias.

    Murphy, Kevin P


    Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

  16. Application of da Vinci® Robot in simple or radical hysterectomy: Tips and tricks

    Iavazzo, Christos; Gkegkes, Ioannis D.


    The first robotic simple hysterectomy was performed more than 10 years ago. These days, robotic-assisted hysterectomy is accepted as an alternative surgical approach and is applied both in benign and malignant surgical entities. The two important points that should be taken into account to optimize postoperative outcomes in the early period of a surgeon’s training are how to achieve optimal oncological and functional results. Overcoming any technical challenge, as with any innovative surgical method, leads to an improved surgical operation timewise as well as for patients’ safety. The standardization of the technique and recognition of critical anatomical landmarks are essential for optimal oncological and clinical outcomes on both simple and radical robotic-assisted hysterectomy. Based on our experience, our intention is to present user-friendly tips and tricks to optimize the application of a da Vinci® robot in simple or radical hysterectomies. PMID:27403078

  17. Laparoscopic Assisted Vaginal Hysterectomy, Setting Up a Service at a Peripheral Teaching Hospital

    Jim Tsaltas; Gab Kovacs; Jenny Dennis; Amanda Pratt


    The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit.

  18. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... Resources Professions Site Index A-Z Children's (Pediatric) Ultrasound - Abdomen Children’s (pediatric) ultrasound imaging of the abdomen ... limitations of Abdominal Ultrasound Imaging? What is Abdominal Ultrasound Imaging? Ultrasound is safe and painless, and produces ...

  19. Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

    Sanam Moradan


    Full Text Available Objectives: Post tubal ligation syndrome (PTLS is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age.Methods: This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age.Results: The mean age of the study group was 44/4±5/7 and the mean age of the control group was 45/2±5/3, (p=0.424.The mean parity of the study group was 3/8±1/8 and the mean parity of the control group was 3/5±1/4, (p=0.220. So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases (37.3% had previous tubal sterilization + hysterectomy (study group and 48 cases (44% were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes (control group. Statistical analyses showed that there were not significant differences between two groups, (RR=0.85; 95% CI: 0.56-1.28; p=0.418.Conclusion: The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding.

  20. Hysterectomy and Bilateral Salpingoovariectomy in a Transsexual Subject without Visible Scaring

    Anna Myriam Perrone; Maria Cristina Scifo; Valentina Martelli; Paolo Casadio; Paolo Giovanni Morselli; Giuseppe Pelusi; Maria Cristina Meriggiola


    Objective. To report on the use of laparoendoscopic single-site surgery (LESS) for the management of total hysterectomy (TH) with bilateral salpingoovariectomy (BSO) in a subject affected by gender identity disorder. Design. Case report. Setting. University Hospital. Patient(s). A 27-year-old affected by Gender Identity Disorder underwent a hysterectomy and BSO as part of surgical sex reassignment. Intervention(s). Laparoendoscopic single-site surgery access for TH and BSO. Main Outcome Measu...

  1. Single-Port Access Laparoscopy-Assisted Vaginal Hysterectomy: Our Initial Experiences with 100 Cases

    Yun-Sang Oh; Ji-No Park; Jin Choi; Kwang-Sik Shin; Young-Sam Choi; Tae-Eel Rhee


    Objectives. To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system. Materials and Methods. We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments. Results. All procedures were successfully completed through th...

  2. Adenomyosis among samples from hysterectomy due to abnormal uterine bleeding in Ahwaz, southern Iran

    Maryam Dehghani Mobarakeh; Ahmadreza Maghsudi; Iran Rashidi


    Introduction: Adenomyosis is one of the most common, yet underdiagnosed, underlying causes of abnormal uterine bleeding (AUB). We aimed to evaluate the prevalence of adenomyosis among subjects who underwent hysterectomy due to AUB. Materials and Methods: We studied the pathological specimens from 100 cases of AUB who underwent hysterectomy and were referred to Jundishapur University of Medical Sciences, Ahwaz (Iran) from 2007 to 2010. All specimens were reviewed by the same pathologist. ...

  3. Mood Symptoms After Natural Menopause and Hysterectomy With and Without Bilateral Oophorectomy Among Women in Midlife

    Gibson, Carolyn J.; Joffe, Hadine; Bromberger, Joyce T.; Thurston, Rebecca C.; Lewis, Tené T.; Khalil, Naila; Matthews, Karen A.


    Objective To examine whether mood symptoms increased more for women in the years after hysterectomy with or without bilateral oophorectomy relative to natural menopause. Methods Using data from the Study of Women’s Health Across the Nation (n=1,970), depression and anxiety symptoms were assessed annually for up to 10 years with the Center for Epidemiological Studies Depression Index and four anxiety questions, respectively. Piecewise hierarchical growth models were used to relate natural menopause, hysterectomy with ovarian conservation, and hysterectomy with bilateral oophorectomy to trajectories of mood symptoms before and after the final menstrual period or surgery. Covariates included educational attainment, race, menopausal status, age the year prior to final menstrual period or surgery, and time-varying body mass index, self-rated health, hormone therapy, and antidepressant use. Results By the 10th annual visit, 1,793 (90.9%) women reached natural menopause, 76 (3.9%) reported hysterectomy with ovarian conservation, and 101 (5.2%) reported hysterectomy with bilateral oophorectomy. For all women, depressive and anxiety symptoms decreased in the years after final menstrual period or surgery. These trajectories did not significantly differ by hysterectomy or oophorectomy status. The Center for Epidemiological Studies Depression Index means were .72 standard deviations lower, and anxiety symptoms .67 standard deviations lower, five years after final menstrual period or surgery. Conclusion In this study, mood symptoms continued to improve after the final menstrual period or hysterectomy for all women. Women who undergo a hysterectomy with or without bilateral oophorectomy in midlife do not experience more negative mood symptoms in the years after surgery. PMID:22525904

  4. Multivariate prognostic analysis of adenocarcinoma of the uterine cervix treated with radical hysterectomy and systematic lymphadenectomy

    KATO, TATSUYA; Watari, Hidemichi; Takeda, Mahito; Hosaka, Masayoshi; Mitamura, Takashi; Kobayashi, Noriko; Sudo, Satoko; Kaneuchi, Masanori; Kudo, Masataka; Sakuragi, Noriaki


    Objective The aim of this study was to investigate the prognostic factors and treatment outcome of patients with adenocarcinoma of the uterine cervix who underwent radical hysterectomy with systematic lymphadenectomy. Methods A total of 130 patients with stage IB to IIB cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy from 1982 to 2005 were retrospectively analyzed. Clinicopathological data including age, stage, tumor size, the number of positive node sites, ly...

  5. Chronic plasma cell endometritis in hysterectomy specimens of HIV-infected women: a retrospective analysis.

    Kerr-Layton, J A; Stamm, C. A.; Peterson, L. S.; McGregor, J A


    OBJECTIVE: Abnormal uterine bleeding is a common and troublesome problem in human immunodeficiency virus (HIV)-infected women. We sought to evaluate endometrial pathology among HIV-infected women requiring hysterectomy to explore if endometritis may be common among these patients. METHODS: We performed a retrospective analysis of uterine pathology specimens obtained from HIV-infected and control patients requiring hysterectomy in two urban hospitals between 1988 and 1997 matched for age, surg...

  6. Chronic Plasma Cell Endometritis in Hysterectomy Specimens of HIV-Infected Women: A Retrospective Analysis

    Kerr-Layton, J A; Stamm, C. A.; Peterson, L. S.; McGregor, J A


    Objective: Abnormal uterine bleeding is a common and troublesome problem in human immunodeficiency virus (HIV)-infected women. We sought to evaluate endometrial pathology among HIVinfected women requiring hysterectomy to explore if endometritis may be common among these patients.Methods: We performed a retrospective analysis of uterine pathology specimens obtained from HIV-infected and control patients requiring hysterectomy in two urban hospitals between 1988 and 1997 matched for age, surgic...

  7. Primary abdominal wall clear cell carcinoma arising from incisional endometriosis

    Burcu Gundogdu; Isin Ureyen; Gunsu Kimyon; Hakan Turan; Nurettin Boran; Gokhan Tulunay; Dilek Bulbul; Taner Turan; M Faruk Kose


    A 49 year-old patient with the complaint of a mass located in the caesarean scar was admitted. There was a fixed mass 30í30 mm in diameter with regular contour located at the right corner of the pfannenstiel incision. Computed tomography revealed a (40í50í50) mm solid mass lesion with margins that cannot be distinguished from the uterus, bladder and small intestines and a heterogeneous mass lesion (50í45í55) mm in diameter, located in the right side of the anterior abdominal wall. Cytoreductive surgery including total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Final pathology was clear cell carcinoma. Clear cell carcinoma arising from an extraovarian endometriotic focus was diagnosed and the patient received 6 cycles paclitaxel-carboplatin chemotherapy as adjuvant treatment. The patient who was lost to follow-up applied to our clinic 2 years after surgery with a recurrent mass in the left inguinal region. After 3 cycles of chemotherapy, the patient's tumoral mass in the left inguinal region was excised. The result of the pathology was carcinoma metastasis. It is decided that the following treatment of the patient should be palliative radiation therapy. The patient who underwent palliative radiation therapy died of disease after 4 months of the second operation.

  8. Adjuvant postoperative radiation therapy following simple hysterectomy and radical hysterectomy in stage IB cancer of the cervix: Analysis of risk factors and patterns of failure

    Between 1969 and 1980, 242 cases of stage IB cancer of the cervix were referred to the department of radiation oncology for curative radiation therapy. In 186 cases treatment was with radiation therapy alone. In 56 cases treatment included adjuvant postoperative radiation therapy; a minimum follow-up of 5 years has been carried out in this group. In 17 cases radiation therapy followed a simple hysterectomy for an unexpected stage IB cancer of the cervix. In 39 cases radiation therapy was given after a radical hysterectomy for stage IB cancer of the cervix because of positive margins and/or positive pelvic lymph nodes

  9. Component separation in abdominal trauma.

    Rawstorne, Edward; Smart, Christopher J; Fallis, Simon A; Suggett, Nigel


    Component separation is established for complex hernia repairs. This case presents early component separation and release of the anterior and posterior sheath to facilitate closure of the abdominal wall following emergency laparotomy, reinforcing the repair with a biological mesh. On Day 11 following an emergency laparotomy for penetrating trauma, this patient underwent component separation and release of the anterior and posterior sheath. An intra-abdominal biological mesh was secured, and the fascia and skin closed successfully. Primary abdominal closure can be achieved in patients with penetrating abdominal trauma with the use of component separation and insertion of intra-abdominal biological mesh, where standard closure is not possible. PMID:24876334

  10. Abdominal aortic aneurysm surgery

    Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald


    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 55......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems.......The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...

  11. CT of abdominal trauma

    Soon after it became available for clinical use, cranial CT became the method of choice for evaluating head trauma. Only relatively recently have newer generation full-body scanners been installed at major trauma centers, but experience is rapidly being gained in the utilization of CT for abdominal trauma. CT has proved highly accurate in diagnosing a wide variety of injuries to both intra- and retroperitoneal organs in pediatric and adult patient populations. The impact has been evident not only in decreasing utilization of other diagnostic tests, such as angiography, but also in practical management decisions, such as whether to perform exploratory laparotomy. This chapter details the authors' approach to evaluation of abdominal trauma by CT

  12. The blunt abdominal trauma

    Up to 1970 the number of patients suffering from blunt abdominal trauma showed a substantial increase. In more than 50% of all cases there are additional injuries. The most important factor influencing the prognosis of these patients is the early and correct indication for operation and the avoidance of unnecessary laparotomies. As a primary aim in diagnosis one should consider the recognition of an intraperitoneal bleeding without risk for the patient. Peritoneal lavage as an invasive method with low complication rates has proved good. First reports also show good results using the sonography of the abdomen. The recognition of the injured organ allows a carefully directed operation. Concerning the prognosis it is of minor importance. The diagnosis in patients with blunt abdominal trauma at the university clinic of Freiburg consists of: sonography, followed in positive cases by laparotomy or angiography and laparotomy. In cases with questionable results a lavage is done. (orig.)

  13. The abdominal circulatory pump.

    Andrea Aliverti

    Full Text Available Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50-75 ml with an ejection fraction of 4-6% and an output of 750-1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61+/-0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57+/-0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart.

  14. The Abdominal Circulatory Pump

    Andrea Aliverti; Dario Bovio; Irene Fullin; Dellacà, Raffaele L.; Antonella Lo Mauro; Antonio Pedotti; Macklem, Peter T.


    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk ...

  15. Obesity-Associated Abdominal Elephantiasis

    Ritesh Kohli


    Full Text Available Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications.

  16. Abdominal aspergillosis: CT findings

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  17. Abdominal aspergillosis: CT findings

    Yeom, Suk Keu, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)


    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  18. Pain and other symptom severity in women with fibromyalgia and a previous hysterectomy

    Vincent A


    Full Text Available Ann Vincent1, Mary O Whipple1, Connie A Luedtke2, Terry H Oh3, Richa Sood1, Robin L Smith1, Aminah Jatoi4 1Department of Medicine, 2Department of Nursing, 3Department of Physical Medicine and Rehabilitation, 4Department of Oncology, Mayo Clinic, Rochester, MN, USA Objective: Fibromyalgia is a troubling disease characterized by chronic pain. This study explored whether pain and other fibromyalgia symptoms are worse among women who had undergone a hysterectomy with or without an oophorectomy versus those who had not. Methods: Consecutive women who were seen at the Fibromyalgia Treatment Program at a tertiary medical center between 2001 and 2004 and who completed the Fibromyalgia Impact Questionnaire (FIQ and Short Form-36 Health Survey (SF-36 at initial evaluation were included in this study. Results: A total of 813 women were included; 328 had had a hysterectomy. Total FIQ scores from women who had had a hysterectomy were higher (worse symptoms than those who had not (58.1 vs 56.4, P = 0.002. FIQ subscale scores of pain (P = 0.003, fatigue (P = 0.030, stiffness (P = 0.035, and depression (P = 0.008 were also worse in women who had had a hysterectomy. Similar to the FIQ, SF-36 physical component scores were worse in women who had had a hysterectomy (P = 0.045. Conclusion: Pain and other fibromyalgia symptom severity was worse in women who had had a hysterectomy with or without an oophorectomy. Keywords: fibromyalgia, hysterectomy, oophorectomy, symptom severity, surgical menopause




    Full Text Available OBJECTIVE To assess safety and feasibility of non-descent vaginal hysterectomy for benign gynaecological disease. METHODS A prospective study was conducted at the Department of Obstetrics and Gynaecology of P K Das Institute of Medical Sciences from January 2013 to December 2013. An effort was made to perform hysterectomies vaginally in women with benign or premalignant conditions in the absence of prolapse. A suspected adnexal pathology, endometriosis, immobility of uterus, uterus size more than 16 weeks was excluded from the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus, morcellation techniques like bisection, debulking, coring, myomectomy, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size, estimated blood loss, length of operation, intraoperative and postoperative complications and hospital stay were recorded. RESULTS A total of 100 cases were selected for non-descent vaginal hysterectomy. Among them, 97 cases successfully underwent nondescent vaginal hysterectomy. Majority of the patients (55% were in age group 40-45 yrs. Four patients were nulligravida and eight patients had previous LSCS. Uterine size was ≤ 12 weeks in 84 cases and > 12-16 weeks in 16 cases. Commonest indication was leiomyoma of uterus (43%. Mean duration of surgery was 70±20.5 minutes. Mean blood loss was 150±65 mL. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in two cases because of adhesions and in one case there was difficulty in reaching the fundal myoma which prevented the uterine descent. Intra–operatively, one case had bladder injury (1% that had previous 2 LSCS. Postoperatively, complications were minimal which included postoperative fever (11%, UTI (8% and vaginal cuff infection was (4%. Mean hospital stay was 3.5 days. CONCLUSION Vaginal hysterectomy is safe, feasible in most of the women requiring hysterectomy for benign conditions with less

  20. Effect evaluation of 91 cases of non-prolapsed vaginal hysterectomy%非脱垂阴式子宫全切术91例效果评价

    杨会英; 张灵武


    目的 评价非脱垂阴式子宫切除术的临床效果.方法 对92例子宫良性病变患者行阴式子宫切除术(TVH)和同期91例患者行腹式子宫切除术(TAH)的临床资料进行回顾性分析,并用SF-36量表评价TVH术后患者的生存质量.结果 TVH手术时间为(107±35) min,手术前后血红蛋白的变化为(14±9)g/L.术中生命体征的波动情况:收缩压波动范围为(14±9)mm Hg(1 mm Hg =0.133 kPa),舒张压波动范围为(10±7)mm Hg,脉搏波动范围为(12±7)次/min.术后48 h内排气53例,术后病率15例,除手术时间外其余各项均明显优于TAH.TVH术中、术后并发症发生率(1.09%)与TAH(5.49%)比较差异无统计学意义.TVH手术前后患者除社会功能外,生理功能、生理角色限制、躯体疼痛,总体健康,活力、情感角色限制、心理健康7个维度差异均有统计学意义.结论 TVH患者术中干扰小,术中出血少,术后恢复快、并发症少;TVH患者术后生存质量提高.%Objective To evaluate the clinical effect of total vaginal hysterectomy on non-prolapsed uterus.Methods The clinical data of 92 patients with benign uterine diseases treated by total vaginal hysterectomy and 91 patients with benign uterine diseases treated by total abdominal hysterectomy were retrospectively reviewed and made use short form 36 health survey (SF-36) to evaluate the postoperative quality of life.Results The operative time was (107 ± 35) min ; changed scope of hemoglobin was (14 ± 9) g/L; the intra-operative vital sign fluctuated range:contractive pressure changed range was (14 ± 9)mm Hg(1 mm Hg =0.133 kPa),diastolic pressure changed range was (10 ±7)mm Hg,pulse changed range was(12 ±7) meta/min.The time of passage of gas by anus in 48 hours(53 cases),the postoperative pyrexia(15 cases),except for the operative time,the rest of total vaginal hysterectomy were better than total abdominal hysterectomy.There were no significant differences between the two groups in

  1. Changing trends in peripartum hysterectomy over the last 4 decades.

    Flood, Karen M


    OBJECTIVE: The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years. STUDY DESIGN: A retrospective cohort study was performed from 1966-2005 of patients who had PH in any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained from the combined patient databases of each hospital. RESULTS: There were 872,379 deliveries during the study period, among which 358 women underwent PH (0.4\\/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005, PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the overall cesarean delivery rate has increased from 6-19% during these 2 decades, the percentage of PH that occurs in the setting of a previous cesarean delivery has increased from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with "uterine rupture" as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5% (P < .00001). CONCLUSION: PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery rate, there has been a marked increase in the incidence of placenta accreta.

  2. Pattern and frequency of uterine pathologies among hysterectomy specimens in rural part of northern India: a retrospective secondary data analysis

    Vineet Chaturvedi


    Full Text Available Background: Hysterectomy is the most commonly performed gynecological surgery throughout the world.  Over the last several years reported cases of hysterectomy was increasing in numbers. However, similar studies from Etawah district with high prevalence of hysterectomy are lacking. Therefore, we have conducted this study to identify the pattern of pathologies identified in hysterectomy specimen and to correlate the pathological findings with the age group of the patient along with frequency of benign, malignant pathologies identified. Material and method:  This   study was conducted on 870 hysterectomy specimen who reported to pathology department .They were compared in terms of age of the patients and pathology of hysterectomy specimens. Result: Out of the hysterectomy specimens, pathological findings were seen in 850 hysterectomies.  Most common lesion was   leiomyoma (22.47% followed by Adenomyosis (21.76% ,Endometrial hyperplasia (14.00 %, ovarian cyst (9.29%, Endometrial atrophy (8.70%, Endometritis (7.76 %, Endo cervical polyp (5.64, Carcinoma intra epithelial neoplasm (3.52%, Endometrial polyp (3.17%, Carcinoma cervix (1.17%, Carcinoma ovary (1.05%, Benign ovarian tumor (0.58%,Carcinoma endometrium(0.35%, Myometritis (0.35%, Chorio carcinoma (0.11% The most common age group was (40-49 years. Conclusion:  Our data suggest that leiomyoma was the most common pathology seen in hysterectomy .The common age group for hysterectomy was (40 -49 years. Benign pathologies are more frequent in hysterectomy than malignant. Histopathology is mandatory for ensuring diagnosis and thus management, in particular of malignant disease.         

  3. [Differential diagnosis of abdominal pain].

    Frei, Pascal


    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain. PMID:26331201

  4. Dolor abdominal recurrente .

    Rodrigo De Vivero


    Full Text Available El dolor abdominal recurrente (DAR es un problema frecuente en la consulta médica y en la subespecialidad médica y quirúrgica. El DAR es frecuentemente funcional, es decir, sin una causa orgánica aparente. El diagnóstico diferencial debe incluir pérdida de peso, sangrado gastrointestinal, fiebre persistente, diarrea crónica y vómito importante. En este artículo se revisa el diagnóstico y tratamiento, pruebas diagnósticas y manejo farmacológico y ambiental.

  5. Obstetric hysterectomy, still a life saving tool in modern day obstetrics: a five year study

    Neetu Singh


    Results: During the study period, 105 emergency obstetric hysterectomies were performed giving an incidence of 0.54% .The incidence of hysterectomy following vaginal delivery was 0.54% and that of caesarean hysterectomy was 2.08%. It was most common in the age group 26-35 years (66.66% and in women of parity 3-4 (71.42%.Rupture uterus was the most common indication accounting for 59.04% cases followed by Atonic PPH (18.09%. Febrile illness and wound infection were the two most common co-morbidities. Maternal mortality was 5.71%. Conclusions: Emergency obstetric hysterectomy is potentially a life saving procedure which every obstetrician must be familiar with in cases of catastrophic rupture uterus and intractable haemorrhage. With the help of prostaglandins, modern policies of active management of labor, timely performance of caesarean section, internal iliac artery ligation, compression sutures etc. obstetric hysterectomy should be made a more rare procedure. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 540-543

  6. Hypnosis for functional abdominal pain.

    Gottsegen, David


    Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712

  7. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Children's (pediatric) abdominal ultrasound imaging produces pictures ...

  8. Practical pediatric abdominal CT

    This course is designed to help the radiologist in a hospital setting successfully approach abdominal CT in the infant and child. Emphasis is placed on techniques necessary for a high-quality examination of the upper abdomen, as applied to common pediatric problems such as trauma, tumor, and infection. Material is presented on technical considerations, including patient sedation, preparation, and potential pitfalls and helpful hints for imaging. An emphasis is placed on dynamic scanning with table incrementation. The section on trauma focuses on an approach to imaging the abdomen in the injured child, typical injuries, patterns of injury in the upper abdomen, and why CT is the best imaging modality for blunt upper abdominal trauma. The discussion of tumor imaging reviews the appearance of typical childhood neoplasia including Wilms tumor, neuroblastoma, non-Hodgkin and Burkitt lymphoma, and disseminated solid tumors such as rhabdomyosarcoma. The authors emphasize what to look for and where, both on initial and on later (for recurrences) examinations. The discussion of infection addresses detection of abscesses and occult infections in children, as well as imaging of abscesses prior to intervention

  9. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)


    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  10. A Marked Increase in Obstetric Hysterectomy for Placenta Accreta

    Xiao-Yu Pan; Yu-Ping Wang; Zheng Zheng; Yan Tian; Ying-Ying Hu; Su-Hui Han


    Background:Obstetric hysterectomy (OH) as a lifesaving measure to manage uncontrolled uterine hemorrhage appears to be increasing recently.The objective of this study was to determine the etiology and changing trends of OH and to identify those at particular risk of OH to enhance the early involvement of multidisciplinary intensive care.Methods:A retrospective study was carried out in patients who had OH in China-Japan Friendship Hospital from 2004 to 2014.Maternal characteristics,preoperative evaluation,operative reports,and prenatal outcomes were studied in detail.Results:There were 19 cases of OH among a total of 18,838 deliveries.Comparing the study periods between 2004-2010 and 2011-2014,OH increased from 0.8/1000 (10/12,890) to 1.5/1000 (9/5948).Indications for OH have changed significantly during this study period with uterine atony decreasing from 50.0% (5/10) to 11.1% (1/9) (P < 0.05),and placenta accreta as the indication for OH has increased significantly from 20.0% (2/10) to 77.8% (7/9) (P < 0.05).Ultrasonography and magnetic resonance imaging (MRI) have been used to make an exact antepartum diagnosis of placenta accreta.A multidisciplinary management led to improved outcomes for patients with placenta accreta.Conclusion:As the multiple cesarean delivery rates have risen,there has been a dramatic increase in OH for placenta accreta.An advance antenatal diagnosis of ultrasonography,and MRI,and a multidisciplinary teamwork can maximize patients' safety and outcome.