Abstract
Background: Word hemi-hysterectomy and removal of rudimentary functional horn may be used interchangeably in published data. The same term may be used when a non-obstructive hemi-uterus is removed when there is an associated pathology. The article tries to standardise classification of Mullerian dysgenesis where this procedure is required according to ESHRE ESGE classification, preoperative diagnosis and discuss the operative details. Objective: The objective was to study the demographic profile, symptoms, association of endometriosis, variation in the anatomy, accuracy of preoperative diagnosis, to classify according to ESHRE ESGE classification and to standardize the laparoscopic surgical steps of hemi-hysterectomy. Study Design: This is a retrospective case series of cases of Mullerian dysgenesis with obstructive hemi-uterus or non-obstructive hemi-uterus with pathology treated by laparoscopic hemi-hysterectomy. (Canadian task force classification III). Methods: Data from hospital electronic records of all cases tagged with word laparoscopic hemi-hysterectomy were collected for 9 years from Jan 2009 to Dec 2018. Results: Total 19 patients of hemi-hysterectomy were analysed. Pre-operative diagnosis was made in 100% of patients. 100% patients with obstructive horn had dysmenorrhoea. ESHRE ESGE class U4aC3V0 was more frequently seen followed by U5aC4V4 and U3bC3V2 as obstructive and U4bC3V0, as non-obstructive. Associated endometriosis along with other pathology was seen in 74% of the patients. 3 patients with HWWS had ipsilateral renal agenesis. Laparoscopic hemi-hysterectomy was offered to all such patients. The operative steps & variants were studied. Post-operative outcome was uneventful in all. Conclusion: An experienced surgeon should deal with these problems of Mullerian dysgenesis discussed in this study. The other variants diagnosed also must be treated by an experienced surgeon only. Laparoscopic hemi-hysterectomy is almost the most standard surgical method to treat pelvic pain in cases with rudimentary non-communicating horns or in cases of non-obstructive horns with other associated pathologies. Post-operative recovery is uneventful, and all patients reported pain free periods as well as they are free of chronic pain which they had before surgery.
Highlights
Mullerian dysgenesis is found in .4 of general population [1] or in normal fertile population 3.2% [2], 7% of adolescent age group [3] and in 24.5% of infertile females [4]
Study Design: This is a retrospective case series of cases of Mullerian dysgenesis with obstructive hemi-uterus or non-obstructive hemi-uterus with pathology treated by laparoscopic hemi-hysterectomy. (Canadian task force classification III)
The present case series will help clinicians to understand and classify such Mullerian dysgenesis according to ESHRE ESGE classification
Summary
Mullerian dysgenesis is found in .4 of general population [1] or in normal fertile population 3.2% [2], 7% of adolescent age group [3] and in 24.5% of infertile females [4]. ESHRE ESGE classification [7] of Mullerian dysgenesis classifies obstructive malformations which may require hemi-hysterectomy are U4aC3V0, U3bC3V2 (HWWS (Herlyn-Werner-Wunderlich syndrome) type 1.2) [8], U5aC4V4 and non-obstructive as U4bC3V0, categories. This is a retrospective study of case series of obstructed hemi-uterus and hemi-uterus with associated pathology treated in last 9 years. Objective: The objective was to study the demographic profile, symptoms, association of endometriosis, variation in the anatomy, accuracy of preoperative diagnosis, to classify according to ESHRE ESGE classification and to standardize the laparoscopic surgical steps of hemi-hysterectomy. Post-operative recovery is uneventful, and all patients reported pain free periods as well as they are free of chronic pain which they had before surgery
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