Abdominal Hysterectomy For Benign Conditions Research Articles

Laparoscopic Hysterectomy versus Abdominal Hysterectomy for Obese Women with Benign Diseases

Background: Obesity is a challenging health problem in gynecologic surgery. Laparoscopic has the potential advantages than abdominal hysterectomy of being quicker, efficient with low estimated blood loss.Aim of the work: To compare the safety and effectiveness of laparoscopic and abdominal hysterectomy for benign conditions in obese patients. Patients and Methods: Sixty patients were submitted to history taking, clinical examination, Lab investigations, abdominal ultrasound and biopsy for suspicious pathology. Patients divided into two equal groups. The first for total laparoscopic hysterectomy and the second for trans-abdominal hysterectomy. Patients were followed for six months after surgery. Data collected include operative time, amount of blood loss, complications and duration of hospital stay. Results: BMI was significantly higher among open when compared to laparoscopic group (43.69±3.86 vs 34.5±4.02 respectively), and low parity and low cesarean deliveries were significantly increased in laparoscopic group. The highest indication of hysterectomy in laparoscopic group was adenomyosis (43.3%) followed by fibroid (30.0%), while in open group, the most common indication was fibroid (53.3%) followed by adenomyosis (26.7%). Operative time showed significant decrease in laparoscopic when compared to open hysterectomy groups (56.23±21.5 vs 78.87±8.22 minutes respectively) and blood loss was significantly decreased among laparoscopic group. Finally, the length of hospital stay was significantly decreased in laparoscopic when compared to open groups (the median was 10 versus 24 hours respectively). Conclusion: Laparoscopic hysterectomy is superior to abdominal hysterectomy in obese females with benign conditions in terms of safety and efficacy.

Clinical Determinants of Vaginal and Abdominal Hysterectomy for Benign Conditions at the University Teaching Hospital, Yaounde-Cameroon.

Background:Little is known about training and the practice of vaginal hysterectomy in many sub-Saharan Africa countries.Objective:The aim of this study was to identify the clinical determinants of choice of hysterectomy route for benign conditions at the University Teaching Hospital in Yaoundé, Cameroon (UTHYC).Methods:This was a retrospective cross-sectional study at the UTHYC from January 1, 2000 to December 31, 2008. Non-emergency hysterectomies for benign conditions were divided into two surgical approaches: vaginal and abdominal. Patients’ files and registers were used for data collection. Variables of interest were socio-demographic, reproductive health, and clinical characteristics, including indications and surgical route. Analysis was performed using Epi-Info version 3.5.1. Logistic regression analysis was conducted to determine the association between clinical variables and surgical routes. Odds ratios with their 95% confidence intervals (CI) were calculated. The level of significance was set up at P < 0.05.Results:One hundred and sixty-three women who underwent hysterectomy for benign conditions were included in the study. Thirty-seven (22.7%) were by vaginal route and 126 (77.3%) by abdominal route. Indications for hysterectomy were: cervical premalignant lesions, symptomatic uterine fibroids, prolapsed uterus, endometrial hyperplasia, recurrent cervical condyloma, and dysfunctional uterine bleeding. All 61 women with estimated uterine size of more than 12 weeks were operated on by abdominal route. At bivariate analysis, compared to women who had vaginal hysterectomy, factors associated with the choice of abdominal route were secondary/tertiary level of formal education, previous history of laparotomy/caesarean section, premenopausal status, age less than 50 years, and symptomatic uterine fibroids as surgical indication. At multivariate analysis, factors remaining independently associated with the choice of abdominal route were: age <50 years (AOR: 2.99 [1.9–4.71]), P < 0.001); previous laparotomy/cesarean section (AOR: 2.95[2.13–4.08], P = 0.001); premenopausal status (AOR: 1.55 [1.06–2.25]; P = 0.001); and myoma as surgical indication (AOR: 7.49.4[3.2–14.4]; P = 0.0001).Conclusion:Less than a quarter of hysterectomies for benign conditions were performed vaginally. All patients with uterine sizes larger than 12 weeks had laparotomy. The determinants of the choice of the abdominal route included age less than 50 years, previous laparotomy/caesarean section, premenopausal status, and fibroid as surgical indication.

Bowel dysfunction after total abdominal hysterectomy for benign conditions

On the basis of retrospective studies, hysterectomy has been considered a risk factor for functional bowel disorders. The aim of this study was to prospectively evaluate the patients' bowel function and general health-related quality of life (QoL) before and after hysterectomy. Our hypothesis was that hysterectomy in properly selected patients can impact positively on the patients' self-reporting of their general health and bowel function. A prospective longitudinal observational study was conducted in a university-based teaching hospital. Eighty-five patients who were scheduled for total abdominal hysterectomy for a nonmalignant cause completed the study. The main outcome measure was the patient's perception of her bowel function, which was assessed preoperatively and at 6, 12, 26 and 52 weeks postoperatively using the gastrointestinal quality of life questionnaire. The patient's general health was also assessed using a generic general health questionnaire (EQ5D and EQVAS). The effect of time on change in questionnaire score was assessed using mixed model repeated measures at a significance level of 0.05. The scores in the three questionnaires declined significantly at 6 weeks postoperatively as compared with those obtained preoperatively. However, there was a subsequent increase in the scores up to 12 months postoperatively. Smoking and use of laxative were identified as potential confounding variables. Apart from a transient negative effect, total abdominal hysterectomy improves the patient's gastrointestinal-related QoL, probably as part of general improvement in their QoL.

The Impact of Quality of Sleep on Recovery from Fast-Track Abdominal Hysterectomy

To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery. A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire. Women in the general anesthesia group experienced bad quality of sleep the night after surgery significantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a significantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the first night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the first night postoperatively (p = 0.002). The quality of sleep the first night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs.

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

To evaluate the effect of stress coping capacity in combination with mode of anaesthesia on postoperative recovery in fast-track abdominal hysterectomy. Prospective longitudinal study. Five hospitals in the south-east of Sweden. A cohort of 162 women undergoing fast-track abdominal hysterectomy for benign conditions. Self-administered questionnaires, the Stress Coping Inventory (SCI) and the Swedish Postoperative Symptom Questionnaire (SPSQ), and clinical information were collected prospectively. Stress coping capacity was categorised as high or low according to the summed score of the SCI. Comparisons of effect variables were adjusted using a propensity score-matching model. Associations between stress coping capacity and hospital stay, sick leave, use of analgesic and self-reported postoperative symptoms. Women with high stress coping capacity had a significantly shorter sick leave, experienced postoperative symptoms significantly less often, and with lower intensity, than women with low stress coping capacity. With the exception of symptom intensity, these findings were related to having had the operation under spinal anaesthesia as opposed to general anaesthesia. Hospital stay, use of analgesics and abdominal pain were not related to stress coping capacity. In patients for whom spinal anaesthesia was applied, high stress coping seems to be a quality that helps patients manage the burden of surgery. It is desirable for the individual, as well as for the healthcare system, to enhance recovery by using intervention programmes designed to improve or manage stress coping, particularly for individuals with low stress coping capacity. This recommendation merits further investigation.

A long‐term prospective study to compare the effects of vaginal and abdominal hysterectomy on micturition and defecation

We compared micturition and defecation symptoms with the route of hysterectomy over a period of 10 years. Prospective multicentre observational study. Thirteen teaching hospitals in the Netherlands. A total of 430 women who underwent vaginal or abdominal hysterectomy for benign conditions (pelvic organ prolapse excluded). The presence and discomfort experienced as a result of micturition and defecation symptoms were assessed using validated questionnaires before surgery, and at 6 weeks, 6 months, 1 year, 3 years and 10 years after surgery. Statistically significant differences in symptoms between vaginal and abdominal hysterectomy were adjusted for pre-operative differences in uterine descent, uterine size, parity and indication for hysterectomy. Presence of bothersome micturition and defecation symptoms, as assessed by the Urogenital Distress Inventory (UDI) and Defecation Distress Inventory (DDI). Ten years after hysterectomy the response rate was 73%. Preoperatively, no differences were observed in the prevalence of micturition symptoms between patients who underwent vaginal and abdominal hysterectomy. However, 10 years after vaginal hysterectomy, significantly more women had been treated for micturition symptoms (18 versus 8%; P = 0.02; adjusted OR 3.8, 95% CI 1.2-11.6). Defecation symptoms also seemed more common after vaginal hysterectomy (58 versus 46%; P = 0.08). After adjustment, no statistically significant differences in defecation symptoms were found. Despite the same incidence of micturition symptoms before surgery, patients undergoing vaginal hysterectomy are more likely to seek medical help for micturition symptoms. Defecation symptoms were also more common after vaginal hysterectomy; however, this difference was not statistically significant.

Experience of our surgery in iatrogenic vesicovaginal fistulas

In this study, transvesical and transvaginal approaches used in our clinic for the treatment of gynecologic iatrogenic vesicovaginal fistulas are discussed. 11 patients with vesicovaginal fistula admitted to the Department of Urogynecology, Zeynep Kamil Teaching- Research Hospital between 2005-2009 were enrolled in our study. Transvesical and transvaginal fistula repair were performed on all patients. All patients were treated by surgical repair, 4 cases by a classic transabdominal approach, 5 cases by an omental flap interposition and 2 cases by a martius flap interposition. The most common cause of iatrogenic vesicovaginal fistula in our patients was total abdominal hysterectomy for benign conditions (n=10/11). The mean patient age was 43 years (34-53) and the mean time from the causative surgery to the operation was 7.5 months (3-12). The surgical techniques were successful in all patients. There were no intraoperative complications and no postoperative recurrences. The mouth of the fistula should be determined clearly on preoperative evaluation and surgery procedure should be planned according to the fistula aperture. The point to be careful of is excision of all diseased tissue in the bladder and vagina, complete separation of the bladder from the vagina with a margin of healthy tissue, and watertight closure of both bladder and vagina without tension. The aim of the vascularized tissue interposition between the closed bladder and the vagina is to provide the improvement of vascularity. We believe that in the treatment of supratrigonal and large fistulas, the transvesical approach with use of omental flap interposition is more effective, while, in the treatment of small and trigonal fistula, the transvaginal approach with use of martius flap interposition is an effective tecnique.

A 1‐year follow up of psychological wellbeing after subtotal and total hysterectomy—a randomised study

Please cite this paper as: Persson P, Brynhildsen J, Kjølhede P on behalf of the Hysterectomy Multicentre Study Group in South‐East Sweden. A 1‐year follow up of psychological wellbeing after subtotal and total hysterectomy—a randomised study. BJOG 2010;117:479–487.Objective To compare subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH) regarding influence on postoperative psychological wellbeing and surgical outcome measurements.Design A prospective, open, randomised multicentre trial.Setting Seven hospitals and one private clinic in the south‐east of Sweden.Population Two‐hundred women scheduled for abdominal hysterectomy for benign conditions were enrolled in the study; 179 women completed the study (94 SH and 85 TH).Methods Four different psychometric tests were used to measure general wellbeing, depression and anxiety preoperatively, and at 6 and 12 months postoperatively. Statistical analysis of variance and covariance were used.Main outcome measures Effects of operating method on psychological wellbeing postoperatively. Analysis of demographic, clinical and surgical data, including peri‐ and postoperative complications and complaints at follow up.Results No significant differences were observed between the two groups in any of the psychometric tests. Both surgical methods were associated with a significantly higher degree of psychological wellbeing at 6 and 12 months postoperatively, compared with preoperatively. No significant differences were found in the clinical measures including complications. A substantial number of women experienced persistent cyclic vaginal bleedings after SH. Neither minor or major postoperative complications, nor serum concentration of sex hormones, were associated with general psychological wellbeing 12 months after the operation.Conclusions General psychological wellbeing is equally improved after both SH and TH within 12 months of the operation, and does not seem to be associated with the occurrence of peroperative complications or serum concentration of sex hormones.

Electrosurgical Bipolar Vessel Sealing Versus Conventional Clamping and Suturing for Total Abdominal Hysterectomy: A Randomized Trial

Study Objective To compare the effects of bipolar vessel sealing versus conventional clamping and suturing in women undergoing total abdominal hysterectomy. Design A randomized controlled trial was performed. Patients were randomized to vessel sealing or conventional surgery. Postoperative pain was the primary outcome. An intention-to-treat analysis was performed (Canadian Task Force classification I). Setting Two Dutch teaching hospitals. Patients A total of 57 women undergoing abdominal hysterectomy for benign conditions. Measurements and Main Results During the first 3 postoperative days, patients operated on using vessel sealing had statistically significantly lower pain scores. The amount of blood loss, surgery time, complication risk, and duration of hospitalization were similar between both groups. Patients in the vessel-sealing group resumed their normal daily activities on average 8 days earlier as compared with the conventional group. Postoperative pelvic floor function was similar in both groups. Conclusion The use of vessel sealing during abdominal hysterectomy for benign conditions appears to be associated with reduced postoperative pain and faster recovery.

Ovarian Changes After Abdominal Hysterectomy for Benign Conditions

To investigate any change in the ovaries, including early follicular serum follicle-stimulating hormone (FSH) level, total ovarian volume, total antral follicle count, and ovarian stromal blood flow, in patients who had undergone abdominal hysterectomy for benign conditions. Fifteen women with abdominal hysterectomy and conservation of ovaries for benign conditions and who were between 29 and 44 years old were recruited to undergo three-dimensional ultrasound examination with power Doppler to assess total ovarian volume, total antral follicle count, and vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of ovarian stromal blood flow. Serum FSH, estradiol, and progesterone levels were checked on the same day. The results of the assessments were considered taken during the early follicular phase if the estradiol and progesterone levels were basal. Fifteen age-matched healthy women underwent the same assessments on the second day of menstruation. Women with hysterectomy had significantly elevated serum FSH level and lower ovarian stromal blood flow indices, including VI, FI, and VFI, as compared with healthy women. The total antral follicle count and the total ovarian volume were similar between the two groups. These changes may suggest altered ovarian function after hysterectomy.

OC148: Reduced ovarian stromal blood flow and elevated serum FSH level after abdominal hysterectomy for benign conditions

OC148: Reduced ovarian stromal blood flow and elevated serum FSH level after abdominal hysterectomy for benign conditions

Minimal invasive laparoscopic hysterectomy with ultrasonic scalpel

Background: The purpose of the study was to assess whether total laparoscopic hysterectomy with the ultrasonic scalpel offers advantages in term of intraoperative and postoperative outcomes over the conventional abdominal hysterectomy. Methods: A case-control study to compare patients undergoing total laparoscopic hysterectomy and women undergoing abdominal hysterectomy for benign conditions was designed. Matching criteria were the menopausal status, the need of adnexectomy, and the uterus weight. The laparoscopic procedure was carried out using an ultrasonically activated scalpel and the amputated uterus was removed transvaginally. Every part of the operation was carried out via laparoscopy, from the adnexal phase to the colpotomy. Abdominal hysterectomy was performed using a conventional laparotomic technique. Intraoperative and postoperative characteristics were analyzed. Results: One hundred forty-four patients were enrolled, of whom 48 underwent total laparoscopic hysterectomy and 98 abdominal hysterectomy. No difference was found between groups in terms of operating time or intraoperative and postoperative infectious and noninfectious complications. The median (range) total consumption of morphine (0 mg [0 to 16] versus 15 mg [0 to 100], P <0.01) during the first 3 postoperative days was significantly lower in the laparoscopic group than in the laparotomic group. The median (range) time to regular diet (1[0 to 4] versus 2 [0 to 5], P <0.05) and the time to passage of stool (1[1 to 2] versus 2 [1 to 5], P <0.05) was shorter in the laparoscopic than in the laparotomic group. Conclusions: Total laparoscopic hysterectomy with the ultrasonic scalpel is feasible and safe, and offers not only cosmetic benefits but also reduces the need of analgesia and the time to return to a normal gastrointestinal function in comparison with the conventional abdominal hysterectomy.

Abdominal Hysterectomy for Benign Gynaecological Conditions at Ibadan, Nigeria

Context: Total abdominal hysterectomy is one of the commonly performed major gynaecological operations in our hospital and it is desirable to review its safety in view of the advanced pathology that is frequently encountered. Objective: To determine the indications for and the pattern of morbidity and mortality in abdominal hysterectomy done for benign conditions over a 10-year period. Study Design: A retrospective study of all cases of abdominal hysterectomy for benign conditions over a ten-year period. Main Outcome Measures: The relative proportion of cases of abdominal hysterectomy compared to the total number of operations, the prevalence of various peri- and post-operative complications or mortality. Results: Total abdominal hysterectomy accounted for 10.2% of all major gynaecological operations during the study period. The indication was uterine fibroids in 82% of cases done for benign indications. The crude morbidity rate was 31% and there was no mortality. Conclusion: In spite of advanced pathology, abdominal hysterectomy for benign conditions is a fairly safe procedure in UCH Ibadan. There is a need to further reduce the high morbidity rate associated with the procedure especially the use of peri-operative antibiotic prophylaxis. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 19-23)

Expression of C-20, 22 desmolase activity by the human fallopian tube in vitro: evidence for steroidogenesis.

With a view to establishing whether cells of the human Fallopian tubes possess the cholesterol side-chain cleavage activity, homogenates of the tubes, obtained from 6 women (39-45 years) following abdominal hysterectomy for benign conditions, were incubated with (7n-3H)-cholesterol as substrate. Controls (n=6, age 40-44 years) were homogenates heated in a boiling water bath for 10 min. Using the reverse-isotope dilution technique, (3H)-pregnenolone was isolated and characterized. No such metabolite was evident in control incubations of heat-denatured enzymes. The extent of enzymic conversion varied from 1.9 x 10(-3) to 1.3 x 10(-2)%. The results reveal for the first time the existence of an active cholesterol-specific C-20, 22 desmolase system in the viable tissues. It is suggested that there exists a potential for substantial pregnenolone synthesis in vivo. This rate-limiting steroid biosynthetic conversion provides a new dimension to the functional capacity of the Fallopian tubes in the synthesis of steroids, which may be necessary for modulating ciliary beat frequency and in maintenance of hormonal milieu essential for embryogenesis.

Conservative treatment of vaginal vault granulation tissue following total abdominal hysterectomy

Objective: To study the incidence, symptoms and spontaneous regression rate of vault granulation tissue in relation to their sizes following total abdominal hysterectomy for benign conditions. Methods: Prospective descriptive study; 352 patients who underwent total abdominal hysterectomy for benign conditions between September 1995 and April 1996 were included. All patients with vault granulation tissue were followed up until the 20th week after the operation. The main outcome measures were incidence of vault granulation tissue, symptoms, sizes of lesions, spontaneous regression rate and relationship between size and regression rate. Results: The incidence of vault granulation tissue was 34%. Nearly 60% of the lesions were≤5 mm. Spontaneous regression occurred in 52% of the cases. If the lesion was≤5 mm the chance of it to completely disappear was 72% whereas the same would happen in only 33% if the lesion was>5 mm ( P<0.01, significant). Although only 7% of the patients with lesions≤5 mm had symptoms as compared to 18% of those with lesions>5 mm; the difference was not statistically significant. Conclusions: Vault granulation tissue is a common complication, occurring in approximately one-third of patients who had total abdominal hysterectomy. The results of our study suggests that if the lesions are small (≤5 mm) it would be reasonable to leave them alone as few give symptoms and most regressed spontaneously; saving the patients' time, inconvenience, expenses and discomfort.

Does a shorter length of hospital stay affect the outcome and costs of hysterectomy in southern England?

To see whether a shorter postoperative length of stay (LOS) for a major procedure, abdominal hysterectomy for benign conditions, was associated with health outcome, the use of formal and lay care after discharge, cost, and satisfaction. Prospective cohort study. Three hospitals in London and three in Hertfordshire and Bedfordshire. A total of 363 women undergoing total abdominal hysterectomy with or without oophorectomy: 112 with a short postoperative LOS (five days or less) and 251 with a standard LOS (six days or more). Wound infection within 10 days and six weeks; change in general health status (Nottingham health profile) after six weeks; general health and change in social activity (lifestyle index) three months after surgery. Mean cost difference for hospitals, use of formal and lay care after discharge, and patient satisfaction. Short LOS was associated with benefits: a lower risk of wound infection in the first 10 days (odds ratio 0.44; p = 0.03) and no deterioration in physical mobility (measured using the NHP) after six weeks- and with adverse outcomes: constipation six weeks later (OR 0.48; p < 0.001) and moderate or severe urinary symptoms six weeks (OR 0.69; p < 0.004) and three months (OR 0.65; p < 0.008) later. On multivariate analysis, the only outcome to remain significantly associated with LOS was physical mobility after six weeks (p = 0.024). There was no significant difference between short and standard stay women as regards their use of formal or lay care after discharge from hospital. The mean cost of hospital care was Pounds251 (in 1992) less for short than for standard stay patients. Most women (73% at six weeks) felt their LOS was appropriate. Short stay women were more likely to feel it was too short, though the difference was not statistically significant. Short postoperative stays do not seem to be associated with any adverse outcomes and result in modest financial saving to the health service. There is potential for greater use of early discharge.

Effects of abdominal hysterectomy on urinary and sexual symptoms.

A prospective study of 102 women undergoing abdominal hysterectomy for benign conditions was performed in order to evaluate pre- and post-operative urinary and sexual symptoms. The mean age of the patients was 44.9 years (range 30-65). Urinary disorders such as urgency, dysuria, frequency, nocturia, slow bladder emptying, sensation of residual urine as well as stress and urge incontinence were observed pre-operatively and 2, 6 and 12 months post-operatively. Dyspareunia, libido and the number of orgasms were evaluated as disorders affecting sexual life. At follow-up 12 months post-operatively a statistically significant decrease in stress incontinence, frequency and nocturia was observed. Dyspareunia was also significantly less frequent and increased libido was experienced. It was concluded that abdominal hysterectomy does not provoke adverse urinary or sexual symptoms and that it can have beneficial effects.

Tissue Destruction Following Cold Coagulation of the Cervix

Eighty patients undergoing total abdominal hysterectomy for benign conditions were studied in order to assess the depth of tissue destruction achieved by using the Semm Cold Coagulator at different temperatures and different durations of application. The results indicate that after a single application, the mean depth of tissue destruction ranged from 2.6 mm (100°C for 20 seconds) to 3.5 mm (120°C for 30 seconds). The depth of tissue destruction increased significantly with higher temperature (P < 0.01) and longer length of exposure (P < 0.01).

POSTOPERATIVE THROMBOSIS IN THAI WOMEN

The 125I-labelled fibrinogen infusion test and phlebography were used to detect evidence of the postoperative development of deep-vein thrombosis (D.V.T.) in the legs of 117 Thai women who had abdominal hysterectomy for benign conditions and of 52 who had major pelvic surgery for malignant disease of the ovary, uterus, and cervix. D.V.T. was demonstrated in 1·7% and 3·8%, respectively. Comparison of these results with an almost identical study in Oxford showed that D.V.T. was significantly more common in women in England— i.e., 12% and 35% in those with benign or malignant diseases, respectively.