Abdominal Hysterectomy For Benign Disease Research Articles

Application of Uterus Manipulator in Total Abdominal Hysterectomy for Benign Diseases.

Pelvic access is a challenging matter in abdominal hysterectomy especially in obese patients and presence of pelvic adhesions. Uterus manipulators (UM) have been used in a number of studies on laparoscopic approach to improve surgical performance. This study aimed to assess the impact of UM application on the operation time and blood loss in total abdominal hysterectomy (TAH) for benign diseases. Forty-one patients aged 34 to 56 years were enrolled for abdominal hysterectomy - 20 as the case group (hysterectomy with UM application) and 21 as the control group (conventional hysterectomy). In the case group, UM was used after uterus artery ligation during TAH. The control group underwent traditional TAH. The mean operation time was significantly less in TAH with UM compared to traditional TAH (90.23 ± 10.54 minutes vs. 140.5 ± 16.61 minutes; p-value<0.001). The mean decline between preoperative and 12-hour postoperative hemoglobin was 0.74 ± 0.23 mg/dL in the TAH with UM group and 1.65± 1.02 mg/dL in the traditional TAH group (p-value<0.001). Also, no difference was detected in intra- and post-operative complications. The current study showed that, using UM is beneficial in total abdominal hysterectomy by decreasing the operative time and blood loss.

Route of Hysterectomy for Benign Disease: Abdominal Hysterectomy

The role of abdominal hysterectomy for benign disease has decreased with time, given the broad application of minimally invasive hysterectomy. Abdominal hysterectomy is indicated when minimally invasive surgery is not feasible due to patient-, disease-, or technical-factors, including uterine size, risk of malignancy, or extensive endometriosis and adhesive disease. Conversion from minimally invasive hysterectomy might also be required when unexpected adhesive disease or intraoperative complications are encountered. Attention to preoperative preparation; surgical planning; and intraoperative setup, exposure, and use of available surgical assistance optimize the success of planned or emergent conversion to abdominal hysterectomy. Finally, intraoperative and advanced pelvic surgical techniques, as well as consultation with colleagues across subspecialties, can be utilized to facilitate safe surgery in patients with complex pelvic diseases or inadvertent intraoperative injuries.

Incidence and Risk Factors of Surgical Site Infections after Abdominal Hysterectomy for Benign Diseases

Incidence and Risk Factors of Surgical Site Infections after Abdominal Hysterectomy for Benign Diseases

Influence of cytokines on the postoperative period

Purpose of Investigation: The relationships between postoperative recovery and changes of circulating levels of pro- and anti-inflammatory cytokines. Materials and Methods: The study included prospectively a cohort of 51 females who underwent abdominal hysterectomy for benign diseases. Recovery was assessed with Quality of Recovery 40 (QoR-40) questionnaire and concentrations of four cytokines during the 72-hours period were measured using human sensitive enzyme-linked immunosorbent assay (ELISA) kits. Results: Total QoR-40 score significantly declined on the first and the second postoperative days and then returned to baseline (p &lt; 0.001). Interleukin-17 serum levels had no significant trend (p = 0.072). Statistically significant patterns of concentration changes of interferon gamma (p = 0.010), interleukin-10 (p &lt; 0.001), and transforming growth factor (p = 0.016) were found. There were no significant correlations between QoR-40 scores and concentrations of any cytokine, at prespecified study power for moderate relationships at least. Conclusion: Recovery after abdominal hysterectomy was rapid and complete and it was unrelated to serum concentration profiles of examined cytokines.

No Differences in the Prevalence and Intensity of Chronic Postsurgical Pain Between Laparoscopic Hysterectomy and Abdominal Hysterectomy: A Prospective Study.

ObjectiveTo compare the prevalence and characteristics of chronic postsurgical pain (CPSP) between laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH) groups 3, 6, and 12 months after surgery, and to assess the impact of pain on the activities of daily living (ADL) of patients.MethodsThe demographic characteristics, intraoperative clinical factors, and postoperative pain score were collected prospectively in patients scheduled for elective LH or AH for benign disease at our institution from July 2014 to June 2015. Patients were interviewed by telephone and followed up for pain assessment 3, 6, and 12 months after surgery. The prevalence, intensity, and specific locations of pain, as well as analgesic administration and impact on the ADL, were included in the questionnaire.ResultsThe results from 406 patients (225 patients in the LH group and 181 patients in the AH group) were obtained. Three months after surgery, the prevalence of CPSP was 20.9% in the LH group and 20.4% in the AH group. At 6 months, the prevalence of pain declined to 11.6% in the LH group and 9.4% in the AH group. At 12 months after surgery, only 13 (5.8%) patients in the LH group and 11 (6.1%) patients in the AH group complained about persistent pain. The prevalence of CPSP, as well as the average numerical rating scale pain scores at rest and during movement, during 12 months after surgery were not significantly different between the groups. CPSP after hysterectomy exhibited a negative impact on the ADL.ConclusionThe prevalence and intensity of CPSP were not significantly different between patients undergoing LH or AH within 12 months after surgery. A tendency towards a reduction in chronic pain over time was documented. Chronic post-hysterectomy pain exhibited a negative impact on the ADL.

1369 Cost and Outcomes Analysis of Robotic, Laparoscopic, and Abdominal Hysterectomy for Benign Disease in a Community Hospital Setting

Study Objective To compare overall costs and quality measures of various methods of benign hysterectomies at a community based hospital system Design A retrospective review of all hysterectomies for benign indications at Saint Peters University Hospital between March 2017 to Dec 2018. Robotic assisted laparoscopic hysterectomies, laparoscopic hysterectomies, and abdominal hysterectomies were compared. Setting Data was collected from admission to discharge. In the OR, all patients were in comparable sized OR rooms and staff were trained in the procedure performed. Patients undergoing robotic assisted hysterectomies and laparoscopic hysterectomies were placed in the dorsal lithotomy position with trendelenberg. Those undergoing abdominal hysterectomies were placed in the dorsal supine position. Patients or Participants The study included 288 women who underwent benign hysterectomy by any method at Saint Peters University Hospital from March 2017 to Dec 2018. 86 (40.4%) patients underwent a robotic assisted laparoscopic hysterectomy, 60 (28.0%) underwent a laparoscopic hysterectomy, and 68 (31.7%) underwent an abdominal hysterectomy. Interventions All patients received a hysterectomy in one of the three following methods: robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy, and abdominal hysterectomy. Concomitant procedures of a salpingo-oophrectomy and/or cystoscopy were performed if indicated. Measurements and Main Results A retrospective chart review was performed for all benign hysterectomies from March 2017 to December 2018 using student t test and a multivariate regression analysis. The primary outcome was the direct total cost of the patient's hospitalization related to their hysterectomy. Secondary outcomes included estimated blood loss, surgery time, days in the hospital postoperatively, and complications postoperatively. Mean total costs of robotically assisted hysterectomies were $26,452 less than abdominal hysterectomies (p Conclusion Overall, total cost was significantly influenced by the mode of hysterectomy, with robotic assisted hysterectomies being the most cost effective.

Trainee participation and perioperative complications in benign hysterectomy: the effect of route of surgery

Intraoperative trainee involvement in hysterectomy is common. However, the effect of intraoperative trainee involvement on perioperative complications depending on surgical approach is unknown. To estimate the effect of intraoperative trainee involvement on perioperative complication after vaginal, laparoscopic, and abdominal hysterectomy for benign disease. Patients undergoing laparoscopic, vaginal, or abdominal hysterectomy for benign disease from 2010 to 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients with and without trainee involvement were compared with regard to perioperative complications. Complications that occurred from the start of surgery to 30-days postoperatively were included. Perioperative complications were defined via the use of the validated Clavien-Dindo scale with ≥grade 3 complications defined asmajor and ≤grade 2 complications defined as minor. Major complications included myocardial infarction, pneumonia, venous thromboembolism, deep or organ space surgical-site infection, stroke, fascial dehiscence, unplanned return to the operating room, renal failure, cardiopulmonary arrest, sepsis, intubation greater than 48 hours, and death. Minor complications included urinary tract infection, blood transfusion, and superficial wound infection. To estimate the effect of trainee involvement depending on route of surgery, a stratified analysis was performed. Bivariable analysis and adjusted multivariable logistic regression were used. We identified 22,499 patients, of whom 42.1% had trainee participation. Surgical approaches were vaginal (22.7%), abdominal (47.1%), and laparoscopic (30.2%). The rate of major complication was 3.2%, and minor complication was 7.2%. In bivariable analysis, trainee involvement was associated with major complications in vaginal hysterectomy (3.3% vs 2.3%, P= .03), but not laparoscopic (3.0% vs 2.9%, P= .78) or abdominal hysterectomy (4.4% vs 3.6%, P= .07). Trainee involvement was also associated with minor complication in vaginal (7.3% vs 5.4%, P= .007), laparoscopic (5.9% vs 4.3%, P < .001), and abdominal hysterectomy (14.1% vs 9.2%, P < .001). In a multivariable analysis in which we adjusted for age, body mass index, medical comorbidity, American Society of Anesthesiologists score, and surgical complexity, the association between trainee involvement in vaginal hysterectomy and major complication persisted (adjusted odds ratio 1.45, 95% confidence interval 1.03-2.04); however, when operative time was added to the model, there was no longer an association between trainee involvement and major complication (adjusted odds ratio 1.26, 95% confidence interval 0.89-1.80). Surgical approach influences the relationship between trainee involvement and perioperative complication. Operative time is a key mediator of the relationship between trainee involvement and complication, and may be a modifiable risk factor.

Case Presentation: Vesicovaginal Fistula Following a Total Abdominal Hysterectomy

2405-4569/# 2016 Published by Elsevier B.V. on behalf of European Associ A 43-yr-old woman underwent a total abdominal hysterectomy for benign disease. The procedure appeared to be straightforward, although heavy bleeding around the left ovarian vascular pedicle was encountered. This needed additional sutures for control. Postoperatively the patient developed left loin pain and was found to have new-onset left-sided hydronephrosis on an abdominal ultrasound scan. A percutaneous nephrostomy was inserted into the left kidney and renal pelvis, and 2 d later this was followed by percutaneous antegrade ureteric stenting. The patient then developed continuous urinary leakage per vagina despite a period of catheterisation. A vesicovaginal fistula was diagnosed and she was referred to our specialist centre for repair. We performed a cystogram (Fig. 1) and upper tract imaging via a computed tomography urogram. We then performed an examination under anaesthesia, including cystoscopy with bilateral retrograde studies (Fig. 2).

Opportunistic and interventional salpingectomy in women at risk: a strategy for preventing pelvic serous cancer (PSC)

ObjectiveSalpingectomy is proposed as a prophylactic measure to reduce the incidence of tubo-ovarian/pelvic serous cancers. We surveyed the attitudes of obstetrician/gynecologists to incorporating salpingectomy opportunistically into surgery for benign conditions, and electively for young BRCA mutation carriers. Study designA questionnaire, designed to assess current standard clinical practice and willingness to perform salpingectomy for female sterilization at abdominal hysterectomy for benign disease (ABH), vaginal benign hysterectomy (VBH) and electively for women with BRCA mutations who wish to postpone oophorectomy was mailed to obstetrician/gynecologists working in Irish hospitals. ResultsIn their current practice of interval female sterilization 96% of gynecologists applied clips at laparoscopy and 4% performed salpingectomy, and 73% were willing to consider salpingectomy. Eighty-one percent were willing to consider salpingectomy for sterilization at cesarean section. Gynecologists performing hysterectomy (without oophorectomy) for benign conditions did salpingectomy in 26% at ABH and 5.4% at VBH, and now 90% would consider salpingectomy at ABH and 66% at VBH. Two-thirds of respondents would consider salpingectomy for women at genetic risk of ovarian cancer who want to postpone oophorectomy. ConclusionChanging general gynecological practice to include more opportunistic salpingectomy has the potential to reduce the incidence of serous cancers. The majority of gynecologists are willing to incorporate more salpingectomies into their surgical practices and consider elective salpingectomy as an interim measure for women with defined genetic risk of pelvic serous cancer.

Abdominal Histerektomi İçin Çeşitli Benign Endikasyonları Olan Hastalarda Standart Sütür Tekniği ile Elektrocerrahi Bipolar Damar Mühürlemenin Karşılaştırılması: Kontrollü Bir Çalışma

Objective: To compare the safety and efficacy of the bipolar plasmakinetic vessel sealing versus standard technique while performing total abdominal hysterectomy for benign disease. Material and Methods: The study is a prospective, controlled trial involving 173 women who underwent total abdominal hysterectomy. Eighty procedures were performed using bipolar plasmakinetics vessel sealing and the remaining 93 with the standard suture technique. Both groups were compared in terms of their operative time, blood loss, postoperative pain scores, postoperative complications and the length of hospital stay. At the end of the operations, patients were given intravenous tramadol hydrochloride 1-1.5 mg/kg, and intramuscular 75 mg IM, 2x1 diclofenac sodium for postoperative analgesia. Pain scores of the patients were recorded postoperatively at 0 and 24 h. A visual analogue scale (VAS) in the range of 0-10 was utilized for scoring the patients. The statistical analysis was performed with SPSS 16.0 (Statistical Package for Social Sciences) for Windows. p<0.05 was considered statistically significant. Results: There were no statistically significant differences between two groups in terms of preoperative and postoperative hemoglobin values, postoperative complications or hospital stay. There were statistically significant differences between groups in terms of reduction (%) in hemoglobin levels, operation time and VAS scores at 0 and 24 h. The median reduction (%) in hemoglobin levels in the study group was -0.08% (min: -0.27-max: 0.10) compared to -0.08% (min: -0.29-max: 0.00) in the control group (p=0.033). The median operation time with LigaSure was 105 min (range70-175) compared to 130 min (range 60-230) with standard suture technique (p=0.001). In the study and control groups, the VAS scores at 0 h were 5 (min: 1- max: 8) and 8 (min: 7- max: 9) respectively (p=0.020), while at 24h they were 3 (min: 1- max: 3) and 4 (min: 3- max: 7), respectively (p=0.011). Conclusion: LigaSure is an effective and reliable device that provides a significant reduction in quantity of bleeding, reduction in operation time (approximately 15 min) and postoperative VAS scores.

Health‐related quality of life and postoperative recovery in fast‐track hysterectomy

To determine whether health-related quality of life (HRQoL) and postoperative recovery of women who undergo abdominal hysterectomy in a fast-track program under general anesthesia (GA) differ from women who receive spinal anesthesia with intrathecal morphine (SA). Secondary analysis from an open randomized controlled multicenter study. Five hospitals in south-east Sweden. One hundred and eighty women admitted for abdominal hysterectomy for benign disease were randomized; 162 completed the study, 80 with GA and 82 with SA. The HRQoL was measured preoperatively using the EuroQoL EQ-5D and the Short-Form-36 health survey (SF-36) questionnaires. The EQ-5D was used daily for 1 week; thereafter, once weekly for 4 weeks and again 6 months after operation. The SF-36 was completed at 5 weeks and 6 months. Dates of commencing and ending sick leave were registered. Changes in HRQoL; duration of sick leave. The HRQoL improved significantly faster in women after SA than after GA. Sick leave was significantly shorter after SA than after GA (median 22.5 vs. 28 days). Recovery of HRQoL and duration of sick leave were negatively influenced by postoperative complications. In particular, the mental component of HRQoL was negatively affected by minor complications, even 6 months after the operation. Spinal anesthesia with intrathecal morphine provided substantial advantages in fast-track abdominal hysterectomy for benign gynecological disorders by providing faster recovery and shorter sick leave compared with general anesthesia.

Quantifying Electrosurgery-Induced Thermal Effects and Damage to Human Tissue: An Exploratory Study with the Fallopian Tube as a Novel In-Vivo In-Situ Model

Objective To develop a human in vivo in situ model for analyzing the extent and the basic mechanisms of thermal spread and thermal tissue damage. Design Prospective, open, uncontrolled, nonrandomized, single-center exploratory study. Setting University hospital. Patients Eighteen adult patients undergoing open abdominal hysterectomy for benign disease. Interventions Unilateral fallopian tube tissue desiccation (10 seconds) with a laparoscopic bipolar clamp at routine settings. Main Outcome Measures Deep tissue temperature (thermal probe), tissue surface temperature (thermal camera), and gross and histologic assessments of lesions with a newly developed composite scoring system. Results Fifteen specimens from 18 patients were evaluated. Lateral thermal damage (LTD; determined by lactate dehydrogenase staining), was strongly correlated with maximum desiccation temperature. Deep tissue LTD and surface LTD were linearly related. Histologic and macroscopic criteria for thermal effects and damage and the corresponding scores proved functional and strongly correlated with LTD. Measurement of deep tissue and tissue surface temperatures consistently yielded complete temporal and spatial temperature distributions that were describable by the heat equation. Conclusions Our novel in vivo in situ model allows standardized, reproducible, quantitative assessment of electrosurgery-induced thermal effects and damage in human tissue. It will likely provide further insight into the underlying biothermomechanics and may prove useful in the development of safety guidelines for laparoscopic electrosurgery.

Long-term assessment of bladder and bowel dysfunction after radical hysterectomy

Objective To determine the long-term effects of radical hysterectomy on bladder and bowel function. Methods Subjects included women who underwent radical hysterectomy for early stage cervical cancer between 1993 and 2003. Two contemporary controls who underwent extrafascial abdominal hysterectomy for benign disease were identified for each subject. Identified subjects and controls were surveyed. The Urogenital Distress Inventory (UDI) was used to assess symptoms of incontinence, and the Incontinence Impact Questionnaire (IIQ) was used to examine the impact of incontinence on quality of life. The Manchester Health Questionnaire and Fecal Incontinence Quality of Life Scale (FIQL) were used to assess anorectal symptoms. Results Surveys were returned by 66 of 209 (32%) subjects and 152 of 428 (36%) controls. Overall, 50% of subjects and 42% of controls reported mild incontinence symptoms; 34% of subjects and 35% of controls reported moderate–severe symptoms ( p = 0.72). Incontinence was associated with moderate–severe impairment in 18% of subjects and 14% of controls ( p = 0.74). Fecal incontinence symptoms were uncommon, not differing between subjects and controls. Conclusion Urinary incontinence is relatively common after radical hysterectomy, but severe anorectal dysfunction is uncommon. Radical hysterectomy does not appear to be associated with more long-term bladder or anorectal dysfunction than simple hysterectomy.

Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: A randomized, controlled trial

Study objective Minimally invasive surgery aims to achieve at least a similar clinical effectiveness with a quicker recovery than traditional open techniques. Although there have been numerous randomized clinical trials comparing laparoscopic hysterectomy with hysterectomy by laparotomy, only a few studies have compared quality of life after different types of hysterectomy. None of these studies evaluated total laparoscopic hysterectomy. In this paper, we report on a randomized comparison of quality of life after total laparoscopic versus total abdominal hysterectomy. Design Randomized, controlled trial (Canadian Task Force classification I). Setting Single-center teaching hospital in The Netherlands. Patients Patients scheduled for hysterectomy for a benign condition, in whom a vaginal hysterectomy was not possible and laparoscopic hysterectomy was feasible (mobile uterus not exceeding the size of 18 weeks’ gestation). Interventions Abdominal versus laparoscopic hysterectomy. Measurements and main results Patients completed the Dutch version RAND-36 health survey preoperatively as well as at 5 time points in the first 12 weeks after surgery. The primary outcome of the study was quality of life as measured by the RAND-36. A linear mixed model was used for statistical analysis while accounting for baseline values. Secondary outcomes were hospital stay and complications. There were 88 patients eligible, of whom 59 gave consent for randomization. Twenty-seven women were allocated to the laparoscopic arm and 32 to the abdominal arm. We found a significant treatment effect favoring laparoscopic hysterectomy in the RAND-36 scale for vitality. Laparoscopic hysterectomy performed better on all other scales of the RAND-36, but these differences were not statistically significant. Conclusions Laparoscopic hysterectomy results in more postoperative vitality when compared with abdominal hysterectomy. For this reason, all women with a benign condition requiring abdominal hysterectomy, in whom the laparoscopic approach is feasible, should have the chance to choose laparoscopic hysterectomy.

Gabapentin attenuates the pressor response to direct laryngoscopy and tracheal intubation

Laryngoscopy and tracheal intubation increase blood pressure and heart rate (HR). The aim of the present study was to investigate the effect of gabapentin when given before operation on the haemodynamic responses to laryngoscopy and intubation. Forty-six patients undergoing abdominal hysterectomy for benign disease were randomly allocated to receive gabapentin 1,600 mg or placebo capsules at 6 hourly intervals starting the day (noon) before surgery. Anaesthesia was induced with propofol and cis-atracurium. Systolic, diastolic arterial blood pressures (SAP, DAP) and heart rate (HR) were recorded before and after the anaesthetic and 0, 1, 3, 5 and 10 min after tracheal intubation. SAP was significantly lower in the gabapentin vs the control group 0, 1, 3, 5 and 10 min after intubation [128 (27) vs 165 (41), P=0.001, 121 (14) vs 148 (29), P=0.0001, 115 (13) vs 134 (24), P=0.002, 111 (12) vs 126 (19), P=0.004 and 108 (12) vs 124 (17), P=0.001 respectively]. DAP also was lower in the gabapentin group 0, 1, 3, and 10 min after intubation [81 (18) vs 104 (19), P=0.0001, 77 (9) vs 91 (16), P=0.001, 71 (10) vs 84 (13), P=0.001 and 67 (10) vs 79 (12), P=0.004]. HR did not differ between the two groups at any time [82 (11) vs 83 (15), 79 (10) vs 80 (12), 86 (17) vs 92 (10), 82 (11) vs 88 (10), 81 (12) vs 81 (11), 77 (13) vs 79 (13), and 75 (15) vs 78 (12)]. Gabapentin, under the present study design attenuates the pressor response but not the tachycardia associated with laryngoscopy and tracheal intubation.

Descending Perineum Syndrome: Are Abdominal Hysterectomy and Bowel Habits Linked?

This retrospective study evaluates the effect of abdominal hysterectomy on patients affected by descending perineum syndrome. Eighty-nine female patients affected by descending perineum syndrome and one group of 10 healthy women with normal bowel habits were studied retrospectively. Thirty-two descending perineum syndrome patients (Group 1) had received an abdominal hysterectomy for benign diseases, while 57 descending perineum syndrome patients (Group 2) had not undergone this surgery. All 99 subjects underwent clinical evaluation, computerized anorectal manometry, and defecography. Dyschezia was found predominantly in Group 2 subjects (P < 0.05). Fecal incontinence was significantly higher in Group 1 than in Group 2 (P < 0.05). The worst anal resting pressure was found in the incontinent Group 1 patients (P < 0.01). Rectoanal intussusception was a significant defecographic sign in Group 1 subjects (P < 0.05). Clinical evaluation and instrumental data suggested a possible link between fecal incontinence and abdominal hysterectomy in patients affected by descending perineum syndrome.

Myomectomy fever: testing the dogma

Objective: To test the hypothesis that elevated temperature is more common after abdominal myomectomy than after hysterectomy. Design: Retrospective cohort study. Setting: Academic medical center. Patient(s): One hundred one women who underwent abdominal myomectomy and 160 women who underwent total abdominal hysterectomy for benign disease from 1988–1993. Intervention(s): Abdominal myomectomy. Main Outcome Measure(s): Temperature of ≥38.5°C within 48 hours after operation. Result(s): Although univariate analysis showed that the incidence of elevated temperature was slightly greater among patients who underwent myomectomy (33% versus 26%, relative risk 1.29, 95% confidence interval 0.88–1.90), multivariate logistic regression analysis showed a 3.29 relative risk of elevated temperature (95% confidence interval 1.56–6.96) with myomectomy after controlling for age, parity, estimated blood loss, and treatment by the general gynecology service. Conclusion(s): After controlling for confounders, myomectomy was found to be an independent predictor for fever in the first 48 hours after operation.

Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy

OBJECTIVE: Our purpose was to quantify and compare the metabolic and inflammatory changes after laparoscopic and abdominal hysterectomy. STUDY DESIGN: Forty-four patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy ( n = 20) and abdominal hysterectomy ( n = 24). Venous blood and 24-hour urine samples were collected the day before and for each of the first 3 postoperative days. RESULTS: No differences were present in demographic characteristics, operating time, and uterine weight between the two groups. No major complications were encountered. The laparoscopic hysterectomy group had a significantly lower postoperative morphine consumption (median 5.5 vs 14 mg, P < .05), lower febrile morbidity rate (15% vs 45.8%, P < .05), and shorter hospital stay (median 4 vs 6 days, P < .001) and demonstrated a less intense stress response in terms of serum interleukin-6 (median 50.6 vs 73.9 pg/mL × hour × 10, P = .01), C-reactive protein (median 28.1 vs 44.7 mg/L × hour × 10 2, P = .005), cortisol (median 23.4 vs 27.2 mg/mL × hour × 10 3, P = .04), white blood cell count (median 59.5 vs 69.8 10 9 /L × hour × 10, P = .009), 24-hour urinary excretion of cortisol (median 34.8 vs 44.2 nmol/L × hour × 10 3, P = .02), and norepinephrine (median 80.8 vs 132.4 nmol/L × hour × 10 2, P = .001). No significant difference was detected in plasma glucose (median 41.5 vs 45.6 mmol/L × hour × 10, P = 6) and 24-hour urinary excretion of epinephrine (median 32.2 vs 34.1 nmol/L × hour × 10 2, P = .3). CONCLUSION: Laparoscopic hysterectomy is associated with a lower morbidity and a less intense stress response than abdominal hysterectomy for benign diseases. (Am J Obstet Gynecol 1998;179:1-5.)

Bilateral Tubo‐Ovarian Abscesses Four Years AfterTotal Abdominal Hysterectomy

Background: Pelvic inflammatory disease (PID) is a common gynecologic disorder. One known complication of PID is tubo‐ovarian abscess (TOA) formation. The predominant theory on TOA formation postulates that an ascending infection from the cervix through the uterus to the fallopian tubes and ovaries results in abscess formation. Other theories include seeding via a hematogenous infection, diverticular disease, and appendicitis.Case: A 39‐year‐old female patient with abdominal pain was referred to our institution and was found to have a pelvic mass. After a thorough evaluation, surgical exploration revealed the presence of TOA. No evidence of gastrointestinal disease was present. The patient’s history was significant for an uncomplicated total abdominal hysterectomy for benign disease of the uterus four years prior. Abscess cultures grew Streptococcus intermedius.Conclusion: This case reports the rare occurrence of TOA in a patient who had undergone an abdominal hysterectomy four years prior to presentation. If the patient reports a surgical history of prior hysterectomy, TOA is often stricken from consideration. Although unlikely, adnexal abscess formation should be considered in the differential diagnosis of a patient with abdominal pain and a pelvic mass, even with a remote history of hysterectomy.

Blood transfusion requirements for abdominal hysterectomy: 3-year experience in a district hospital (1993-1995).

Two hundred and thirty six women who underwent abdominal hysterectomy for benign disease at Fairfield District Hospital were studied retrospectively. Eleven patients received a total of 28 units of blood. The transfusion rate was 4.7%. The average number of units transfused per operation was 0.12. Each transfused patient received an average of 2.5 units with a range of 1-4 units. Only 27% of cross-matched blood was actually transfused. Patients with preoperative anaemia, prolonged operation time and a larger uterus were more likely to require blood transfusion. The group and screen procedure is an adequate preoperative blood order for patients having abdominal hysterectomy.