Abdominal Hysterectomy For Benign Disease Research Articles

Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study.

To describe the indications for total abdominal hysterectomy for women with nonmalignant disease and to determine the immediate (initial ten days) and medium term outcome. A prospective cohort study. Three district general hospitals in shire counties, two in outer London and one London teaching hospital. Three hundred and sixty-six women undergoing total abdominal hysterectomy (with or without other procedures) for nonmalignant disease. Self-completed patient questionnaires before and ten days, six weeks and three months after surgery. Data extracted from patients' hospital case notes. Complications plus change in symptoms, urinary and bowel function, general health status, sexual function, activities of daily living and quality of life. The principal indications were bleeding, pain or both. Symptoms were severe enough to be socially debilitating and have a major impact on lifestyle. Otherwise, the women were in good health. During the first ten post-operative days the women suffered more pain, urinary discomfort, constipation and a reduction in their ability to perform activities of daily living. Urinary (25%) and wound (25%) infections were the commonest complications. At the same time, significant improvements in psychological health occurred. By six weeks, the principal symptoms had resolved for 95% of the women and early adverse effects on urinary and bowel function had settled. This was reflected in improvements in health status and quality of life including sexual activity. Despite this, these changes did not meet the pre-operative expectations of some women. Most women reported substantial benefits from hysterectomy. However, women should be warned about early, transient adverse effects. These findings can serve as a benchmark for nonexperimental evaluations of the effectiveness of new treatment modalities.

A prospective cohort study of the clinical management of total abdominal hysterectomy for benign disease

SummaryThis study describes the clinical management of women undergoing total abdominal hysterectomy, identifies aspects of care that could be improved and variations in clinical practice that require evaluation. A cohort of 366 women undergoing surgery for non-malignant disease in six hospitals completed questionnaires before, 10 days and 6 weeks after their operation. Data were also extracted from hospital case notes and senior ward nurses were interviewed.Aspects of care that could be improved included use of prophylactic antibiotics (only 60 per cent) and single unit transfusions (6 per cent), legibility and completeness of case notes (20 per cent had no histology report), early postoperative mobilisation (29 per cent not sitting out on first day), prescription of hormone replacement therapy (24 per cent not prescribed), discharge delays (up to 21 per cent in one hospital), and better information for patients (27 per cent dissatisfied). Aspects of clinical practice that varied and require evaluation i...

Early discharge after hysterectomy for benign diseases by mini-laparotomy

SummaryTo determine the safety and feasibility of total abdominal hysterectomy for benign diseases through a mini-laparotomy (40–75 mm) incision and discharge 48 hours after operation a prospective study of 60 patients with benign uterine conditions for whom surgical treatment was indicated was planned. Main outcome measures included intra-operative complications, duration of operation, postoperative complications, postoperative hospital stay, amount of analgesia needed, hospital readmission, scar length, patient satisfaction and ability for early return to work. Forty-two patients (70 per cent) were discharged home 48 hours postoperatively; eight patients (13%) at 60 hours, eight patients (13%) at 72 hours and two patients (3%) at 84 hours postoperatively. There were no intra-operative complications and post-operative complications were minimal. No patient required hospital readmission. On a simple four item questionnaire, nearly all patients were happy regarding the entire experience particularly the ho...

The residual adnexa—Asset or liability?

Nine hundred and twenty-two patients who had one or both adnexa conserved at the time of abdominal hysterectomy for benign disease are presented. Thirteen patients (1.4 per cent) have required subsequent re-exploration for adnexal pathology. Corpus luteum cysts were found in 10 (77 per cent) of these patients. The primary pathology was found in the Fallopian tube in five patients (38 per cent). No patient was found to have an ovarian malignancy in the short period of follow-up. Conservation of ovarian function is recommended in patients who have not undergone menopause.