Common Gynecological Surgery Research Articles

Predictors and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries: A single-center retrospective study

Objectives: As iatrogenic ureteral injury carries a high burden and is associated with increased postoperative morbidity and mortality, the purpose of this study is to determine the incidence and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries in King Abdulaziz Medical City. Methods: This was a single-center retrospective cohort study based on data extracted from an electronic hospital information system conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Three thousand four hundred and sixty-four cases of cesarean section (C-section) and hysterectomy from January 1, 2021, to December 31, 2022, were reviewed. All cases of C-section and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were included in the study. All cases other than C-sections and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were excluded from the study. Results: A total of 45 patients for whom urology was consulted for suspected ureteral injury were included in this study. Approximately (35.6%) one-third of the patients had positive findings of ureteral injury following common obstetric and gynecological surgeries. About 41.2% of these patients had previous gynecological surgeries. Other potential risk factors were tested such as age and body mass index. Older patients were slightly at higher risk of iatrogenic ureteral injury (P < 0.05). Conclusion: Ureteral injury in obstetric and gynecological surgeries is rare yet serious complication. The findings of this study suggest that the incidence of iatrogenic ureteral injury was relatively associated with older age.

Cost-effectiveness of robot-assisted total hysterectomy for benign pathologies compared to laparoscopic surgery: A retrospective study with propensity score

BackgroundHysterectomy for benign pathologies is one of the most common gynecological surgeries. In recent years, robotic surgery has become an alternative to traditional surgery, but at a higher cost. ObjectiveEstimate the cost of benign robot-assisted hysterectomy for the purpose of supporting public decision-making, as well as the additional cost per major postoperative complication (ClavienDindo score ≥ 3) avoided one month after surgery robotic versus traditional laparoscopic. MethodsSingle-center retrospective study including patients operated on for benign hysterectomy at La Pitié Salpêtrière hospital between January 2016 and December 2019: 99 by robotic approach, and 86 by laparoscopic approach. Comparison of robotic surgery to laparoscopy. Calculation of a cost-effectiveness ratio (ICER). Use of the propensity score inverse weighting method to ensure comparability of groups. ResultsRobotic surgery has a total cost of € 6,615 at 1 month per patient compared to € 3,859 for laparoscopic surgery with an additional cost of € 377,534 per major postoperative complication avoided, longer operating time and an absence of significant difference in terms of complications and length of hospitalization. ConclusionIn terms of cost-effectiveness, according to this study, the robot does not appear to be better than laparoscopy. In the years to come, we can expect a development of robotic surgery with rationalization of the practice, with appropriate selection of patients for robotic surgery, development of outpatient surgery and a reduction in the cost of the equipment.

Analysis of the Relationship Between Body Perception and Self-Esteem of Women with Total Abdominal Hysterectomy Bilateral Salpingo-Oophorectomy Surgery – A Secondary Publication

Objective: To determine the relationship between body image and self-esteem of women who underwent total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH-BSO). Method: The sample of the descriptive study consisted of 118 women who underwent TAH-BSO in the obstetrics and gynecology service of a university hospital in Mersin. Data was collected using a self-made questionnaire, the Body Perception Scale (BAS), and the Rosenberg Self-Esteem Scale (RBSS). Descriptive statistics included median, mean, standard deviation, number, and percentage values. Data evaluation methods included Mann-Whitney U Test and t-test to compare the means of two groups; Kruskal Wallis test and one-way ANOVA were used to compare the means of more than two groups; and Spearman correlation coefficient was used to determine the relationship between two continuous variables. Results: The mean age of the women was 50.13 ± 9.57, and the mean duration of marriage was 26.53 ± 11.97 years. It was found that 86.4% of the women were married, 40.7% were primary school graduates, and 55.1% had at least three children. Besides, 47.5% of the women applied to the hospital with the complaint of bleeding and according to 39% of them, the uterus meant nothing to them. Furthermore, the mean score of the women in BAI was 151.05 ± 26.64, and the mean score from RBSS was 5.02 ± 1.08. In the study, it was found that there was no statistically significant relationship between BAI and RBRS (r = -0.113; P = 0.224). Conclusion: In this study, it was determined that TAH-BSO surgery did not have a negative effect on women’s body perceptions and self-esteem. This result shows that women’s perspectives on common gynecological surgeries such as TAH-BSO have changed.

Standard Opiate Prescribing in Pediatric and Adolescent Gynecologic Surgery to Reduce Opiate Use: Brief Report

Study objective: The aim of this quality improvement (QI) project was to assess postoperative narcotic use after pediatric gynecologic surgeries and establish standard postoperative opioid dosing. Through standard dosing we hoped to decrease variability in postoperative opioid prescriptions and decrease excess opioid doses in the community. Methods: This QI project was approved by the Children's Minnesota IRB. Counseling on postoperative pain management was provided pre- and post-operatively. At the two-week postoperative visit, patients were asked the number of opioid doses used and pain control satisfaction. Baseline data was collected for 6 months with surgeons prescribing the number of opioid doses based on their personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established, and data collection repeated. Results: Complete data was recorded for 30 cases prior to implementation of standard doses and for 29 cases following implementation. Standardized opioid dosing resulted in 30% decrease in total opioid doses in circulation (252→176 doses; P=0.014) and 15% reduction in excess doses in circulation (162→137 doses). Forty-three percent of patients did not use any opioid doses. There was no significant difference P=0.8818) in patient pain control satisfaction rating. Conclusions: Standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient pain control satisfaction. Opioid dose standardization may decrease opioid circulation within the community. Approximately 2 out of every 5 patients used zero opioid doses which suggests further reduction in the standard dose prescriptions is possible.

Patterns of opioid use after surgical discharge: a multicentre, prospective cohort study in 25 countries.

Excessive opioid prescribing following surgery contributes to the growing opioid crisis. Prescribing practices are modifiable, yet data to guide appropriate prescription of opioids at surgical discharge remain sparse. This study aimed to evaluate factors associated with opioid consumption following discharge from surgery. An international prospective multicentre cohort study was performed recruiting adult patients undergoing common general, orthopaedic, gynaecological and urological surgery, with follow-up 7 days after discharge. The primary outcome measures were the quantities of prescribed and consumed opioids in oral morphine milligram equivalents. Descriptive and multivariable analyses were performed to investigate factors associated with the primary outcome measures. This analysis included 4273 patients from 144 hospitals in 25 countries. Overall, 1311 (30.7%) patients were prescribed opioids at discharge. For those patients prescribed opioids, mean (SD) 179 (240) oral morphine milligram equivalents were prescribed, yet only 81 (145) oral morphine milligram equivalents were consumed within the first 7 days after discharge. An increased dose of opioids prescribed at discharge was associated with an increased dose of opioids consumed during the follow-up period (β = 0.33 (95%CI 0.31-0.34), p < 0.001). The risk of prescribing more opioids than patients consumed increased as quantities of opioids prescribed at discharge exceeded 100 oral morphine milligram equivalents, independent of patient comorbidity, procedure and pain. Patients were prescribed more than twice the quantity of opioids they consumed in the first 7 days following discharge from surgery. Our data suggest that the current quantities of opioids provided at discharge exceed patient needs and may contribute to increasing community opioid use and circulation.

A STUDY ON INDICATIONS, MODE OF HYSTERECTOMY AND HISTOPATHOLOGICAL ANALYSIS OF HYSTERECTOMY SPECIMENS

Objectives: To study the age distribution, indications, modes of hysterectomy, concurrent surgery done along with hysterectomy, and histopathological analysis of hysterectomized specimens. Methods: This study was conducted in the Department of Obstetrics and Gynecology, Mediciti Institute of Medical Sciences, a tertiary teaching hospital at Medchal. Medical records of 240 cases of hysterectomy performed from January 2015 to December 2021 were retrieved from the Medical Record Department. The age distribution, indications of hysterectomy, mode of hysterectomy, concurrent oophorectomy, and histopathological reports of hysterectomy specimens were analyzed in this study. Results: Out of the total 240 hysterectomies, 51.25% were in the age group of 40–49 years, followed by the age group of 50–59 years, i.e., 19.5%. Common indications for hysterectomy were AUB (36.25%), fibroids (34.58%), and UV prolapse (29.16%). Abdominal hysterectomy (62.5%) was performed more commonly than vaginal hysterectomy (29.16%). Histopathological analysis showed the most common pathologies as atrophic endometrium, leiomyoma in the myometrium, and inflammation in the cervix. Concurrent bilateral oophorectomy was done in 51.66%, unilateral oophorectomy was done in 10%, and ovaries were conserved in 38.33%. Conclusion: Hysterectomy is a common major gynecological surgery performed, most commonly in the perimenopausal age group. Although there is an increased trend toward the laparoscopic route, the abdominal route is still the preferred route. Leiomyoma is the most common pathology found in hysterectomized specimens. AUB being the most common indication for hysterectomy, there should be increased use of medical management, and patients should be counseled for conservative management in order to prevent increased surgical interventions.

Retrospective analysis between total laparoscopic and vNOTES hysterectomy in obese patients: single-center study.

Hysterectomy is one of the most common major gynecological surgeries, and it is performed for benign and malignant reasons. Currently, five types of hysterectomies are described: vaginal (VH), abdominal (AH), laparoscopic (LH), robotic, and vNOTES (vaginal natural orifice transluminal endoscopic surgery). This paper compares these two types of surgery in obese patients by analyzing the surgeries performed by our team. The research was conducted from January 2022 to December 2023 at the Department of Gynecology and Obstetrics of the General Hospital in Zadar. The study included female patients aged 18-75years with a BMI > 30kg/m2, regardless of parity, who were operated on for benign pathology. There were 24 patients included in total. One conversion was observed in the TLH group because of excessive bleeding. Median operative time (IQR) was significantly lower in the vNOTES group (p < 0.05) than in the TLH group 35 (10.9) vs 125 (74.0) min. The results concerning the duration of surgery, conversion rate, and postoperative bleeding and complications show that vNOTES hysterectomies seem to be feasible for obese patients. Further studies are needed to confirm these observations.

Histopathological Analysis of Hysterectomy Specimens in a Tertiary Care Centre: A Retrospective Study.

Introduction The uterus is a crucial reproductive organ that is susceptible to the development of several non-neoplastic and neoplastic diseases in women, greatly increasing morbidity and mortality. Although there are various therapeutic options, hysterectomy is still a popular treatment option throughout the world.Abnormal uterine bleeding, pelvic pain, pelvic inflammatory disease (PID), prolapse of the uterus, adenomyosis, endometriosis, fibroids, gynecological malignancies, and obstetric problems that require hysterectomy, all samples must be examined histopathologically.Histopathological examination of the specimens obtained after hysterectomy is important for both diagnosis and treatment. The current work aimed to identify the various clinical indications, analyze the clinicopathological correlation in hysterectomy specimens, and analyze the patterns of lesions in hysterectomy specimens. Materials and methods This study was conducted in the Department of Pathology at the Datta Meghe Medical College, Wanadongari, Nagpur, from February 2022 to January 2023. All types of hysterectomy specimens received during this year were examined, and the tissues were processed and stained with H&E. Histopathological examination was performed, and various lesions in the hysterectomy specimens were examined.The study included all forms of hysterectomy, including abdominal, vaginal, laparoscopic, and total abdominal hysterectomy. Results An analysis of 110 cases of hysterectomy revealed that abdominal hysterectomy was the type of hysterectomy in 79 (71.82%) cases, with a maximum age range of 35 to 45 years (42.72%). The proliferative phase endometrium was the most common endometrial pathology, accounting for 43 (39.09%) cases, followed by the atrophic endometrium in 35 (31.82%) cases. Leiomyoma was the most prevalent myometrial lesion, accounting for 52 (47.28%) cases, followed by adenomyosis, accounting for 23 (20.91%) cases. Chronic cervicitis was the most common incidental finding in the hysterectomy samples, accounting for 85 (77.28%) cases. Follicular cysts, representing 22 (20%) cases, were the most common ovarian lesions, followed by serous cystadenoma in seven (6.37%) cases. Two cases of malignant tumors were noted: one case of endometrial carcinoma and one case of mucinous cystadenocarcinoma of the ovary. In most cases, ranging from 70% to 100%, the final histopathological diagnosis supports the preoperative clinical diagnosis. Conclusion Hysterectomy is the most common major gynecological surgery performed under elective conditions. Although histological studies and clinical diagnoses are closely correlated, several lesions, including chronic cervicitis and adenomyosis, were discovered incidentally. Therefore, every hysterectomy specimen must undergo a thorough histological investigation, even if it appears superficially normal, to confirm the diagnosis and improve postoperative care.

A Prospective Randomized Study between Laparoscopically Assisted Vaginal Hysterectomy and Total Laparoscopic Hysterectomy in a Tertiary Care Hospital

Introduction: Hysterectomy is one of the most common gynecological surgeries conducted worldwide. Total Laparoscopic Hysterectomy (TLH) and Laparoscopy Assisted Vaginal hysterectomy (LAVH) have been the mainstays of hysterectomy procedures. When compared with Total Abdominal Hysterectomy (TAH) and LAVH, TLH has been reported to result in shorter durations of procedure, lower blood losses, and shorter hospital stays.Therefore the present study was conducted to compare between operative outcome of LAVH and TLH.&#x0D; Objectives: To compare the surgical outcomes of laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in a tertiary care hospital and to determine the challenges of the two methods in terms of cost, logistic supports and need for trained manpower.&#x0D; Study design: A prospective, randomized study was performed at a tertiary care center between January 2019 to January 2020. A total of 50 women indicated to undergo hysterectomy for benign uterine disease were randomly assigned to two groups (25 LAVH, and 25 TLH). The randomization procedure was based on a computer-generated list using serially numbered, opaque, sealed envelopes. A blinded physician randomly assigned each patient to either LAVH (n = 25) or TLH (n = 25). The sequence was concealed until interventions were assigned. Those who performed surgical procedures did not know which patients undergoing surgery had been included in the study. Those assessing the outcomes were blinded to the group assignments. Outcome measures, including operating time, blood loss, rate of complications, level of Hb before and after surgery, need of blood transfusion, consumption of analgesics, and length of hospital stay, were assessed and compared between groups.&#x0D; Results: There were no differences in baseline demographics between the two groups. The TLH group required shorter operating time than the LAVH group. The estimated blood loss was significantly more in the LAVH group than the TLH group. Postoperative hospital stay was slightly more in the LAVH group than the TLH group. Complication rate were similar between the two groups. Three cases in the TLH group needed conversion. Two cases needed conversion to LAVH and 1 case was converted to TAH, all were related to a large lower uterine segment prohibiting visualization during colpotomy. No statistical significant difference was found in regards of postoperative outcome between groups.&#x0D; Conclusions: TLH and LAVH are both safe, feasible procedures with similar surgical outcomes. TLH was associated with shorter operating time and per operative blood loss, whereas LAVH may be preferred in patients with a uterus with a large lower uterine segment. TLH needs more advanced logistic support and more trained manpower in comparison to LAVH. Cost is higher in TLH group than LAVH group.&#x0D; Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 18-22

Comparison of the Quality of Life and Post-traumatic Stress in Postmenopausal and Non-menopausal Women after Hysterectomy in Selected Hospitals of Shiraz University of Medical Sciences in 2020

Background: Hysterectomy is one of the most common gynecological surgeries that affect women's mental health and quality of life. Objective: This study aimed to investigate the correlation between the quality of life and posttraumatic stress in hysterectomized postmenopausal and non-menopausal women. Materials and Methods: This cross-sectional analytical study was conducted from August to December 2019 on hysterectomies postmenopausal and non-menopausal women. There were 77 subjects in each group with a mean age of 52.55 ± 1.098. They were selected via convenience sampling at Hazrat Zeinab (PBUH) and Shahid Dr. Faghihi Hospitals in Shiraz. They were evaluated in a two-month follow-up using the Impact of Event Scale-Revised (Weiss &amp; Marmar, 1997) and WHO Quality of Life-BREF (WHOQOL-BREF) questionnaires. Data were analyzed in SPSS-16 software using descriptive and inferential statistics (independent t-test, paired t-test, and Pearson or Spearman correlation coefficients). Results: Unlike the first stage of the study (before and a week after the surgery, P = 0.289), there was a significant negative relationship in the quality of life and post-traumatic stress between postmenopausal and non-menopausal women (P = 0.001) in the second stage (two months after the surgery). Hysterectomy increased the mean score of post-traumatic stress in postmenopausal and nonmenopausal women after the surgery (P = 0.179), while the quality of life improved and stress decreased two months later (P = 0.0001). Conclusion: Hysterectomy improved the quality of life in postmenopausal and significantly in nonmenopausal women. Hence, due to the correlation and significant negative relationship between post-traumatic stress and quality of life, midwives, families, and society need to pay attention to women’s quality of life.

Standard Opioid Prescribing in Pediatric and Adolescent Gynecology [ID: 1381154

INTRODUCTION: Enhanced Recovery After Surgery principles reduce opioid use postoperatively. There are no recommendations for optimal opioid dose prescribing for postoperative pain. The aim of this quality improvement project was to assess postoperative opioid use after pediatric gynecologic surgeries and establish standard opioid prescriptions across all surgeons based on procedural type. METHODS: Counseling on postoperative care including pain management was provided preoperatively and postoperatively. At the 2-week postoperative visit, patients were asked the number of opioid doses used and their pain control satisfaction. Baseline data were collected for 6 months with surgeons prescribing opioid doses via personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established with 10 doses provided for laparotomy with incision greater than or equal to 5 cm, 5 doses for laparoscopy or mini-laparotomy with incision(s) 4 cm or less, 5 doses for combined laparoscopic/vaginal approach, and 0 doses for vaginal cases. Data collection was repeated after implementation of standard opioid dose prescriptions. RESULTS: Complete data were recorded for 30 cases prior to implementation and 29 cases after implementation. Standard opioid dosing resulted in 30% decrease in total opioid doses (252–176 doses; P=.014) and 15% reduction in unused doses (162–137 doses). Forty-three percent of patients used no opioid doses. There was no significant difference in patient satisfaction (P=.014) in pain control. CONCLUSION: Application of standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient satisfaction. This quality improvement project suggests further reduction in standard dose prescriptions is possible.

Indications and Outcomes of Abdominal and Vaginal Hysterectomies at Tertiary Hospital in Nnewi, Nigeria

Background: Hysterectomy is a common gynecological surgery done for malignant and benign conditions of the uterus and structures around it. Uterus can be assessed through various routes with each having its indications, contraindications and associated complication. Objectives: To determine the prevalence and compare biosocial characteristics, indications, complications of procedure, durations of stay in the hospital and mortality between both abdominal and vaginal hysterectomies.

Hysterectomy and risk of osteoarthritis in women: a nationwide nested case–control study

Objective Hysterectomy is the most common gynaecological surgery, performed mainly for benign uterine pathologies in women. Studies have suggested that hysterectomy is associated with osteoarthritis (OA); however, the association remains controversial. This study aimed to investigate the association between hysterectomy and the risk of OA. Method We performed a population-based nested case–control study using the National Health Insurance programme database from 2000 to 2016 in Taiwan. All medical conditions for each case and control were categorized using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10. A multiple conditional logistic regression model was applied to analyse the adjusted odds ratio (aOR) and 95% confidence interval (CI) for the association between hysterectomy and OA. Results Our analyses included 16 592 patients with OA and 66 368 matched controls. After adjustment for possible confounders, hysterectomy had a significant association with OA (aOR = 1.19, 95% CI = 1.09–1.30), especially knee OA (aOR = 1.25, 95% CI = 1.13–1.38). Furthermore, women who received oestrogen therapy (ET) alone and patients who underwent hysterectomy without ET showed a greater risk of OA development compared to women who did not receive ET (aOR = 1.14, 95% CI = 1.07–1.23, and aOR = 1.19, 95% CI = 1.08–1.31, respectively). Conclusion Our findings indicate that hysterectomy is associated with OA, especially knee OA. We also found that women who received ET alone and patients who underwent hysterectomy without ET had an increased risk of OA.

Analysis of Indications and Different Surgical Approaches for Gynecological Hysterectomies and their Consequences

Background: Hysterectomy is one of the most common gynecological surgeries regardless of the surgeon’s approach. Purpose: This study was conducted to compare three hysterectomy techniques, viz abdominal, vaginal and laparoscopic hysterectomy, in terms of their effectiveness and low post-op complications. Methods: The study's cohort included 631 women who underwent benign hysterectomies between 2018 and 2022 in tertiary care hospitals in three areas of Pakistan. The patients in Groups A, B, and C comprised 277, 43 and 311 patients, who were surgically operated by LHs, VHs, and AHs, respectively. Findings: Most of the patients with BH were of age 39-50 years and multiparous with an average weight of 71.4+15 Kg. The major (p&lt;0.05) underlying medical conditions were endometriosis, followed by uterine bleeding, fibroids, pelvic prolapse, adenomyosis and gynecological cancer having an incidence of 44.05, 36.45, 11.88, 5.38, 1.26 and 0.95%, respectively. The AH and VH had the highest incidence of surgical and post-operative problems (p&lt;0.05) compared to the LH, with percentages of 56.59, 55.81, and 20.21%, respectively. Among complications, most often observed were thrombosis, post-operative infections, and bleeding (p&lt;0.05). Practical implications: It was recommended that the gynaecologist should pursue LH, which is less invasive and has a high success rate, for BH. Conclusion: It was thus concluded that the laparoscopic hysterectomy was minimally invasive and was associated with a low incidence of intraoperative and postoperative complications. Keywords: Endometriosis; Non-invasive hysterectomy; Laparoscopic hysterectomy; Intraoperative complications.

HISTOMORPHOLOGICAL PATTERNS OF HYSTERECTOMY SPECIMENS IN A TERTIARY CARE HOSPITAL: A TWO-YEAR STUDY

Introduction: Hysterectomy is the second most common gynecological surgery next to caesarean section. The indications for hysterectomy may vary from one region to another and histomorphological pattern may also vary. Aim: The aim of the study is to analyze the various histomorphological patterns of uterine and adnexal pathology in the hysterectomy specimens. Material and Methods: This is a retrospective study done over a period of two years at the department of Pathology, Zoram Medical College, Mizoram. Data of all hysterectomy specimens during this period were analyzed. Results: Out of the 142 cases, Leiomyoma was the most common uterine pathology seen followed by adenomyosis, 63% and 13% respectively. Chronic cervicitis was the most common cervical pathology and, in the ovaries, tumor-like lesions functional cysts were the most common pathology seen. The most common indication for hysterectomy was fibroid followed by dysfunctional uterine bleeding. Conclusion: The histopathological findings correlate with the pre-operative clinical indications however, a number of lesions were incidental findings. Therefore, it is important that every hysterectomy specimen be subjected for histopathological examination for better post-operative management.

Hysterectomies: An Audit at A Tertiary Care Public Sector Hospital in Lahore, Pakistan

Background: Hysterectomy is a common gynecological surgery worldwide. Thorough preoperative clinical and radiological assessment of the patients followed by histopathological evaluation of the specimens is mandatory for providing good health care services to the patients. Objective: The objective of the study was to analyze the spectrum of histopathological findings in hysterectomy specimens &amp; correlate them with their clinical &amp; radiological findings. Patients and Methods: This was a retrospective, descriptive, cross sectional study, carried out at the Pathology Department of Fatima Jinnah Medical University, Lahore. All the gynecological hysterectomies received at the department from 1st December 2018 to 30th November 2020 were included in the study. Data collected, included age of the patient, clinical presentation, radiological findings, type of hysterectomy performed and complete histopathology report of the specimen. Data was analyzed using SPSS version 17. Results: A total of 637 hysterectomy specimens were included in the study. The age of the patients ranged from 22 years to 80 years with a mean age of 46 ± 9 years. The commonest clinical indication was a uterine mass (47.7%). Most frequent preoperative radiological (USG/ CT scan/MRI) finding was uterine mass/polyps (52%). The commonest surgical procedure was total abdominal hysterectomy (52.4%). On histopathological evaluation, 99% of the cases showed chronic cervicitis. The commonest diagnosis in the uterine corpus was leiomyoma. Uterine malignancy accounted for 7.3% of the cases and 4.7% of hysterectomies were done for ovarian malignancies. Practical implicationThis study aims to highlight the need for a multi-disciplinary audit for all hysterectomy cases to reduce the incidence of this surgery &amp; for better patient care &amp; management. Conclusion: Hysterectomy is a major, invasive surgical procedure. A vigilant preoperative clinical and radiological evaluation of the patient can reduce the incidence of this surgery. Histopathological analysis of all hysterectomy specimens is mandatory for diagnosis of benign and malignant conditions, recognition of precancerous lesions and detection of incidental findings. Keywords: Hysterectomies, Audit, Leiomyoma, preoperative radiological evaluation, histopathological evaluation

The Prevalence, Indications, Outcomes of the Most Common Major Gynecological Surgeries in Kazakhstan and Recommendations for Potential Improvements into Public Health and Clinical Practice: Analysis of the National Electronic Healthcare System (2014-2019).

Major gynecological surgeries are indicated for the treatment of female genital pathologies. It is key to examine trends in gynecologic surgical procedures and updated recommendations by international gynecological societies to find opportunities for improvement of local guidelines. To date, a very limited number of reports have been published on the epidemiology of gynecological surgeries in Kazakhstan. Moreover, some local guidelines for gynecological conditions do not comply with the international recommendations. Thus, this study aims to investigate the prevalence, indications, and outcomes of the most common major gynecological surgeries by analyzing large-scale Kazakhstani healthcare data, and identifying possible opportunities for improvement of the local public health and clinical practice. A descriptive, population-based study among women who underwent a gynecological surgery in healthcare settings across the Republic of Kazakhstan during the period of 2014-2019 was performed. Data were collected from the Unified Nationwide Electronic Health System (UNEHS). In total, 80,401 surgery cases were identified and analyzed in the UNEHS database for a period of 6 years (2014-2019). The median age of the participants was 40 years old, with 61.1% in reproductive age. The most prevalent intervention was a unilateral salpingectomy-29.4%, with 72.6% patients aged between 18-34 years. The proportion of different types of hysterectomies was 49.4%. In 20% of cases, subtotal abdominal hysterectomy was performed due to uterine leiomyoma. The proportion of laparoscopic procedures in Kazakhstani gynecological practice is as low-11.59%. The Kazakhstani public health and gynecological care sector should reinforce implementation of contemporary treatment methods and up-to-date policies and guidelines. The overall trends in surgical procedures performed for gynecological pathologies, including uterine leiomyoma and ectopic pregnancy treatment, should be changed in favor of the minimally invasive methods in order to adopt a fertility-sparing approach.

Use of antidepressants following hysterectomy with or without oophorectomy: A national sample in the US

ObjectiveHysterectomy is one of the most common gynecological surgeries conducted around the world. Previous studies reported inconsistent results on depressive symptoms experienced after hysterectomy. This study explored the association between hysterectomy with or without oophorectomy and the use of antidepressants. Study designThis cross-sectional study included 4888 subjects between 20 and 80 years old who participated in the US National Health and Nutrition Examination Survey (NHANES) between 2015 and 2018. The associations between hysterectomy with or without oophorectomy and the use of antidepressants were estimated using multivariable logistic regression models. Main outcome measuresThere was a positive relationship between hysterectomy, both with and without oophorectomy, and the use of antidepressants after adjusting for all potential confounders (OR = 2.13, 95 % CI = 1.43–3.17, p = 0.000; OR = 2.04, 95 % CI = 1.35–3.06 p = 0.001). In the subgroup analysis stratified by race, a positive association between hysterectomy without oophorectomy was found among non-Hispanic white women (OR = 1.89, 95 % CI = 1.04–3.44, p = 0.038) and women of other races (OR = 3.14, 95 % CI = 1.30–7.56, p = 0.010), and a positive association between hysterectomy with oophorectomy was found among non-Hispanic black women (OR = 3.09, 95 % CI = 1.15–8.27, p = 0.024). However, no association was found among non-Hispanic black and Mexican American women who had undergone hysterectomy with oophorectomy, and it was not reported in women of non-Hispanic white, Mexican American or other race who underwent hysterectomy with oophorectomy. ConclusionThis study suggested that hysterectomy was significantly associated with antidepressant use, but the extent of the associations may vary by race.

Posttraumatic stress disorder symptoms and timing of menopause and gynecological surgery in the Nurses' Health Study II

BackgroundEarlier menopause, either natural or through gynecologic surgeries, has been associated with various negative health sequelae. While posttraumatic stress disorder (PTSD) has been linked to dysregulated biological processes, including reproductive system changes that could alter menopausal timing, little work has examined whether trauma and PTSD are associated with greater risk of early cessation of menses. MethodsData are from 46,639 women in the Nurses' Health Study II, a prospective cohort study of women followed for up to 26 years. Lifetime trauma and PTSD symptoms were assessed with the Brief Trauma Questionnaire and a PTSD symptom screener in 2008. Age at cessation of menses and reason for cessation of menses (i.e., natural menopause, gynecologic surgery including hysterectomy and/or bilateral salpingo-oophorectomy [BSO]) were assessed. Cox proportional hazards models estimated hazards ratios (HR) of cessation of menses (separately for naturally or surgically) associated with trauma alone or PTSD symptoms, relative to no trauma, adjusting for covariates. ResultsTrauma/PTSD status was associated with earlier cessation of menses due to surgery, but not natural menopause. Women with trauma exposure, low, and high PTSD symptoms had higher hazard of cessation of menses due to surgery relative to those with no trauma exposure (HRtrauma = 1.16, 95%CI 1.07–1.26; HRlow PTSD = 1.25, 95%CI 1.15–1.36; HRhigh PTSD = 1.29, 95%CI 1.17–1.42). Trauma exposure and PTSD symptoms were associated with similarly increased risk of hysterectomy and BSO surgeries. ConclusionsWomen who experienced trauma and PTSD may be at elevated risk for common gynecological surgeries premenopausally, potentially due to increased clinical indications or gynecological conditions.

Evaluation of Antibiotic Prophylaxis Regimens in Gynecological Surgeries in a Referral Teaching Hospital: A Cross Sectional Study

Background: Drug utilization Evaluation is the main tool to assess the clinical and economic effects of drug on health-care system. The aim of the current study is to evaluate the regimens of antibiotic prophylaxis in common gynecological surgeries in a referral teaching hospital Methods: This cross-sectional study was done in Alzahra hospital, Tabriz, Iran, from July 2017 to December 2017. Patients who received antibiotics as surgical site infection prophylaxis were enrolled. Data were collected from patients’ medical records and adherence rate to the American Society of Health-System Pharmacists (ASHP) guideline was studied as the primary endpoint. Results: A total of 210 patients who undergoes common gynecological surgeries were evaluated. Cesarean section (58.6%) and total abdominal hysterectomy (28.1%) were the majority of surgeries. The type of administered antibiotic was adherent to guideline in 71.4%. Doses and duration of prescribed antibiotic (Cefazolin, the most prescribed antibiotic) were not in accordance with the guideline in 100%. Only in 58%, the time of antibiotic administration was corrected. Conclusion: In this study, the misuse of antibiotics in most cases was documented in terms of type, dose and duration of drug administration in Al-Zahra Hospital. It seems necessary to publish evidence-based guidelines and monitor their proper implementation, not only to reduce costs but also to combat antibiotic resistance.