Hysterectomy For Benign Causes Research Articles

Analysis of unexpected malignancy rates in patients undergoing hysterectomy for benign causes.

Analysis of unexpected malignancy rates in patients undergoing hysterectomy for benign causes.

Intervenção educacional de enfermagem em mulheres histerectomizadas: um protocolo de estudo de método mista

ABSTRACT Objectives: To know the meaning of education in the perioperative period, in women undergoing hysterectomy for benign causes and to determine the effectiveness of educational nursing intervention in improving female sexual function, quality of life and self-esteem in women undergoing hysterectomy for benign causes. Methods: Mixed design, exploratory sequential Qualitative phase semi-structured interviews and content analysis. Quasi-experimental study quantitative phase, non-equivalent control group. 26 women in 2 groups. Instruments: Biosociodemographic, Female Sexual Function Index, SF-36 Questionnaire, Rosenberg Scale. Both groups will receive traditional care and the experimental group will receive nursing educational intervention with web page support. Ethical requirements will be considered. Expected results: The women in the experimental group will improve their sexual function, health-related quality of life and self-esteem in relation to the comparison group. Conclusions: Education in the perioperative period of hysterectomy is essential for the recovery of women who go through this experience.

8771 The Impact of Social Determinants of Health Delaying Treatment for Women That Undergo Hysterectomy for Abnormal Uterine Bleeding

<h3>Study Objective</h3> 1) Identify the social determinants of health that contribute to delayed treatment for abnormal uterine bleeding (AUB), defined as women presenting with large uteruses at the time of hysterectomy, and patterns of healthcare utilization over a 3-year period and 2) Assess health-related outcomes in women with delayed hysterectomy for AUB. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Single hospital system. <h3>Patients or Participants</h3> 1,361 women who underwent hysterectomy for benign causes of abnormal uterine bleeding over a 3-year period between January 1, 2014, to December 31, 2017. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Women with enlarged uteri ≥ 500 g at time of hysterectomy were more likely to present to the emergency department (10.9% vs. 7.0%, p=0.034) and subspecialty care visits (34.2% vs. 28.0%, p=0.047). There were no differences in generalist gynecological visits among the two groups. Black women disproportionately composed those with enlarged uteri (59.9% vs. 36.1%, p=<0.001). There were no differences identified in age, BMI, socioeconomic status, ethnicity or insurance type. Women who delayed treatment for AUB were more likely to undergo mini-laparotomy (2.7% vs. 0.8%, p=0.01) or laparotomy (68.9% vs. 24.2%, p=<0.001) compared to minimally invasive approaches, demonstrated lower pre-operative hemoglobin levels (11.5 vs. 12.3, p=<0.001), lower hemoglobin levels in a 3-year period leading up to hysterectomy (10.0 vs. 11.3, p=<0.001), increased estimated blood loss (373.3mL vs. 178.7mL, p=<0.001), procedure time (171.9 min vs. 145.1min, p=<0.001) and length of hospital stay (1.4 days vs. 0.6 days, p=<0.001). <h3>Conclusion</h3> Delayed treatment for women who ultimately underwent hysterectomy for abnormal uterine bleeding was associated with increased emergency department and subspecialty care visits, and this population was disproportionately composed of Black woman. Perioperatively, delayed treatment was associated with more open surgeries, increased blood loss, increased operative time, and longer hospital stays.

Long-term incidence of endometrial cancer after endometrial resection and ablation: A population based Swedish gynecologic cancer group (SweGCG) study.

Minimally invasive methods to reduce menorrhagia were introduced in the 1980s and 1990s. Transcervical endometrial resection (TCRE) and endometrial ablation (EA) are two of the most frequently used methods. As none of them can guarantee a complete removal of the endometrium, there are concerns that the remaining endometrium may develop to endometrial cancer (EC) later in life. The primary aim was to analyze the long-term incidence of EC after TCRE and EA in a nationwide population. The secondary aim was to assess the two treatment modalities separately. The Swedish National Patient Registry and National Quality Registry for Gynecological Surgery were used for identification of women who had TCRE or EA performed between 1997-2017. The cohort was followed from the first TCRE or EA until hysterectomy, diagnosis of EC, or death. Follow-up data were retrieved from the National Cancer Registry and the National Death Registry. Expected incidence for EC in Swedish women was calculated using Swedish data retrieved from the NORDCAN project after having taken into account differences of age and follow-up time. Cumulative incidence of EC after TCRE and EA, was calculated. A standardized incidence ratio was calculated based on the expected and observed incidence, stratified by age and year of diagnosis. In total, 17 296 women (mean age 45.1 years) underwent TCRE (n=8626) or EA (n=8670). Excluded were 3121 who had a hysterectomy for benign causes during follow up. During a median follow-up time of 7.1 years (interquartile range 3.1-13.3 years) the numbers of EC were 25 (0.3%) after TCRE and 2 (0.02%) after EA, respectively. The observed incidence was significantly lower than expected (population-based estimate) after EA but not after TCRE, giving a standardized incidence ratio of 0.13 (95% confidence interval [CI] 0.03-0.53) after EA and 1.27 (95% CI 0.86-1.88) after TCRE. Median times to EC were 3.0 and 8.3 years after TCRE and EA, respectively. There was a significant reduction of EC after EA, suggesting a protective effect, whereas endometrial resection showed an incidence within the expected rate.

New surgical realities: implementation of an enhanced recovery after surgery protocol for gynecological laparoscopy\u2014a prospective study

BackgroundMultimodal rehabilitation allows optimization of functional recovery in surgery patients by reducing the postoperative stress and hospital stay duration, without increasing the morbidity and mortality. It is reportedly successful in other surgical disciplines, and guidelines for its application to gynecological surgery are available; however, most evidence for these guidelines is derived from observational and/or retrospective studies. Therefore, this study aimed to investigate the applicability of an enhanced recovery after surgery (ERAS) protocol in laparoscopic gynecological surgery and its influence on the postoperative stay, morbidity, mortality, and readmission, through a prospective approach.MethodsThis prospective cohort study was performed on 90 patients who underwent laparoscopic hysterectomy for benign causes from October 2017 to October 2019. Patients in whom the ERAS (ERAS group, n = 30) and traditional (control group, n = 60) protocols were implemented were compared. All patients were followed for 6 months.ResultsThe groups were homogeneous and did not differ significantly with respect to the demographic characteristics (age, ASA score, body mass index), surgical indications, and surgery types. Adherence to the ERAS protocol was over 99%. The postoperative hospital-stay durations were 1.73 days (r = 1–3) and 2.97 days (r = 2–6) in the ERAS and control groups, respectively (p = 0.000). No significant intergroup differences were observed in the rates of complications and readmissions.ConclusionsThe ERAS protocol is applicable in laparoscopic gynecological surgery and can be implemented with good adherence. This can allow optimization of patient recovery by reducing the hospital stay duration, without increasing the rates of morbidity, mortality, or readmission.

Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease.

Hysterectomy is one of the most frequently performed surgical procedures in the United States. Selection of the route of hysterectomy for benign causes can be influenced by the size and shape of the vagina and uterus; accessibility to the uterus; extent of extrauterine disease; the need for concurrent procedures; surgeon training and experience; average case volume; available hospital technology, devices, and support; whether the case is emergent or scheduled; and preference of the informed patient. Vaginal and laparoscopic procedures are considered "minimally invasive" surgical approaches because they do not require a large abdominal incision and, thus, typically are associated with shortened hospitalization and postoperative recovery times compared with open abdominal hysterectomy. Minimally invasive approaches to hysterectomy should be performed, whenever feasible, based on their well-documented advantages over abdominal hysterectomy. The vaginal approach is preferred among the minimally invasive approaches. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible. Although minimally invasive approaches to hysterectomy are the preferred route, open abdominal hysterectomy remains an important surgical option for some patients. The obstetrician-gynecologist should discuss the options with patients and make clear recommendations on which route of hysterectomy will maximize benefits and minimize risks given the specific clinical situation. The relative advantages and disadvantages of the approaches to hysterectomy should be discussed in the context of the patient's values and preferences, and the patient and health care provider should together determine the best course of action after this discussion.

Committee Opinion No. 701 Summary: Choosing The Route Of Hysterectomy For Benign Disease.

Hysterectomy is one of the most frequently performed surgical procedures in the United States. Selection of the route of hysterectomy for benign causes can be influenced by the size and shape of the vagina and uterus; accessibility to the uterus; extent of extrauterine disease; the need for concurrent procedures; surgeon training and experience; average case volume; available hospital technology, devices, and support; whether the case is emergent or scheduled; and preference of the informed patient. Vaginal and laparoscopic procedures are considered "minimally invasive" surgical approaches because they do not require a large abdominal incision and, thus, typically are associated with shortened hospitalization and postoperative recovery times compared with open abdominal hysterectomy. Minimally invasive approaches to hysterectomy should be performed, whenever feasible, based on their well-documented advantages over abdominal hysterectomy. The vaginal approach is preferred among the minimally invasive approaches. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible. Although minimally invasive approaches to hysterectomy are the preferred route, open abdominal hysterectomy remains an important surgical option for some patients. The obstetrician-gynecologist should discuss the options with patients and make clear recommendations on which route of hysterectomy will maximize benefits and minimize risks given the specific clinical situation. The relative advantages and disadvantages of the approaches to hysterectomy should be discussed in the context of the patient's values and preferences, and the patient and health care provider should together determine the best course of action after this discussion.

Combined Laparoscopic, Vesicoscopic, and Vaginal Repair of a Vesicovaginal Fistula

Study ObjectiveTo demonstrate a combined laparoscopic, vesicoscopic, and vaginal approach to repair of a complex vesicovaginal fistula. DesignTechnical video demonstrating a combined laparoscopic, vesicoscopic, and vaginal approach for repairing a vesicovaginal fistula (Canadian Task Force classification level III). SettingUrogynecology and Urology Departments of a tertiary referral center for urogynecology. InterventionsA 38-year-old woman presented with a vesicovaginal fistula secondary to a previous total abdominal hysterectomy. An initial attempt to repair the fistula vaginally was unsuccessful owing to infection and comorbidities. After counseling, the patient agreed to a combined laparoscopic, vesicoscopic, and vaginal repair of her vesicovaginal fistula. ConclusionThe incidence of vesicovaginal fistula following a total abdominal hysterectomy for benign causes is 1 in 540 [1]. Management of this complication can be challenging, and success rates vary. Initially, laparoscopy was performed, which allowed mobilization of the omentum to provide an interposition patch between the bladder and vagina after repair of the fistula. The fistula tract was then identified vesicoscopically and excised. Once the tract was closed and the patch secured, a vaginal approach was adopted to excise the remaining fistula tract as well as scar tissue. Interrupted closure of the vagina was performed in multiple layers to reduce the risk of recurrence. We have used vesicoscopy since 2007 for a variety of female urogynecologic problems, including bladder diverticula, ureteric stenosis, vesicoureteric reflux, foreign body removal, and vesicovaginal fistula repair [2]. This combined multidisciplinary approach offers a minimally invasive option for the repair of complex vesicovaginal fistulae, and should be considered in selected complex cases.

Sonographically Diagnosed Vault Hematomas Following Vaginal Hysterectomy and Its Correlation with Postoperative Morbidity

Objective. Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity. Methods. We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity. Results. The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20) had fever while only 2.4% (2/83) of cases without vault hematoma suffered from fever. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma. Fifty percent of patients (3/6) with large-sized hematoma, as compared to only 35% (5/14) with small-sized hematoma, suffered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The significant difference was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group. Conclusion. Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be significant. Vaginal ultrasound examination should not be performed routinely after hysterectomy.

Modulation of vascular endothelial growth factor and thymidine phosphorylase in normal human endometrial stromal cells

To study the regulation of vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP), two angiogenic factors, in cultured endometrial stromal cells. The effects of steroids, E2, and P, the gonadotropin, hCG, and hypoxia were investigated. Quantitative experimental study. Academic medical department. Women undergoing hysterectomy for benign causes. Endometrial cells were collected from subjects and cultured. The secretion of VEGF in supernatant media and the numbers of cells expressing VEGF or TP. Estradiol increased VEGF secretion and the number of cells that contained VEGF and TP, and those effects were inhibited by hCG. Human chorionic gonadotropin alone could increase number of cells that expressed VEGF and TP. Hypoxia increased both VEGF secretion and number of cells containing VEGF and TP. Progesterone had no observed effect on VEGF secretion or number of VEGF- or TP-containing cells. Vascular endothelial growth factor and TP are present in stromal cells of normal endometrium, and E2 may interact with gonadotropins to regulate angiogenic compounds to modulate stromal functioning.

Severe Complications of Hysterectomy: The VALUE Study

In a 12-month period from October 1994 to September 1996, over 350 hospitals in England, Wales, Northern Ireland, the Channel Islands, and the Isle of Man participated in an investigation of major operative and postoperative complications associated with hysterectomy for benign causes. The staff at participating hospitals collected information for all such hysterectomies performed during this 12-month period by completing questionnaires at 3 points in the management of the patient. The first was at the time of surgery, the second at discharge, and the third 6 weeks after surgery. There were a total of 37,295 qualifying procedures performed during the study period. Information from the sixth-week postoperative visit was available for 26,973 (72%) cases. The average age of patients undergoing hysterectomy was 45 years. The most common indication for surgery was dysfunctional uterine bleeding (46%), followed by fibroids (19%) and prolapse (19%). Other indications included endometriosis and adenomyosis (5%) and pelvic mass (3%). Over half (58%) of the procedures were performed by consulting-level surgeons who also served as supervisors in 34% of the cases carried out by nonconsultants. Two thirds of the cases (24,772; 67%) were total abdominal hysterectomy (TAH), 30% (11,122) were vaginal hysterectomy (VAH), and 3% (1154) were laparoscopically assisted vaginal hysterectomy (LAVH). There were 14 deaths in this study (mortality rate 0.38 per 1000). Eight women died before discharge and 6 died within 6 weeks after surgery. No patient died during surgery and no deaths were among the women who had LAVH. There were a total of 1295 (3.5%) major operative complications and 383 (1%) postoperative complications. The number of complications tended to decrease with increasing age of the patient (11% decrease in odds of complications for each 10 years of age; P = 0.002). The risk of operative complications increased with increasing parity (odds ratio, 1.04; 95% confidence interval, 1.01–1.08 for each pregnancy). Operative and postoperative complications were most common in LAVH procedures (6.1% and 1.7%, respectively), with comparable rates of 3.1% and 0.9% in TAH and 3.1% and 1.2% in VAH (P <0.001 and P = 0.15, respectively). Hysterectomies being performed to remove fibroids had the highest risks of complications (operative 4.4% and postoperative complications 1.2%). Other indications carried risk of 3.6% and 1.0% for dysfunctional uterine bleeding, 2.7% and 1.1% for prolapse, 3.1% and 0.8% for endometriosis/adenomyosis, and 3.7% and 0.8% for pelvic mass. The risk of operative and postoperative complications was higher in women with a history of serious illness (4.8% and 1.5%) compared with no such history (3.4% and 1.0%, P <0.001 and P = 0.024, respectively). Serious illness was also associated with higher risk of operative complications in women undergoing hysterectomy for fibroids. No significant differences in rates of operative or postoperative complications were seen according to the operator or presence of a supervisor. The use of prophylactic antibiotics did not influence postoperative complication rates.

Trends in hysterectomy for benign causes - A retrospective study at Kohalpur Teaching Hospital

ABSTRACTA retrospective study of all hysterectomies was done from 1st January 2001 to 31st December 2001. Theobjective was to study the trends in age, parity, indications, type of surgery (abdominal or vaginal),conservation of ovaries, repair of pelvic floor and postoperative complications. All cases were reviewed forthe above parameters.73 hysterectomies were performed during this period, of which 57.53 % were abdominal and 42.47% werevaginal.Maximum numbers of operations (41.09%) were in the age groups of 31 to 40 years and 41-50yrs (35.61%).Ovaries were conserved in 50 %cases.Commonest indication was utero-vaginal prolapse (46.6%) followed by cervical intra-epithelial neoplasia(CIN) (28.77%), leiomyomas (20.54%) and dysfunctional uterine bleeding (DUB) (4.10%). Pelvic floorrepair accompanied almost all (97%) vaginal hysterectomies.Key Words: Hysterectomy, pelvic inflammatory disease, cervical intra epithelial neoplasia,utero-vaginal prolapse, DUB.