Hysterectomy For Benign Disease Research Articles

Whether surgical procedure can improve the prognosis of endometrial cancer arising in adenomyosis (EC-AIA)? A systematic review and meta-analysis.

Endometrial cancer arising in adenomyosis (EC-AIA) is frequently detected accidentally following a general hysterectomy for adenomyosis. Whether supplemental lymphadenectomy in patients with EC-AIA can improve the survival outcome remains inconclusive. Herein, the authors summarized the data of patients with EC-AIA and further explored the impact of lymphadenectomy on the prognosis of these patients. Five electronic databases, namely MEDLINE, Web of Science, PubMed, Embase, and the Cochrane Library were employed for searching articles from inception to May 2023. In total, 38 eligible studies enrolling 56 patients were included. Of these, 44 patients had a traceable prognosis. Kaplan-Meier curves demonstrated that patients who had undergone lymphadenectomy had a better progression-free survival (PFS) compared with those who had not undergone lymphadenectomy ( P =0.016), but there was no difference in overall survival. Univariable ( P =0.025, HR=0.25, 95% CI=0.08-0.84) and multivariable ( P =0.042, HR=0.13, 95% CI=0.020-0.930) Cox regression analyses revealed that lymphadenectomy was an independent protective factor for PFS. For patients diagnosed with EC-AIA following hysterectomy for benign disease, further supplementary lymphadenectomy is recommended to improve PFS.

Trends in surgical approaches and adnexal surgeries during hysterectomies for benign diseases between 2015-2021.

Hysterectomy is a widely used surgical approach for benign gynecological conditions, although recently there have been differences in the surgical route selected in different regions. To estimate recent temporal trends, this study collected data on surgical approaches and adnexal surgeries during hysterectomies for benign diseases at a single institute from 2015 to 2021. We retrospectively analyzed data from Xiangyang No.1 People's Hospital, Hubei University of Medicine in Xiangyang, China, and identified 1828 women who underwent hysterectomies for benign gynecologic conditions performed with or without bilateral salpingectomy (BS) or bilateral salpingo-oophorectomy (BSO) between January 2015 and December 2021. There was an upward trend in the performance of hysterectomy and hysterectomy with BS, and there was a difference in the trends of concomitant adnexal surgery between AH, TLH, and VH, especially in TLH with BS. Patient characteristics data demonstrated that the most frequent indication for hysterectomy was leiomyoma, especially in women aged 45 to 65. Compared to AH, TLH, and VH, the operative bleeding, duration of surgery, and length of hospital stays of patients undergoing TLH with BS and BSO was the lowest. The surgical approach to benign diseases has changed dramatically due to a growing proportion of patients choosing minimally invasive procedures. The laparoscopic approach is becoming popular due to its capacity to decrease intraoperative blood loss and reduce hospitalization. We should put more emphasis on surgical training for the TLH approach and help gynecologic surgeons provide the proposed added benefit of BS to their patients.

Prophylactic Salpingectomy during Hysterectomy for Benign Disease: A Prospective Study to Evaluate High-Grade Serous Ovarian Carcinoma Precursors

Recent findings suggest that high-grade serous ovarian cancer can originate in the fallopian tube. Not only has that made the identification of precursor lesions pivotal in early detection and prevention of these cancers, prophylactic salpingectomy alongside hysterectomy for benign indications has been increasingly proposed as well. The present prospective single-center study included 273 women who underwent opportunistic salpingectomy alongside laparoscopic supracervical hysterectomy. Uterine and tubal histopathological results as well as intra- and postoperative complications were evaluated. The complication rate was 3.3%, of which none were caused by salpingectomy. Uterine histopathology diagnosed 181 patients (66.8%) with uterine myomas, 60 patients (22.1%) with adenomyosis, 29 patients (10.7%) with adenomyomatosis, and, 1 patient (0.4%) without pathological abnormality. p53 signatures were detected in 221 right fallopian tubes (80.9%) and in 229 left tubes (83.9%). In total, 8 patients showed bilateral STIL (2.9%), whereas in 1 patient (0.4%) STIL was detected in the left tube only. No STIC were detected. Laparoscopic opportunistic salpingectomy is demonstrated to be both safe and feasible. It appears to be promising to reduce the risk for ovarian cancer, yet more studies are needed to undoubtedly confirm this.

Ovarian tumors in women after hysterectomy for benign diseases

Varian cancer is one of the most common malignant neoplasms of the female reproductive systemand ranks first as the cause of women’s mortality from oncogynecological pathology. Over thepast 10 years, the increase in the incidence of ovarian cancer was 11.5% and remains high todaywithout a clear downward trend. According to the United Kingdom Collaborative Study, for one woman with a confirmed diagnosisof ovarian cancer, ten women underwent unnecessary surgical interventions and manipulationsbased on the results of imaging methods.Hysterectomy without accompanying ovariectomy has traditionally been considered one of theways to protect against ovarian cancer. But the latest data, which includes a large numberof contemporary studies of women recently diagnosed with ovarian cancer, did not find asimilar correlation. These findings may be related to changes in surgical practice, the use ofmenopausal hormone therapy, or perhaps improved reporting of oophorectomy.The risk of detecting epithelial ovarian cancer after hysterectomy has been repeatedly studied,but summarizing the data of most studies, no statistically reliable data were found that wouldindicate an increase in the risk of developing a malignant disease after this surgical intervention.However, the question needs further study in terms of the rapid development of modern oncology.

Surgical Indication and Approach are Associated with Transfusion in Hysterectomy for Benign Disease.

Objective:To identify pre-operative and intraoperative factors associated with the risk of red blood cell transfusion among women undergoing hysterectomy.Methods:A retrospective cohort study of hysterectomy for benign indications between January 1, 2011 – December 31, 2017. Patients receiving blood transfusion within 30 days of surgery were compared to patients who did not receive any transfusion. Multivariate logistic regression analysis was performed to identify clinical and surgical variables associated with blood transfusion.Results:Among 171,940 women who underwent hysterectomy for benign indication, 4,667 (2.7%) required blood transfusion. The rate of transfusion was highest among patients with uterine fibroids (4.3%) and lowest in patients with genital prolapse (1.1%) (p < 0.05). Odds of blood transfusion were significantly elevated in patients undergoing hysterectomy for uterine fibroids compared to patients with genital prolapse (adjusted odds ratio [aOR] 1.36, 95% confidence interval [CI] 1.15 – 1.61). Other patient characteristics included body mass index, smoking, bleeding disorders, pre-operative sepsis, and American Society of Anesthesiologists score ≥ 2 (p < 0.05). Higher pre-operative hematocrit significantly decreased the risk of blood transfusion (aOR 0.84, 95% CI 0.84 – 0.85 per percent increase in hematocrit). Abdominal and vaginal hysterectomies were associated with greater odds of transfusion compared with laparoscopic approaches (aOR 5.06, 95% CI 4.70 – 5.44; aOR 1.87, 95% CI 1.67 – 2.10, respectively).Conclusion(s):Certain patient comorbidities, surgical indication, and approach to hysterectomy are associated with increased risk of blood transfusion. These results may have implications for pre-operative patient counseling, perioperative care, and health system planning.

Influence of COVID-19 in Selection of Route of Hysterectomy in Benign Disease

Study ObjectiveThe objective of this study is to show how prioritizing minimally invasive surgical routes during the COVID 19 allowed our gynecology department to continue performing surgery during operational shutdowns during the pandemic.DesignThis is a retrospective chart review study of all patients who underwent hysterectomy for a benign indication between July 1, 2020, and Feb 28, 2021.SettingNA.Patients or ParticipantsCharts of all patient's undergoing hysterectomy for benign disease between July 1, 2020, and Feb 28, 2021, were reviewed. Patients were excluded if they underwent hysterectomy for malignancy.InterventionsBetween July 2020 and Feb 2021 out institution experienced two operational shutdowns. The first operational shutdown was July through August 2020 and the second was January through February 2021. During both shutdowns our department had limited operating room availability. During the second shutdown we moved the majority of our minor cases to outpatient ambulatory surgery centers and prioritized cases than could be performed laparoscopically and vaginally.Measurements and Main ResultsDuring our chart review we collected information including age, race, BMI, route of hysterectomy, comorbidities (including need for transfusion due to abnormal uterine bleeding), length of surgery, estimated blood loss, weight of uterus reported by pathology, length of hospital stay, and complications for all patient undergoing hysterectomy in the between July 1, 2020, and February 28, 2021, at University Hospital.ConclusionIn conclusion utilization of ambulatory surgery centers for our minor cases and prioritizing vaginal and laparoscopic approach to benign hysterectomy allowed our department to double the number of hysterectomies we were able to perform during our 2nd COVID-19 shutdown.

Association between Obesity and Surgical Outcomes for Minimally Invasive Hysterectomy

Study Objective To investigate the morbidity associated with minimal invasive hysterectomy in obese women. Design This is a retrospective cohort study. The National Surgical Quality Improvement Project database from 2014 to 2017 was queried for all women who underwent laparoscopic, robotic or vaginal hysterectomy. Our primary outcome was the composite morbidity (including surgical site infection, pulmonary, sepsis, thromboembolic, cardiac and renal complications). Our secondary outcomes included length of stay, readmission, reoperation and surgical complications. A multivariable logistic regression adjusting for Age, Race, ASA, smoking, surgical approach and operation time was performed. Setting Hospitals participating in the program. Patients or Participants Patients undergoing minimally invasive hysterectomy for benign disease excluding urogynecologic, cancer or additional procedures. Interventions N/A Measurements and Main Results 39,368 (36.8%) hysterectomies were analyzed including 18,767 (47.8%) obese and 20,501 (52.2%) non-obese women. Obesity was associated with increased risk for the primary outcome compared to nonobese women (2.9% vs 2.2%, aOR 1.27, 95% CI 1.12-1.45). When assessing the different components of the primary outcome, obesity was associated with increased risk for superficial site infection compared to nonobese women (1.0% vs. 0.6%, aOR 1.63, 95% CI 1.29-2.06) and there was no difference in the risk of the other surgical morbidity. Obesity was associated with increased risk for length of stay > 2 days (2.8% vs 2.4%, p Conclusion The rate of surgical morbidity in obese women undergoing minimally invasive hysterectomy is low but remains significantly higher than that of nonobese women. It is mainly driven by the superficial wound infection rate. Future interventions such as specific wound care interventions in obese patients could be explored to minimize that risk.

Predictors of Urinary Tract Infection after Benign Hysterectomy Performed at a Teaching County Hospital: Can We Improve Our Infection Rate

Study Objective To describe the rate of urinary tract infection (UTI) after benign hysterectomy at the county hospital and to evaluate clinical predictors of UTI at the time of discharge from the hospital. Design This is a retrospective cohort study. Patients were separated in two groups: those with and those without UTI within 30 days of their hysterectomy. Demographics, surgical procedures and outcomes were compared. Setting Teaching county hospital in Texas. Patients or Participants All patients undergoing hysterectomy for benign disease from January 2017 to December 2018. Interventions NA. Measurements and Main Results 474 patients were included in the study. Our patient population was comprised of Hispanics (70%), Obese (58.4%), diabetics (14.3%), menopausal (13.5%) and smokers (12.45%). Our minimally invasive rate was 70%. 14% of patients had an additional urogynecological procedure. Cystoscopy was used in only 49.2% of cases. 18.7% of patients were discharged the same day. 5% of patients were sent home with an indwelling catheter. The rate of UTI was 11.4% (54 patients). On univariate analysis, patients with UTI were more likely to be Hispanic, undergo a vaginal approach compared to a laparoscopic or abdominal route, undergo a concomitant urogynecological procedure, have a Foley catheter for longer than 24 hours and be sent home with an indwelling catheter (all p On multivariate regression and after adjusting for all significant variables, prolonged catheterization was the only significant predictor for UTI in our cohort, (14.8% versus 12.1%, OR=2.86(1.04-7.3), p=0.03). Conclusion Our UTI rate after benign hysterectomy is high and appears to be driven by the rate of prolonged catheterization. Improved patients education related to catheter care and possibly prophylactic antibiotics may be helpful in improving this rate and could be performed as a quality improvement project.

Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies.

How does the risk of cardiovascular disease (CVD) vary with type and age of menopause? Earlier surgical menopause (e.g. <45 years) poses additional increased risk of incident CVD events, compared to women with natural menopause at the same age, and HRT use reduced the risk of CVD in women with early surgical menopause. Earlier age at menopause has been linked to an increased risk of CVD mortality and all-cause mortality, but the extent that this risk of CVD varies by type of menopause and the role of postmenopausal HRT use in reducing this risk is unclear. Pooled individual-level data of 203767 postmenopausal women from 10 observational studies that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE) consortium were included in the analysis. Postmenopausal women who had reported menopause (type and age of menopause) and information on non-fatal CVD events were included. Type of menopause (natural menopause and surgical menopause) and age at menopause (categorised as <35, 35-39, 40-44, 45-49, 50-54 and ≥55 years) were exposures of interest. Natural menopause was defined as absence of menstruation over a period of 12 months (no hysterectomy and/or oophorectomy) and surgical menopause as removal of both ovaries. The study outcome was the first non-fatal CVD (defined as either incident coronary heart disease (CHD) or stroke) event ascertained from hospital medical records or self-reported. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CI for non-fatal CVD events associated with natural menopause and surgical menopause. Compared with natural menopause, surgical menopause was associated with over 20% higher risk of CVD (HR 1.22, 95% CI 1.16-1.28). After the stratified analysis by age at menopause, a graded relationship for incident CVD was observed with lower age at menopause in both types of natural and surgical menopause. There was also a significant interaction between type of menopause and age at menopause (P < 0.001). Compared with natural menopause at 50-54 years, women with surgical menopause before 35 (2.55, 2.22-2.94) and 35-39 years (1.91, 1.71-2.14) had higher risk of CVD than those with natural menopause (1.59, 1.23-2.05 and 1.51, 1.33-1.72, respectively). Women who experienced surgical menopause at earlier age (<50 years) and took HRT had lower risk of incident CHD than those who were not users of HRT. Self-reported data on type and age of menopause, no information on indication for the surgery (e.g. endometriosis and fibroids) and the exclusion of fatal CVD events may bias our results. In clinical practice, women who experienced natural menopause or had surgical menopause at an earlier age need close monitoring and engagement for preventive health measures and early diagnosis of CVD. Our findings also suggested that timing of menopause should be considered as an important factor in risk assessment of CVD for women. The findings on CVD lend some support to the position that elective bilateral oophorectomy (surgical menopause) at hysterectomy for benign diseases should be discouraged based on an increased risk of CVD. InterLACE project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). GDM is supported by Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844). There are no competing interests.

Post-traumatic stress following total hysterectomy for benign disease: an observational prospective study

Purpose Over the last decade, there has been growing interest in the psychophysical integrity of surgical patients in the context of healthcare events. In the present study, we aimed to evaluate the incidence rate of postoperative distress symptoms, namely post-traumatic stress disorder (PTSD), following total hysterectomy for benign disease. We also investigated possible associations between sociodemographic characteristics, clinical outcomes, anxiety, depression, and PTSD. Methods We prospectively enrolled 100 consecutive patients who underwent total hysterectomy for benign disease between 01/01/2019 and 15/04/2019. Demographic and surgical-related characteristics have been registered. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered preoperatively (Time1), postoperatively (Time2), and at follow-up clinical evaluation, between two and three months after surgery (Time3). PTSD was defined based on the results of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) at Time3. Results At Time3, the median PCL-5 score was 12,8 (0–70), and 16.4% of patients had PTSD symptoms (PCL-5 > 33). No correlation between sociodemographic or gynecologic characteristics and PTSD was detected. A significant association between depression (HADS > 8) at Time2 (p = 0.002) and Time3 (p < 0.001) and PTSD symptoms was shown. Conclusion Hysterectomy for benign disease is associated with a non-negligible risk of PTDS; the use of the HADS questionnaires might be useful to select patients who might benefit from dedicated psychological support.

Risk‐factors for continuous long‐term use of prescription opioid drugs 3 years after hysterectomy: A nationwide cohort study

The widespread misuse of prescription pain medication, including opioids, has serious public health implications. Postoperative pain is a risk factor for persistent or chronic pain unless treated effectively. There are only a few studies that have assessed the use of opioid-containing drugs after gynecological surgery and most of these usually have a short follow-up period. The aim of this study was to identify risk-factors for long-term use of prescription opioid drugs following hysterectomy. We performed a nationwide cohort study based on prospectively collected data. Information from two population-based registers, the Swedish National Quality Register of Gynecological Surgery and the Swedish National Drug Register, was linked. The study population consisted of women with benign disease undergoing a total hysterectomy from 1 January 2012 until 31 December 2015. To identify long-term changes in prescription of opioids, individual data were collected from 1year prior to to 3years after surgery between 2011 and 2018. Data analysis was performed using multivariable logistic regression models. The population included 17385 women having had hysterectomy for benign disease. Of these women, 4233 (24.4%) were prescribed analgesics continuously for 3years postoperatively and 1225 (7.1%) used opioids long term. Perioperative predictors of opioid use 3years after surgery included a diagnosis of adenomyosis (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.2-2.7) and preoperative use of opioids (aOR 29.6, 95% CI 19.7-44.4), psycho- (aOR 3.5, 95% CI 2.4-5.0) and neuroactive drugs (aOR 1.8, 95% CI 1.0-3.1). For women with no opioid prescription preoperatively (n=260, 1.5%), mild (aOR 2.8, 95% CI 1.1-7.3) and severe (3.0% vs 6.2%: aOR 6.4, 95% CI 1.4-20.0) postoperative complications and preoperative prescription of psychoactive drugs (aOR 4.6, 95% CI 1.9-10.7) were associated with long-term use of drugs containing opioids. Long-term use of prescription opioids after hysterectomy is common and is, among other risk factors, strongly associated with preoperative use of opioids, as well as psychoactive drugs and adenomyosis. To avoid opioid misuse disorders among women at risk for long-term opioid drug prescriptions after hysterectomy, further studies and strategies are needed.

The Impact of Robotic Assisted Total Laparoscopic Hysterectomy on Pelvic Floor Function and Sexual Function.

Study Objective To investigate the long-term effects of hysterectomy on benign indication on pelvic floor function and sexual function. Design Prospective clinical cohort study Setting Academic affiliated district general hospital. Patients or Participants Patients undergoing hysterectomy for benign disease between 2016 and 2018 Interventions A comparison of robotic assisted total laparoscopic hysterectomy with traditional techniques of surgery regarding pelvic floor function and sexual function. Measurements and Main Results The study includes 259 women going through hysterectomy. Participants fills in validated questionnaires (PFIQ, PFDI-20, FSFI) on pelvic floor function and sexual function before surgery, six months, 1, 3 and 5 years after surgery. General health and obstetric history are registered in a separate protocol. Multivariate regression and nonparametric statistics are used. The one-year results are not complete but will be presented in November 2019. The results for the six-months follow up of the first 150 women show that the mean age at surgery was 50.2 (SD 9,7), the mean parity was 1,8 (SD 1,2) and mean BMI was 26.4 (SD 4.9). Robotic assisted laparoscopic hysterectomy was performed in 37,3% of the women, laparoscopic hysterectomy in 22%, laparoscopically assisted hysterectomy in 1,1%, vaginal hysterectomy in 3,3% and abdominal hysterectomy in 36,7%. There was a significant higher amount of bleeding at surgery 453 ml (range 50-1300) in the abdominal cohort. Urinary, bladder and pelvic symptoms were significantly reduced six months after hysterectomy. The reduction of symptoms was most prominent in the abdominal hysterectomy cohort but also significant in the robotic hysterectomy cohort. There were no significant changes in sexual function in the cohorts after six months. Conclusion There was a reduction of urinary, bladder and pelvic symptoms six months after hysterectomy but no differences in sexual function. Remaining analysis will show whether those results persist at the one-year follow-up.

Optimization of Pre-Operative Oral Analgesics in Patients Undergoing Ambulatory Minimally Invasive Hysterectomy

Study Objective To determine the optimal time to administer pre-operative non-opioid oral analgesics to achieve superior post-operative pain modulation in patients undergoing outpatient minimally invasive hysterectomy for benign disease. Design Randomized controlled trial. Setting Minimally invasive gynecologic surgery practice. Patients or Participants Women undergoing benign minimally invasive hysterectomy. Interventions From January 2018 to October 2018, 60 women aged 34-67 years were randomized to treatment (n=30) and control (n=30). Patients in the treatment arm self-administered oral celecoxib, gabapentin, and acetaminophen 3-4 hours prior to surgery, while those in the control arm received these medications in the pre-anesthesia care unit. All patients were administered intravenous nausea and vomiting prophylaxis. Time of oral medication ingestion and orogastric tube placement were collected. Post-operatively, patients were administered intravenous ketorolac and pain scores were assessed on an eleven-point numeric rating scale. Pain medications and anti-emetics were administered as needed prior to discharge. Opioid consumption was collected and converted to oral morphine equivalents (OME). Patients were sent an electronic survey assessing patient satisfaction and surgical recovery score on post-operative day 10. Measurements and Main Results 53 subjects (29 in treatment and 24 in control) were included in the study. Baseline characteristics were balanced between treatment and control arms, with the exception of pre-existing gastro-esophageal reflux which was higher in the treatment group (20.7% vs. 0.0%, p=.026). 24.1% of the treatment arm required OME >50 compared to 41.7% of the control group (p=.174). There were no significant differences in pain score at discharge (p=.234), patient satisfaction (p=.90), or surgical recovery score (p=.189). Conclusion Advanced administration of pre-operative oral analgesia trended towards a decrease in immediate post-operative opioid use when compared to immediate pre-operative administration. Timing of administration had no impact on pain scores, patient satisfaction, or surgical recovery scores. Either technique of administration of pre-operative oral analgesia is acceptable.

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.

Effects of hysterectomy with simultaneous bilateral salpingectomy on the subsequent pelvic mass

ObjectivesTo analyze the clinicopathological characteristics of subsequent pelvic masses after hysterectomy for benign diseases, and to compare the masses following hysterectomy with or without simultaneous bilateral salpingectomy.MethodsThis study retrospectively analyzed patients undergone reoperation for pelvic mass subsequently to previous hysterectomy for benign disease from January 2012 to December 2016 in Peking Union Medical College Hospital.ResultsA total of 247 patients were enrolled in this study, of which 80.16% (n = 198) received simple hysterectomy, and 5.67% (n = 14) underwent hysterectomy with bilateral salpingectomy. The clinicopathological data of patients undergone simple hysterectomy or simultaneous bilateral salpingectomy was compared. In the former group, we found that 68.18% (n = 135) of the pelvic massed were benign, and the remaining 31.82% (n = 63) were malignant. In latter group, 57.10% (n = 8) were benign (8%) and 42.90% (n = 6) were malignant. Univariate analysis showed that the age of surgery for pelvic masses in patients undergoing hysterectomy with simultaneous bilateral salpingectomy was significantly younger than that in patients without salpingectomy (median, 44.5 vs 50 years, P < 0.0001), and the time interval between hysterectomy and onset of pelvic masses was also significantly shorter (median, 2 vs 5 years, P < 0.0001). And the probability of pelvic encapsulated effusion was significantly higher for the salpingectomy group. Multivariate analysis showed that there was no significant difference of the age of resection of pelvic mass, the time interval hysterectomy and pelvic mass onset, and the probability of pelvic encapsulated effusion between the two groups.ConclusionsThe results showed that the incidence of secondary benign pelvic masses may be reduced when hysterectomy was performed with simultaneous bilateral salpingectomy. However, there was no statistical difference in the clinical characteristics and pathological types of pelvic masses between patients received hysterectomy with or without salpingectomy.

Outcome of total laparoscopic hysterectomy in relation to BMI – A prospective study

Introduction: Laparoscopy can be more complicated in the obese patient, but the complications tend to decrease over time with surgical experience. The aim of this study was to know the safety of total laparoscopic hysterectomy (TLH) for benign diseases in overweight and obese women when compared with women with lesser BMI. Materials and Methods: Total of 105 cases of TLH were analysed prospectively from October 2014 to August 2016. The patients were divided into 4 groups based on BMI; underweight, normal weight, overweight and obese and the demographic data and intra and post-operative parameters were recorded until one month post-operative follow up. The data obtained was analyzed using descriptive and inferential statistics. Result: Of 105 patients, 2(1.9%) were underweight, 14(13.3%) were normal weight, 20(19.0%) were overweight and 69 (65.7%) were obese. Majority were in the age group of 40 to 50 years. Fibroid was the main indication for hysterectomy. There were more number of women with blood loss of more than 100ml in overweight and obese group but the difference was not statistically significant. None of the women in all the groups suffered any major complication. The operation time was more in obese women when compared with the other groups but the difference was not statistically different. Also, when we compared the pain scores at 6 hours, 24 hours and at discharge, we found no difference between the groups. Conclusion: TLH is safe and effective in women of all BMI categories undergoing hysterectomy for benign diseases. Keywords: TLH, BMI, Operation time, Complications, Pain score, Opioid analgesia.

Predictors of 30-day morbidity after hysterectomy for benign disease.

To determine the 30-day morbidity rate after hysterectomy for benign disease and identify predictors of 30-day morbidity. A retrospective study was conducted among women undergoing hysterectomy for benign indications between January 1, 2010, and December 31, 2015, at Konkuk University Hospital, South Korea. Multivariable regression analysis identified independent factors for morbidity. 1609 women were included. 30-day morbidity rates were 4.5% (n=72) for the whole cohort: 7.5% (28/371), 3.2% (22/686), and 4.0% (22/552) for abdominal hysterectomy, laparoscopic-assisted vaginal hysterectomy (LAVH), and vaginal hysterectomy, respectively. The most common 30-day postoperative morbidities were urinary complications (1.2%, 20/1609), wound infection (0.9%, 14/1609), and blood transfusion more than 4units (0.7%, 11/1609). In multivariate regression analysis, Charlson comorbidity index of 2 or more, operative time, and estimated blood loss were independently associated with morbidity. Propensity score-matching indicated no difference in morbidity rates for the abdominal hysterectomy and LAVH or vaginal hysterectomy groups (P=0.351), whereas the LAVH or vaginal hysterectomy groups were more strongly associated with operation time, estimated blood loss, and length of postoperative hospital stay. Comorbidity index, operative time, and blood loss were independently associated with morbidity following hysterectomy. These findings supported the preoperative optimization of comorbidities and the appropriate selection of surgical approaches.

Total laparoscopic hysterectomy for benign disease: outcomes and literature analysis

ObjectiveTo analyze surgical outcomes of total laparoscopic hysterectomy (TLH) for benign disease.MethodsRetrospective analysis of 361 consecutive cases, prospectively collected from January 2012 to June 2016, of women who underwent TLH in St. Chiara Hospital in Trento, Italy. Clinical, demographic, surgical, and intra and perioperative data were recorded. Complications were graded on the Clavien-Dindo morbidity scale. Data were compared with literature. Statistical analysis was performed with SPSS (SPSS Chicago, IL).FindingsMain indication for TLH was uterine fibromatosis (78.6%). Mean uterine size was 327 ± 249 g (range 30–1800 g). Mean operating time was 115 ± 36 min. No laparotomy conversion occurred. Mean length of hospital stay was 2.6 ± 1.1 days (range 1–12 days).Complications requiring surgical intervention in general anesthesia occurred in 3 patients (0.8%): 1 (0.3%) hydroureteronephrosis, 1 (0.3%) bowel adhesions, and 1 (0.3%) port side hernia; complication requiring surgical intervention without general anesthesia occurred in 6 patients (1.6%): 2 (0.6%) hydroureteronephrosis, 1 (0.3%) vaginal cuff dehiscence, and 3 (0.8%) vaginal cuff bleeding.ConclusionsTotal laparoscopic hysterectomy is a procedure with a low incidence of complications. Our data compare favorably with the data of the other listed studies.

Comparison of Intra-Operative and Post-Operative Complications between Non-Descent Vaginal Hysterectomy and Total Abdominal Hysterectomy

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologists and can be done through abdominal and vaginal routes. Vaginal hysterectomy technique has been introduced and performed centuries back, but is less popular due to lack of experience and misconception that the abdominal route is easier and safer. Worldwide gynaecologists continue to use abdominal route for hysterectomy that could be performed vaginally which is less invasive and has minimal complications.Objective: To compare the complications during intra-operative and post-operative period between vaginal hysterectomy and abdominal hysterectomy in non-descent uterus.Materials and Methods: This prospective randomised study was performed in Enam Medical College &amp; Hospital, Savar, Dhaka during a period of one year. Sixty consecutive patients requiring hysterectomy for benign diseases were included in this study. Group A (n=30) underwent vaginal hysterectomy (non-descent vaginal hysterectomy) and were compared with Group B (n=30) who underwent abdominal hysterectomy. The primary outcome measures were operative time, intra-operative blood loss, post-operative complications like wound infection, febrile morbidity, post-operative systemic infection and hospital stay. Secondary outcome measures were conversion of vaginal to abdominal route and re-laparotomy. Data were collected in structured questionnaire and analysed by computer using R programming version 3.4.3.Results: Baseline characteristics were similar in two groups. There were no intra-operative complications in either group. Intra-operative blood loss was significantly more in Group B than in Group A. The overall complication rate was significantly higher with abdominal hysterectomy with a rate of 56.67% against 30% for vaginal hysterectomy. Wound infection (23.33%) was significantly higher in Group B as compared to Group A (0%). Post-operative hospital stay was significantly higher in Group B (7.03 days) than in Group A (4.57 days).Conclusion: Considering intra-operative blood loss, post-operative complications and hospital stay, vaginal route was found safer than abdominal route in this study.J Enam Med Col 2018; 8(3): 128-134

Risk of hypertension after hysterectomy: a population-based study.

Hysterectomy is the second most common surgery performed mainly for benign uterine pathologies in females. The association between hysterectomy and the subsequent risk of hypertension remains controversial. This study investigated the risk of developing hypertension in women who had a hysterectomy. Population-based retrospective cohort study. We used the Taiwan National Health Insurance Research Database with claims data of 1 million randomly selected insured individuals. Women with and without hysterectomy and bilateral salpingo-oophorectomy, aged 30-49years, were identified in 2000-2013 from the insurance data. From the claims data, we identified 6674 women with hysterectomy without hypertension at the time of the surgery. The comparison cohort were 26696 women randomly selected from women without hysterectomy and hypertension, matched by age and the year hysterectomy was performed. Adjusted hazard ratio (aHR) of hypertension was estimated after controlling for comorbidities. Prediction for hypertension following hysterectomy for benign disease. Both cohorts had a median age of 43.9years. After a median follow up of 6.4years, the incident hypertension was higher in the hysterectomy cohort than in the comparison cohort, with an adjusted hazard ratio (aHR) of 1.35 [95% confidence interval (CI)1.27-1.44]. The incidence increased with age, with a higher aHR in hysterectomised women aged 40-49years (aHR1.37, 95% CI1.06-1.83) than in those aged 30-39years (aHR 1.22, 95% CI1.02-1.46). Findings in this study suggest that women with hysterectomy are more likely to be diagnosed with hypertension in the follow-up period. Women with hysterectomy before 50years of age are at an increased risk of developing subsequent hypertension. Hysterectomy is one of the most common surgeries for women with benign uterine disease. Hysterectomy may lead to a sudden decline in the production of sex hormone (estrogen and progesterone), which is responsible for vessel wall endothelial dysfunction leading to hardening of arteries and subsequent hypertension. However, the association between hysterectomy and risk of hypertension remains controversial. This study investigated whether premenopausal women have an elevated risk of hypertension after hysterectomy. This study employed the Taiwan National Health Insurance Research Database to identify 6674 women 30-49 years old who had a hysterectomy between 2000 and 2013, and a comparison group of 26696 women who did not have a hysterectomy matched by age. Women in both the groups had no hypertension at baseline (recruiting date or within 1 year after recruiting date). By the end of 2013, we found that 1196 (17.9%) and 3613 (13.5%) women had developed hypertension in the hysterectomy and the comparison groups, respectively. The hypertension incidence was 1.4-fold greater in the hysterectomy group than in the control group (27.8 versus 20.2/1000 person-years).