Hysterectomy For Benign Gynecologic Conditions Research Articles

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance.

NDVH is a minimally invasive, safe, effective, and economical surgery. Still AH is preferred for benign gynaecological indications. Our study aims to promote NDVH in all technically possible cases by adequate counselling of the patient. This prospective observational study enrolled 100 women seeking hysterectomy for benign gynaecological conditions (excluding prolapse) in a teaching hospital. Women were counselled on the basis of 'PREPARED' questionnaire to assess their awareness about NDVH and were offered NDVH as the proposed surgery and result is analysed. We observed that there was a little awareness about NDVH and its outcome among the subjects. Ten out of 100 patients refused to perform NDVH after counselling and underwent TAH. Rest of the 90 patients opted for NDVH. Forty out of 90 patients were aware about NDVH, but they were sceptical about the outcome, and 50 were totally unaware. After applying 'PREPARED' questionnaire and counselling, we could motivate them to accept NDVH. It was successful in all cases except one where laparotomy was done for ovarian artery retraction. With no significant post-operative complications, early return to routine activity and low cost of surgery, all patients were satisfied with surgical outcome and improved quality of life. We conclude that patients accept the surgery with open mind after proper counselling and detailing of the procedure. Most of the abdominal hysterectomy can be converted successfully to NDVH in technically feasible cases by experienced hands so adequate training to gynaecology residents is the need of the time. NDVH is economical to the patient as well as for the healthcare system.

Comparison of the depth of tissue necrosis between double-freeze and single-freeze nitrous oxide-based cryotherapy.

Background:Cryotherapy is one the methods of treating cervical premalignant lesions. It is particularly suitable for low-resource countries because of it is relative cheaper, has low cost of maintenance, ease of use and that does not require electricity which is in short supply in many rural areas of developing countries where the incidence and mortality from cervical cancer is very high. In this study we compared single and double freezing on the cervices of women admitted for hysterectomy for benign conditions using Nitrous-based cryotherapy.Materials and Methods:Patients admitted for elective hysterectomy for benign gynaecological conditions were randomized into two arms. The first group had single freeze cryotherapy while the second arm received double freeze cryotherapy. The cervices were examined 24 hours later to determine the depth of tissue necrosis.Results:In this comparative study, the depth of tissue necrosis was deeper with double freeze compared with single freeze. Also in both arms, the depth of necrosis was deeper on anterior lips than on posterior lips of the cervix.Conclusion:Double freeze technique achieve more depth of tissue necrosis than single-freeze on both anterior and posterior lips of the cervix.

Trends in Morbidity Mortality Associated with Hysterectomy for Benign Gynaecological Disorders in Low Resource Settings

Background: Hysterectomy for benign gynaecological conditions is effective in relieving symptoms but ripple effects do occur. Hysterectomies are being performed for conditions where alternatives are available so there is a trend of more surgeries. Not much is known about India, but hysterectomy is very commonly performed. Aim: Study was carried out to know trends of morbidity, mortality with hysterectomy for benign gynaecological disorders in women of low resource settings. Methods: Study commenced in 1998. Retrospective records were collected and prospective cases were included till completion of 2 decades. Analysis of 4223case records of hysterectomies was done, at rural medical institute where most patients are rural. Overall 3985 (94.4%) hysterectomies were performed for benign gynaecological disorders (noncancerous tumours, inflammatory conditions, displacements, miscellaneous like adenomyosis, dysfunctional uterine hemorrhage). Analyses was done by dividing into four five yearly blocks A,B,C,D to know the trends. Results: Complications rate in abdominal hysterectomy was 19.39%, in Block A 26.42%, B 26.65%, C 18.72% and D 14.2%, 50% reduction in complications from recent past. Postoperative vaginal bleeding occurred in 1.18% in Block A, 0.37% in B, 0.52% in C and 0.7% in Block D. Wound infection rate decreased from 10.14% in Block A, 7.1% in D. Other complications had decreasing trend. In vaginal hysterectomy complications rate was 11.14%, 15% in Block A, 18.61% in B, 10.55% in C and 8.4% in D. Mortality was 0.1% (4 cases) 0.19% (one) in Block A, 0.14%(one) in B and 0.16% (2) in C and no mortality in Block D. Conclusion: Severe complications mortality can occur in hysterectomy for benign conditions also. Preoperative care, intraoperative care can reduce morbidities, mortalities, but not totally eliminate, even in present times. Keywords: Benign, disorders, gynaecological, hysterectomy, morbidity, mortality.

Effects of adrenomedullin on the expression of inflammatory cytokines and chemokines in oviducts from women with tubal ectopic pregnancy: an in-vitro experimental study

BackgroundThe occurrence of tubal ectopic pregnancy (tEP) is related to the inflammation of the oviduct. Recently, Adrenomedullin (ADM) was found highly expression in human oviduct. The current study is to investigate whether ADM have a modulatory action on inflammatory cytokines and chemokines in oviductal tissue from women with tubal ectopic pregnancy (tEP).MethodsOviductal isthmus samples were collected from women with tEP undergoing salpingectomy, and women undergoing hysterectomy for benign gynaecological conditions. The mRNA and protein levels of inflammatory cytokines/chemokines were assayed by PCR (n = 6 for tEP, n = 5 for controls) and protein microarray methods (n = 5 for both tEP and controls) respectively.ResultsSome of the inflammatory cytokines/chemokines were upregulated by ADM in oviducts from tEP patients at both mRNA and protein levels. Incubation of oviduct from tEP patients with ADM for 24 h down-regulated some of these cytokines/chemokines.ConclusionOur results suggest an additional mechanism whereby ADM insufficiency may increase the susceptibility to tEP through diminished anti-inflammatory activity. The actual impact of the relationship between ADM and inflammatory process on tubal implantation needs further exploration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-015-0117-x) contains supplementary material, which is available to authorized users.

Costs and Benefits of Opportunistic Salpingectomy as an Ovarian Cancer Prevention Strategy

Evidence accumulated over the past decade suggests that the majority of ovarian cancers arise in the fallopian tube and not the ovary. This led to the recommendation that opportunistic salpingectomy be offered as an elective concurrent procedure for premenopausal women at average risk of ovarian cancer who undergo either hysterectomy for benign gynecologic conditions or surgical sterilization. It has been estimated that opportunistic salpingectomy could reduce the ovarian cancer risk by 20% to 40% over the next 20 years. There are few hard data, however, on the long-term risks and benefits associated with this procedure. Because a clinical trial is not feasible, a population-based cohort study is essential to establish the long-term risks, benefits, and cost-effectiveness of opportunistic salpingectomy. Such a cohort study would take many years to yield results; more timely data on the likely costs and benefits of this strategy could be obtained from a decision analytic model. The aim of this study was to conduct a cost-effectiveness analysis of opportunistic salpingectomy as an ovarian cancer prevention strategy in the general population. A Markov Monte Carlo simulation model was used to estimate the costs and benefits of opportunistic salpingectomy in a hypothetical cohort of premenopausal Canadian women undergoing hysterectomy for benign gynecologic conditions or surgical sterilization as permanent contraception. Three strategies were compared: hysterectomy alone, hysterectomy with salpingectomy, and hysterectomy with bilateral salpingo-oophorectomy (BSO). The main outcome measure was the incremental cost-effectiveness ratio. Effectiveness was calculated in terms of average years of life expectancy gain. Multiple sensitivity analyses accounted for uncertainty around various parameters, including treatment costs, age at surgery, and estimates of risk reduction attributable to salpingectomy. The number of ovarian cancer cases associated with each strategy was estimated in the simulation model. The model predicted that salpingectomy with hysterectomy would be less costly ($11,044 ± $1.56) and more effective (21.12 ± 0.02 years) than either hysterectomy alone ($11,207 ± $29.81, 21.10 ± 0.03 years) or BSO ($12,627 ± $13.11, 20.94 ± 0.03 years), respectively. The model also predicted that salpingectomy for sterilization would be marginally more costly than tubal ligation ($9720 ± $3.74 vs $9339 ± $26.74) but more effective (22.45 ± 0.02 vs 22.43 ± 0.02 years of life expectancy), with an incremental cost-effectiveness ratio of $27,278 per year of life gained. Results were stable over a wide range of treatment costs and estimates of risk reduction. In the Monte Carlo simulation model, salpingectomy reduced the risk of ovarian cancer by 38.1% (95% confidence interval, 36.5%–41.3%) compared with hysterectomy alone and 29.2% (95% confidence interval, 28.0%–31.4%) compared with tubal ligation. This analytic model shows that opportunistic salpingectomy with hysterectomy for benign conditions has the potential to decrease ovarian cancer risk at acceptable cost and that salpingectomy is a cost-effective alternative to use of tubal ligation for sterilization. These findings suggest that prophylactic salpingectomy should be considered in all women undergoing these procedures.

Ovarian cancer risk reduction through opportunistic salpingectomy.

There has been increasing evidence over the past decade that the majority of ovarian cancers arise in the fallopian tube and not primarily in the ovary [1,2,3]. In 2010 the British Columbia Ovarian Cancer Research Group (OVCARE) launched an educational campaign about the potential benefit of done concurrently with hysterectomy for benign gynecologic conditions, or instead of tubal ligation as surgical sterilization. It was estimated that this practice could reduce ovarian cancer risk by 20% to 40% over the next 20 years [4]. Salpingectomy is favorable to salpingo-oophorectomy because it avoids health risks associated with premature menopause after oophorectomy, including osteoporosis and coronary heart disease [5]. However, there has been skepticism about the safety and absolute benefit of this practice [6,7]. There are no long-term studies confirming that salpingectomy does not compromise ovarian function. Similarly, there are no long-term clinical studies confirming that the fallopian tube is the site of origin of most ovarian cancers. However, the available evidence so far suggests that opportunistic salpingectomy is safe, and likely to be effective and cost-effective as an ovarian cancer prevention strategy.

Evaluation of the Learning curve in Total laparoscopic hysterectomy

Introduction: Laparoscopic hysterectomy is a minimally invasive surgery. Retrospective studies have demonstrated a number of advantages of laparoscopic hysterectomy. There is a lot of concern over the training period of it, as it is associated with higher complications during training period. Many studies suggest that complication rates are inversely proportional to the volume of surgical work load. Objective : To assess the learning curve in Total laparoscopic hysterectomy. Material and method : This study had included consecutive 140 cases of total laparoscopic hysterectomy for benign gynecological conditions were considered performed during the period May 2010 to April 2013. We had made first 70 cases as early group and later 70 cases as late group. Results: The mean operating time in early group was 101min and in late group was 81min (P= 0.000). There were total of five complications, three in early group and two in late group. Mean Hb deficit in early was 1.83% as compared to 1.14% in late case which was statistically significant (0.00). Mean hospital stay was 3.31 day as compared to 2.14 day in late group. Discussion: Reduction in operating time and perioperative complications are the two factors most often quoted in the medical literature. Our analysis showed statistically significant reduction in operating time, hemoglobin drop and hospital stay in late group as compared to early group. But the complication rates were not statistically significant. There was a positive association between the size of uterus and operating in both the group and overall as shown by correlation coefficient. Conclusion: There need to be minimum number of 70 surgeries needs to be performed to improve the outcome significantly. Total laparoscopic surgeries can be performed safely during the learning curve.

Cost‐effectiveness of hysterectomy for benign gynecological conditions: a systematic review

The objective of this study was to assess the cost-effectiveness of hysterectomy performed for benign indications. Hysterectomy remains the most common major gynecological operation in the Western world. Rates of hysterectomy have not declined as expected with the introduction of new treatment options. Furthermore, use of laparoscopic techniques varies widely within the Nordic countries. We designed a systematic review in a University Central Hospital. The sample included all published studies regarding the cost-effectiveness of hysterectomy performed for benign indications (n=1666). Medline, Cochrane Library, PsycINFO, CINAHL, and Nursing databases were searched. Inclusion criteria were the availability of pre- and post-intervention health-related quality of life measures (HRQoL) and data on costs. HRQoL, costs, and cost-effectiveness of treatment were the main outcome measures. Studies (n=24) focused on treatment of symptomatic fibroids (n=8), treatment of heavy menstrual bleeding (n=10), various surgical techniques (n=5) and the effect of various indications for hysterectomy (n=2). Follow-up periods varied from 4months to over 10years. SF/RAND-36 or EQ-5D measures and societal cost perspective were most commonly used. Only 11 studies used individual patient data. HRQoL following hysterectomy was generally good but costs were high. The cost-effectiveness depended on indication, age, and duration of follow-up. The cost-effectiveness of hysterectomy has been surprisingly poorly studied. Conclusions are difficult to draw due to different study designs, indications, follow-up times, and HRQoL instruments used. Rates of hysterectomy have declined less than expected with the introduction of new treatment modalities. Costs of surgery are high. Laparoscopic hysterectomy seems to be the least cost-effective, although further data from original patient cohorts with long-term follow-up are needed.

Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease

Although robotically assisted hysterectomy for benign gynecologic conditions has been reported, little is known about the incorporation of the procedure into practice, its complication profile, or its costs compared with other routes of hysterectomy. To analyze the uptake of robotically assisted hysterectomy, to determine the association between use of robotic surgery and rates of abdominal and laparoscopic hysterectomy, and to compare the in-house complications of robotically assisted hysterectomy vs abdominal and laparoscopic procedures. Cohort study of 264,758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals across the United States from 2007 to 2010. Uptake of and factors associated with utilization of robotically assisted hysterectomy. Complications, transfusion, reoperation, length of stay, death, and cost for women who underwent robotic hysterectomy compared with both abdominal and laparoscopic procedures were analyzed. Use of robotically assisted hysterectomy increased from 0.5% in 2007 to 9.5% of all hysterectomies in 2010. During the same time period, laparoscopic hysterectomy rates increased from 24.3% to 30.5%. Three years after the first robotic procedure at hospitals where robotically assisted hysterectomy was performed, robotically assisted hysterectomy accounted for 22.4% of all hysterectomies. The rates of abdominal hysterectomy decreased both in hospitals where robotic-assisted hysterectomy was performed as well as in those where it was not performed. In a propensity score-matched analysis, the overall complication rates were similar for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%; relative risk [RR], 1.03; 95% CI, 0.86-1.24). Although patients who underwent a robotic-assisted hysterectomy were less likely to have a length of stay longer than 2 days (19.6% vs 24.9%; RR, 0.78, 95% CI, 0.67-0.92), transfusion requirements (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55-1.16) and the rate of discharge to a nursing facility (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35-1.76) were similar. Total costs associated with robotically assisted hysterectomy were $2189 (95% CI, $2030-$2349) more per case than for laparoscopic hysterectomy. Between 2007 and 2010, the use of robotically assisted hysterectomy for benign gynecologic disorders increased substantially. Robotically assisted and laparoscopic hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs.

Clinical Audit on Hysterectomy for Year 2011 in Fatima Memorial Hospital Lahore

Abstract Background: Hysterectomy is a major gynaecolo-gical procedure performed in Pakistan. The aim of this audit was to assess the standard of hysterectomy in Fatima memorial hospital, so as to improve the quality of patient care and outcome. Methods: This was a clinical audit and included all patients undergoing hysterectomy for benign gynaeco-logical conditions at initial assessment during the per-iod from 1st Januarv2011 to 31st December 2011 in all three gynae units of Fatima memorial hospital Lahore. Results: A total of 114 patients were included for analysis: 83.33% having abdominal hysterectomies, 2.63% having laparoscopic hysterectomies and 14.04% undergoing vaginal hysterectomies. Uterine fibroids constituted the commonest indication for abdominal hysterectomies, while the genital prolapse was the most common indication for vaginal hyste-rectomy. The overall incidence of complications for vaginal hysterectomy was lower than that for both abdominal hysterectomy and laparoscopic hysteric-tomy. Conclusion: Vaginal approach should be considered as first choice for uterus less than 12 weeks size, along with more vigorous training for this approach. Keywords: Abdominal hysterectomy, Vaginal hyste-rectomy, Laparoscopic hysterectomy.

Total versus subtotal hysterectomy for benign gynaecological conditions

Hysterectomy using an abdominal approach removes either the uterus alone (subtotal hysterectomy) or both the uterus and the cervix (total hysterectomy). The latter is more common but the outcomes have not been systematically compared. To compare short term and long term outcomes of subtotal hysterectomy (STH) with total hysterectomy (TH) for benign gynaecological conditions. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials (July 2011), CENTRAL (July 2011), MEDLINE (1966 to July 2011), EMBASE (1980 to July 2011), CINAHL (January 2005 to July 2011), Biological Abstracts (1980 to December 2005), the National Research Register and relevant citation lists. Only randomised controlled trials of women undergoing either total or subtotal hysterectomy for benign gynaecological conditions were included. Nine trials including 1553 participants were included. Independent selection of trials, assessment for risk of bias and data extraction were undertaken by two review authors and the results compared. There was no evidence of a difference in the rates of multiple outcomes that assessed urinary, bowel or sexual function between TH and STH, either in the short term (up to two years post-surgery) or long term (nine years post-surgery). Length of operation (difference of 11 min) and amount of blood lost during surgery (difference of 57 ml) were significantly reduced during subtotal hysterectomy when compared with total hysterectomy. These differences are unlikely to constitute a clinical benefit and there was no evidence of a difference in the odds of blood transfusion. Post-operative fever and urinary retention were less likely (fever: OR 0.48, 95% CI 0.3 to 0.8; retention: OR 0.23, 95% CI 0.1 to 0.8) and ongoing cyclical vaginal bleeding up to two years after surgery was more likely (OR 16.0, 95% CI 6.1 to 41.6) after STH compared with TH. There was no evidence of a difference in the rates of other complications, recovery from surgery, alleviation of pre-surgery symptoms or readmission rates between the two types of hysterectomy carried out through the abdominal or laparoscopic route, although trials comparing the laparoscopic route were underpowered to detect some differences. This review has not confirmed the perception that subtotal hysterectomy offers improved outcomes for sexual, urinary or bowel function when compared with total abdominal hysterectomy. Women are more likely to experience ongoing cyclical bleeding up to a year after surgery with subtotal hysterectomy compared to total hysterectomy.

Possible Role of Adrenomedullin In the Pathogenesis of Tubal Ectopic Pregnancy

Tubal ectopic pregnancy (tEP) is currently the leading cause of pregnancy-related deaths during the first trimester. Our current knowledge on the molecular pathogenesis is limited. The objective of the study was to find out the possible role of adrenomedullin (ADM) in the pathogenesis of tEP. This was an experimental in vitro study on oviductal tissue. The study was conducted at a university teaching hospital. Patients included those having oviducts removed surgically during salpingectomy for tEP or hysterectomy for benign gynecological conditions. Oviductal tissues were incubated in hormonal condition mimicking early pregnancy before used for in vitro experiments. Plasma ADM concentration, oviductal expression of ADM and its receptors, ciliary beat frequency, smooth muscle contraction were measured. The ciliary beat frequency and frequency of muscle contraction were lower in the oviducts from patients with tEP than those from simulated normal pregnancy. The plasma and oviductal tissue ADM levels were also lower. The decreases in ciliary beat and frequency of contraction were restored to normal after ADM treatment. The results suggest that the lower ADM level in the oviducts of tEP may lead to the decrease in ciliary beating and muscle contraction, with the result that the embryo is retained and implanted in the oviduct. Our findings explain for the first time the etiology of tubal pregnancy on the basis of an impairment of the transport of the fertilized ovum resulting from an ADM deficiency and raise the possibility of using the plasma ADM level as a predictor for tubal ectopic pregnancy.

Does obesity complicate perioperative course in patients undergoing abdominal hysterectomy?

Obesity is traditionally believed to increase the incidence of perioperative complications in abdominal surgery. Recently this paradigm has been challenged mainly by observations from surgical specialties other than gynecology. Our aim was to assess the impact of obesity on perioperative course in women undergoing total abdominal hysterectomy. We analyzed medical charts of 126 patients who underwent total abdominal hysterectomy for benign gynecological conditions through a low transverse incision in the Department of Obstetrics and Gynecology of the Provincial Specialist Hospital in Czestochowa, Poland. Perioperative course was compared between obese [n = 55; body mass index (BMI) ≥ 30 kg/m(2): mean 32.6 ± 3.2 kg/m(2)] and non-obese patients (n = 71; mean BMI 24.3 ± 3 kg/m(2)). The mean operative time in obese women was significantly prolonged (112 ± 32 vs. 100 ± 31 min, P = 0.036). However, complication rates and other perioperative outcomes were comparable between the groups. In our study, mild obesity does not significantly affect the perioperative course in women undergoing total abdominal hysterectomy.

Regional and temporal variation in hysterectomy rates and surgical routes for benign diseases in the Netherlands

To provide descriptive statistics on hysterectomy for benign gynecological conditions in the Netherlands and to analyze regional and temporal variations in hysterectomy rates and surgical routes. Retrospective cohort study. Dutch hospitals. All women with a hysterectomy for benign gynecological conditions in the Netherlands in 1995-2005. This study is based on an analysis of the Dutch registry of hospital admissions for 1995-2005. The age-adjusted hysterectomy rate and age- and diagnosis-adjusted proportion of vaginal hysterectomies for each Dutch healthcare region and time period. The average annual crude hysterectomy rate for benign disease only, was 17.2 per 10,000 women of all ages. The vaginal route was chosen for 50.8% of the patients. During the study period, the number of hysterectomies for bleeding disorders declined almost 25%. Among 27 Dutch healthcare regions, the age-adjusted hysterectomy rates for bleeding disorders and pelvic organ prolapse varied 2.2- and 2.3-fold, respectively. The average annual age- and diagnosis-adjusted proportion of vaginal hysterectomies varied from 43.4 to 63.8%. The regional differences with regard to rate and proportion declined slightly over time. The Netherlands is among the countries with the lowest hysterectomy rates and the highest proportion of vaginal hysterectomies. The regional differences indicate that a further decrease in the hysterectomy rates and an increase in the proportion of vaginal hysterectomies are possible.

Urodynamic Outcomes After Hysterectomy for Benign Conditions

Hysterectomy, the most common gynecological surgery performed in the United Kingdom, has been highlighted as a possible etiological factor in urinary dysfunction in women who have undergone nonradical hysterectomy. Multiple studies in recent years have examined this question with both clinical and urodynamics metrics. The aim of this systematic review was to analyze urodynamic outcomes before and after total hysterectomy for benign conditions, and report if urinary function was changed after hysterectomy. English articles on MEDLINE and CINAHL from 1950 to February 2009 and on Web of Knowledge all years were searched. The search strategy used combinations of search terms related to urinary function and hysterectomy. The keywords used were "urodynamics," "stress incontinence," "urge incontinence," "bladder instability," "overactive bladder," "detrusor overactivity," and "hysterectomy." Observational studies and randomized controlled trials investigating urodynamic outcomes before and after hysterectomy were included. The data were analyzed in Review Manager 5 software. Overall, symptoms of urinary incontinence were significantly reduced after hysterectomy (relative risk [RR] = 1.37, 95% confidence interval [CI] [1.01, 1.84]). The urodynamic diagnosis of detrusor overactivity was significantly reduced after hysterectomy (RR = 1.58, 95% CI [1.16, 2.16]), but there was no significant reduction in the prevalence of urodynamic stress incontinence after hysterectomy (RR = 0.89, 95% CI [0.58, 1.38]). There was no significant change to urine flow rate after hysterectomy (RR = -0.36, 95% CI [-1.40, 0.68]). Hysterectomy for benign gynecological conditions does not adversely impact urodynamic outcomes nor does it increase the risk of adverse urinary symptoms and may even improve some urinary function. Obstetricians & Gynecologists and Family Physicians. After the completing the CME activity, physicians should be better able to categorize changes in urinary function following hysterectomy, assess changes in urinary symptoms following hysterectomy.

Robotic Assisted Hysterectomy Versus Vaginal Hysterectomy for Benign Gynecologic Conditions. A Comparative Analysis of Surgical Outcomes

Robotic Assisted Hysterectomy Versus Vaginal Hysterectomy for Benign Gynecologic Conditions. A Comparative Analysis of Surgical Outcomes

Estudio comparativo de variables clínicas y costo de la técnica quirúrgica de histerectomía por vía abdominal y laparoscópica

The purpose of the present study is to compare clinical and economic outcomes of abdominal versus laparoscopic hysterectomy. The study design was retrospective and observational, and it was conducted on 1.663 patients aged between 27 and 83 undergoing hysterectomy for benign gynecologic conditions between 1997-2005, at the Hospital Clínico of the University of Chile.Of the 1.663 surgeries, 11,36% were laparoscopic hysterectomies and 88,63% accounted for abdominal hysterectomies. The global complication rate was 42,8%for abdominal hysterectomy and 16,4% for laparoscopic hysterectomy.Laparoscopic hysterectomy offers advantages such as a fewer complications and a shorter hospital stay when compared to abdominal hysterectomy. However, its cost is significantly higher than that of the abdominal approach.

Evidence of prokineticin dysregulation in fallopian tube from women with ectopic pregnancy

To demonstrate expression and regulation of prokineticins (PROKs) and their receptors (PROKRs) in fallopian tube (FT) from women who are not pregnant and women with ectopic pregnancy (EP). Tissue analysis. Large United Kingdom teaching hospital. Women undergoing hysterectomy for benign gynecological conditions (n = 15) and surgery for EP (n = 16). Quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemistry were used to determine FT PROK/PROKR messenger RNA (mRNA) expression and protein localization, respectively. The PROK/PROKR levels were measured in tubal explant cultures stimulated with estrogen (E) and progestogen. Differential expression of PROK and PROKR. The FT PROK2 and PROKR1 mRNA levels were up-regulated during the P-dominant midluteal phase of the menstrual cycle. Increased PROKR1 expression was observed in tubal explant cultures treated with medroxy-progesterone acetate (MPA). The PROK and PROKR proteins were localized to the epithelium and smooth muscle layers of the FT. The PROKR1 and PROKR2 mRNA levels were lower in FT from women with EP compared with nonpregnant FT from the midluteal phase. These data suggest a potential role for PROKs in FT function. The PROKs are known to affect smooth muscle contraction in the gut. Dysregulated PROK expression in FT could affect FT smooth muscle contractility and embryo-tubal transport, providing a potential cause for EP.

Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: Results from a prospective multicentric study in Italy

Objective We conducted a cross-sectional study on the frequency and risk factors for adenomyosis in women who underwent hysterectomy for benign gynecological conditions. Study design All women who consecutively underwent hysterectomy during the study period for benign gynecological conditions at 18 gynecological departments were eligible for the study. A total of 820 women entered the study. Pathological data were collected prospectically. Results Adenomyosis was identified in 231 women (28.2%, 95% confidence interval, CI, 24.6–32.5). The frequency of adenomyosis was similar in women with indication for surgery fibroids/menorrhagia (143 cases, 28.5%) or genital prolapse (69 cases, 28.2%). The rate ratio (RR) of adenomyosis was 1.9 (95% CI 1.2–2.8) in women reporting one or more induced abortions, in comparison with those reporting no induced abortion. Women with adenomyosis reported more frequently dysmenorrhoea and chronic pelvic pain, but not dyspareunia. Conclusions This study shows that adenomyosis is common in women who undergo hysterectomy and that it is more frequent among women reporting induced abortions dysmenorrhoea and chronic pelvic pain.

Trends in the Safety of Inpatient Hysterectomy for Benign Conditions in California, 1991–2004

The introduction of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign uterine conditions and its increasing use during the 1990s coincided with a dramatic decrease in the incidence of total abdominal hysterectomy (TAH). The aim of this study was to assess the effects of this marked shift in hysterectomy technique on inpatient safety and to analyze the complications associated over time with increasing use of inpatient LAVH. Data was obtained from the California Patient Discharge Database for the years 1991 to 2004 for 649,758 women age 20 years and older undergoing inpatient hysterectomy for nonmalignant and nonobstetric indications. The incidence and complication rates for LAVH, TAH, vaginal hysterectomy (VH), and subtotal hysterectomy (SAH) were compared. Multiple logistic regression models analyzed factors contributing to the risk of medical and surgical complications. During the study period, there was a substantial decrease in the incidence of any type of inpatient hysterectomy for benign conditions (P < .001). TAH decreased 38.8% (P < .001). The rates of LAVH and STH increased 10-fold and 17-fold, respectively. The median length of hospital stay for each type of hysterectomy also decreased. The odds of the medical and surgical complications of each type of hysterectomy decreased during the study period (P < .001). Older age, African-American race, and the presence of comorbidities were associated with increased odds of complications. There was a simultaneous reduction in TAH rates and increase in SAH rates. As surgeons became experienced with LAVH, there was a steep decline in the LAVH-to-laparotomy conversion rates (conversion rates: 61% in 1991; 24% in 1992; 4.5% in 2004). These data show substantial reductions in the both incidence of inpatient hysterectomy for benign gynecological conditions and the odds of complications in California between 1991 and 2004.