Hysterectomy Procedures Research Articles

Comparison of Abdominal and Vaginal Hysterectomy: A Comparative Clinical Study at A Tertiary Hospital of Southern Part of Bangladesh

Background: Hysterectomy is indicated in several common gynecologic problems and is one of the commonly performed operations in many hospitals of Bangladesh. Though Hysterectomy is a reasonably safe operative procedure but at times minor to major complications may occur. Current study was undertaken to compare the feasibility and safety of abdominal hysterectomy (AH) and vaginal hysterectomy (VH) procedures in the treatment of benign uterine diseases, and to determine the outcomes of both procedures. Objectives: To compare outcomes of vaginal and abdominal hysterectomy procedures in women with benign gynaecological diseases. Materials and Methods: This was a prospective study of outcomes of consecutive patients who underwent AH or VH for benign gynaecological diseases. Patient characteristics before, during, and after the operations were reviewed. Patients were followed up for three months to evaluate postoperative complications. Results: This study included a total of 305 patients. 199 patients underwent AH and 106 patients underwent VH. Baseline characteristics were similar between the two groups. Mean operative time was 95.78±18.46 minutes for AH group and 76.26±19.24 minutes for VH group (p<0.006). Mean hospital stay was 5.32±0.67 days for AH group and 4.08±0.19 days for VH group with p-value <0.047. There was a significant lesser total operation cost in VH group than AH group (VH: 12058±386 BDT, AH: 14275±276 BDT; P < 0.05). Furthermore there was no wound infection; paralytic ileus and no need to reopening any patient in case of VH group compared to AH group. Conclusion: This study showed that vaginal hysterectomy was associated with less intraoperative complications and postoperative morbidities and complications as compared to abdominal hysterectomy. KYAMC Journal Volume: 15, No: 01, April 2024: 40-45.

Tumeurs mésenchymateuses utérines associées à translocation : du nouveau sans oublier l’ancien. Une approche diagnostique intégrée

This review focuses on uterine mesenchymal tumors that are defined on a molecular level by a single and unique genetic alteration, that is somehow necessary and sufficient to allow tumor growth and progression. Although diverse from a clinical, morphological and immunohistochemical point of view, the different entities we are going to talk about share both a simple genomic profile with a low number of chromosomal alterations observed by CGH Array (few deletions, gains or amplifications...) and a low mutational burden observed by sequencing technics. Some of these entities are already well known and described in the literature when found outside of the uterus and gynecological tract. It remains intriguing that uterine mesenchymal pathology has been lagging behind when compared to its extrauterine counterpart. How can we explain that when it comes to inflammatory myofibroblastic tumors, abundant numbers of articles have been published since the 70's, but it was only in the early 2000s that the first relevant descriptions of this tumor in the uterus emerged? Certainly, the increased accuracy, availability, and use of molecular biology technics and in particular RNA sequencing in the area of uterine pathology can partly explain the reduction of the gap between soft tissue and uterine pathology we currently observe. Other reasons explaining this gap may be the high prevalence of smooth muscle tumors in the uterus and the abounding diversity of their morphological aspects, which may have partly eclipsed the array of differential diagnoses. Last but not least, one can hypothesize that the relative "simplicity" of hysterectomy procedures, referring to their safety and accessibility, has cured most of the lesions and partly clouded our knowledge regarding the biological potential and natural history of these newly described entities. As a consequence of this situation, our reader will often encounter the wording "uncertain malignant potential", as for some of these rare entities, evidence to establish reliable prognostic variables is still insufficient. We hope this review to be a useful tool to guide pathologists through the diversity and complexity of uterine mesenchymal tumors. As a scientific and medical community, sharing this knowledge will help us to collectively raise our vigilance and awareness by expanding the array of our differential diagnoses. We hope this will lead to more cases being accurately diagnosed, and ultimately, to a deeper knowledge regarding the biological potential and clinical evolution of these tumors. From a therapeutical point of view, the consequences of an accurate diagnosis for the patient are already appreciable through the use of targeted therapy. Examples include: ALK inhibitors in inflammatory myofibroblastic tumor, tyrosine-kinase inhibitors in COL1A::PDGFB rearranged sarcomas or mTOR inhibitors in PEComa.

All-cause 30-day mortality associated with hysterectomy in Sweden from 2015 to 2021 using data from the Swedish perioperative register

ObjectiveHysterectomy is one of the most common gynaecological procedures. All-cause mortality within 30 days is an important indicator of care quality.The primary objectives of this quality project were to study all-cause 30-day mortality following hysterectomy in Sweden and the impact of age, ASA class, and malignant indication on outcomes. Population and methodsAll hysterectomy procedures documented in the Swedish Perioperative Register (SPOR) were included from 2015 to 01-01 until 2021-12-31. Patient demographics and perioperative observations were collected and analysed. Main outcome measureAll-cause 30-day mortality. ResultsThe study cohort consisted of 25,391 patients with a mean age of 55.0 ± 13.8, and 54 % of patients were ASA I-II. All-cause 30-day mortality was low: only 1 patient died within the first 24 h, and 23 deaths were noted within 30 days among 25,391 procedures studied; equal to a perioperative mortality rate (POMR) 0.09 %. Higher age, higher ASA class, malignant indication, and combined general and neuraxial anaesthesia increased numerical POMR. Elderly (>65-years) and ASA III-IV were associated with significant increased un- and adjusted Odds Ratio for death within 30-days at 4.3 (95%CI 1.3–14.3, p = 0.02) and 15.3 (95%CI 4.8–84.4, p = 0.001) respectively. ConclusionsAll-cause 30-day mortality associated with hysterectomy in Sweden during recent years is low with a POMR of 0.09 %. Higher age and more pronounced higher ASA class increased the odds ratio for all-cause 30-day mortality. Further efforts to optimise the perioperative care of elderly and frail patients are important.

LeFort Colpocleisis: Unmet Expectations about Correction of Urinary Symptoms Are Related to Disappointment and Regret

ABSTRACT Introduction and Hypothesis: The aims of this study were to define long-term anatomic outcome, satisfaction rate, and reasons for disappointment and regret in a group of patients with advanced pelvic organ prolapse who underwent LeFort colpocleisis (LFC). Materials and Methods: This was a retrospective, single-center, cohort study including consecutive patients who underwent LFC from 2007 to 2021. All patients had surgery involving vaginal hysterectomy and anti-incontinence procedure where clinically indicated. All patients were examined 3 months after surgery. A cross-sectional telephone survey was performed in 2022 using the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), and Patient Global Impression of Change (PGI-C) questionnaires, as well as the Decision Regret Scale. Student’s t-test, Fisher’s Chi-square test, and univariable logistic regression analysis were carried out. Results: One hundred and forty-one patients (mean age 74.95 ± 6.25 years) were included. The mean preoperative POP Quantification C/D point was +6 (±2.7). In 86 (60.99%) patients, a hysterectomy and in 56 (39.71%), a mid-urethral synthetic sling was performed. At 3-month follow-up, there was one prolapse recurrence (0.71%) and no case of regret of sexual function loss. In the long term, 28 patients died, and 69 patients were interviewed through telephone (follow-up 61.65 months). The mean PGI-S, PGI-I, and PGI-C scores were 1.42 (±0.81), 1.93 (±1.45), and 5.91 (±1.69) respectively, and no patient declared regret about vaginal intercourse loss. Preoperative and postoperative persistent or de novo mixed UI appeared to be related to decreased satisfaction and regret post-LFC (P = 0.0021). Conclusion: LFC is a valuable, easy-to-perform technique with long-lasting results and decreased postoperative anti-incontinence rates. However, de novo or persistent urinary incontinence appears to be related to decreased satisfaction rates.

Chronic Uterine Inversion in a Young Adult: Case Report

Background: Uterine inversion is a rare but serious complication wherein the uterus is partially or completely turned inside out. It can either be acute or chronic. Unlike acute uterine inversion which occurs as a complication during parturition, which can be promptly managed, chronic uterine inversion poses a diagnostic difficulty even for an experienced gynecologist. We, herein, report a patient who was managed and followed up at our institution for chronic uterine inversion. Case presentation: A 30-year-old female, P4L4 previous all vaginally delivered, presented with complaints of something coming out of her vagina, per vaginal bleeding and foul-smelling discharge. On Physical examination, the patient was severely anaemic and revealed a bleeding, necrotic mass on inspection and the entrance of the cervix felt high up on per speculum and per vaginal examination. The patient was diagnosed as having chronic uterine inversion. The patient was admitted and was made hemodynamically stable with intravenous fluids and three units of blood. Manual reduction using vaginal procedure to reposition the uterus wasn’t successful, hence she was taken up for surgery. Fibroid was resected vaginally. Then Haultain rectification procedure was performed and then the definitive procedure of hysterectomy was done. Postoperatively, the patient was kept under observation and was vitally stable. Histopathology reported leiomyoma. Conclusion: Though non-puerperal uterine inversion is rare, a few cases will still have to be managed without any previous experience. This differential has to be considered as a possibility in a non-pregnant woman presenting with bleeding or mass per vagina with or without hypotension and can very rarely present as postmenopausal bleeding. Irrespective of age or parity, pre-operatively or intra-operatively, associated malignancy is to be ruled out in every case of uterine inversion. The prognosis depends on prompt diagnosis and timely intervention. Keywords: Fibroid, chronic, non-puerperal, uterus, inversion.

A Meta-analysis of the Efficacy of Different Surgical Methods in the Treatment of Uterine Prolapse.

The management of uterine prolapse poses a significant clinical challenge, with surgical intervention often necessary for symptom relief and restoration of pelvic floor function. However, the optimal surgical approach for uterine prolapse remains uncertain, prompting a comprehensive meta-analysis to compare the efficacy of various surgical methods. This study aims to assess the effectiveness of different surgical methods for treating uterine prolapse. We used computer search to retrieve relevant literature to compare the therapeutic effects of different surgical methods for treating uterine prolapse. The search was conducted in the Web of Science and PubMed databases, and articles published until October 2023 were obtained. We employed random effects and fixed effects models and performed a meta-analysis using the R software. This study included 40 standard papers covering 25,896 patients with uterine prolapse. We used random and fixed effects models to conduct a meta-analysis of hysterectomy and uterine fixation procedures. The findings indicated that different surgical approaches had no significant impact on surgical success rates (I2 = 69%, p < 0.01; risk ratio (RR) (95% confidence intervals (CI)): 1.00 [0.98; 1.03]) or postoperative adverse reactions (I2 = 54%, p < 0.01; RR (95% CI), 1.10 [0.83; 1.45]). However, the durations of the surgical procedure for hysterectomy (I2 = 91%, p < 0.01; standardized mean difference (SMD) (95% CI), 0.78 [0.49; 1.07]), surgical blood loss (I2 = 97%, p < 0.01, SMD (95% CI): 1.14 [0.21; 2.07]), and intraoperative adverse reactions (I2 = 0%, p = 0.61, RR (95% CI): 1.37 [1.10; 1.71]) were statistically significant between hysterectomy and uterine fixation procedures. Additionally, publication bias and sensitivity tests showed no publication bias in this meta-analysis and no literature causing significant sensitivity. In the treatment of uterine prolapse, both hysterectomy and uterine fixation are similar in terms of surgical success rates and postoperative adverse reactions. However, hysterectomy is associated with longer duration of the surgical procedure, increased blood loss and higher incidence of intraoperative adverse reactions compared to uterine fixation.

A randomised trial comparing preoperative administration of single-dose kefazolin to kefazolin plus metronidazole as prophylactic antibiotics at caesarean section.

Caesarean section is a life-saving procedure which is associated with high rates of maternal and neonatal complications. It has been estimated that globally, 29.7 million births occur by caesarean section annually. The risk of postpartum infection is estimated to be five to ten times higher compared with normal vaginal delivery. Pregnancy-related sepsis was listed as a top-six cause of maternal mortality in the South African Saving Mothers report between 2017 and 2019. Multiple trials have been conducted in an attempt to optimise administration of prophylactic antibiotics in an effort to reduce postpartum infection and maternal sepsis, and current practice guidelines suggest that there is sufficient evidence that extended-spectrum antibiotics, in combination with kefazolin, result in reduction of postpartum infections. To investigate the effect of perioperative administration of kefazolin alone compared with kefazolin plus metronidazole on postpartum infection in women undergoing caesarean section at Kalafong Provincial Tertiary Hospital, Pretoria, South Africa. All patients undergoing emergency or elective caesarean section were randomised and then sequentially numbered in opaque sealed envelopes, which were placed in the caesarean section operating theatre. The intervention group received kefazolin and a sealed envelope with metronidazole. The control group received kefazolin and a sealed envelope with normal saline. A total of 57/1 010 patients (5.64%) had surgical site infections, of which 27 (5.33%) were in the control group, and 30 (5.96%) were in the intervention group (p=0.66). Two patients in each arm (0.40% in the intervention arm and 0.39% in the control arm) underwent laparotomy procedures, while three women (0.60%) in the intervention arm and four women (0.79%) in the control arm underwent hysterectomy procedures. There were no statistically significant differences in all the measured secondary outcomes between the two groups. The overall sepsis rate in this study was 5.64%. Postpartum infection is multifactorial and there are multiple factors that can be addressed in strengthening the sepsis care bundle. We do not recommend the addition of metronidazole to kefazolin as prophylaxis at caesarean section.

Early online.

Caesarean section is a life-saving procedure which is associated with high rates of maternal and neonatal complications. It has been estimated that globally, 29.7 million births occur by caesarean section annually. The risk of postpartum infection is estimated to be five to ten times higher compared to normal vaginal delivery. Pregnancy-related sepsis was listed as a top six cause of maternal mortality in the South African Saving Mothers report between 2017 and 2019. Multiple trials have been conducted in an attempt to optimise administration of prophylactic antibiotics in an effort to reduce postpartum infection and maternal sepsis, and current practice guidelines suggest that there is sufficient evidence that extended spectrum antibiotics, in combination with kefazolin, result in reduction of postpartum infections Objectives. To investigate the effect of perioperative administration of kefazolin alone compared to kefazolin plus metronidazole on postpartum infection in women undergoing caesarean section at Kalafong Provincial Tertiary Hospital. All patients undergoing emergency or elective caesarean section were randomised and then sequentially numbered in opaque sealed envelopes, which were placed in the caesarean section operating theatre. The intervention group received kefazolin and a sealed envelope with metronidazole. The control group received kefazolin and a sealed envelope with normal saline. A total of 57/1 010 patients (5.64%) had surgical site infections, of which 27 (5.33%) were in the control group, and 30 (5.96%) were in the intervention group (p=0.66). Two patients in each arm (0.40% in the intervention arm and 0.39% in the control arm) underwent laparotomy procedures, while three women (0.60%) in the intervention arm and four women (0.79%) in the control arm underwent hysterectomy procedures. There were no statistically significant differences in all the measured secondary outcomes between the two groups. The overall sepsis rate in this study was 5.64%. Postpartum infection is multifactorial and there are multiple factors that can be addressed in strengthening the sepsis care bundle. We do not recommend the addition of metronidazole to kefazolin as prophylaxis at caesarean section.

Retroperitoneal Müllerian Cyst Found Incidentally During Total Laparoscopic Hysterectomy: Is There a Role for MRI in Pre-Operative Evaluation?

Retroperitoneal cysts of Müllerian origin are rare and often discovered incidentally during surgical procedures or imaging studies. We present a case of a retroperitoneal cyst found during a total laparoscopic hysterectomy performed for myoma removal. A 40-year-old female presented with symptomatic myomas and underwent pre-operative evaluation, including pelvic ultrasound, which revealed no abnormalities apart from the myomas. A cyst was incidentally discovered in the retroperitoneal space during a total laparoscopic hysterectomy procedure. The cyst was excised and sent for histological examination, which confirmed its Müllerian origin. Retroperitoneal cysts of Müllerian origin are rare findings during TLH. This case report highlights the importance of thorough pre-operative evaluation and imaging studies and the significance of intraoperative awareness in identifying incidental findings. Further research is warranted to determine the optimal diagnostic imaging strategies for such cysts.

Analyzing the Efficacy of Metronidazole as Additional Surgical Site Infection Prophylaxis in Patients Undergoing Hysterectomy [ID 2683482

INTRODUCTION: The American College of Obstetricians and Gynecologists recommends cefazolin for antibiotic surgical prophylaxis for hysterectomy procedures. In 2018, hysterectomy surgical site infection (SSI) data at John Peter Smith Hospital demonstrated a higher proportion of anaerobic growth identified on cultures. The addition of metronidazole with cefazolin became surgical prophylaxis protocol at our institution. The purpose of the study is to compare rates of non-superficial SSI before and after the addition of metronidazole in hysterectomy procedures. METHODS: This was a retrospective cohort study of patients who underwent hysterectomy of any surgical approach from January 2015 to July 2023. The primary exposure of interest was administration of metronidazole with additional covariates including age, body mass index, diabetes, oncology status, and wound class. The association between metronidazole administration and non-superficial SSI was examined using a logistic regression model. Appropriate waiver was received from the institutional IRB. RESULTS: Two thousand five hundred thirty-four hysterectomies were included in our cohort. 1,207 (44%) cases had metronidazole administration, with 98% of those cases occurring after the antibiotic was incorporated into the protocol. Of the patients who did not receive metronidazole, 49 (3.7%) patients had a non-superficial SSI compared to 14 (1.2%) patients that had a non-superficial SSI with metronidazole administration. After adjusting for age and oncology status, patients who did not receive metronidazole had higher odds of having a SSI compared those who did (adjusted odds ratio [aOR]: 3.6; 95% CI: 1.97, 6.3; P≤.0001). CONCLUSION: The results demonstrate potential infection prevention benefit with metronidazole to patients undergoing hysterectomy, supporting the institutional prophylaxis protocol. The findings could have further implications across hospitals with similar patient populations.

Assessing the Effectiveness of a Unique Visual Aid in Improving Women's Knowledge of the Hysterectomy Procedure [ID 2683416

INTRODUCTION: This study aims to determine the efficacy of a visual aid in improving women's knowledge of the hysterectomy procedure. Currently, there is a lack of literature that examines evidence-based hysterectomy patient education, and a recent literature review stated that there is a deficit in education surrounding the different hysterectomy treatment options. METHODS: This is IRB study #Pro2021000882. Patients were recruited from the Department of Obstetrics, Gynecology &amp; Reproductive Health at the Ambulatory Care Center at University Hospital in Newark, New Jersey. Participants consented and patient information was de-identified. Participants completed a 28-question pre-test, watched the visual aid in either English or Spanish, and then completed the same 28-question post-test. For both English- and Spanish-speaking participants, the percentage of participants who answered each pre- and post-test question correctly was calculated. Finally, average pre-test scores were compared to average post-test scores for each language. RESULTS: After watching the video, average test scores of English-speaking (N=30) participants increased by 19.76 (95% CI: 10.9, 28.6) percentage points, whereas Spanish-speaking (N=20) participants increased by 28.93 (95% CI: 19.7, 38.1) percentage points. From the 28-question knowledge test, there were 15 questions in the English version and 23 questions in the Spanish version where the percent of respondents who answered that question correctly after watching the video improved by 20 percentage points or greater compared to before watching the video. CONCLUSION: Our preliminary data provide evidence that the hysterectomy visual aid/video we created significantly improves knowledge of the hysterectomy procedure as measured by a validated hysterectomy knowledge quiz.

Optimizing Hysterectomy: A Prospective Comparative Analysis of Surgical Techniques and Their Impact on Women's Lives.

To investigate diverse hysterectomy techniques to determine their influence on patient outcomes, including pain levels, sexual function, anxiety, and quality of life. Of particular focus is the comparison between vessel sealing and traditional suturing in abdominal, vaginal, and laparoscopic hysterectomies. This study is unique in its comprehensive evaluation, considering patient satisfaction, recommendation rates, recovery times, and various other aspects. Our prospective cohort study adhered to ethical guidelines, involving a meticulous assessment of patients, including medical history, anxiety levels, pelvic pain, sexual function, and quality of life. Surgical methods were explained to patients, allowing them to actively participate in the decision-making process. Sociodemographic information was collected, and exclusion criteria were applied. Hysterectomy methods included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and a modified vaginal technique known as VH Mujas. Several parameters were recorded, including operation indications, uterine volume, hospital stay, operation duration, pre-operative and post-operative complications, and more. In all groups, a statistically significant increase was found in pre-operative-post-operative FSFI sexual function values (p < 0.001). The patient's basal Beck Anxiety Scale scores significantly decreased following the decision for vaginal surgery, both in the VH and VH Mujas groups (p < 0.05). However, Beck Anxiety Scale scores at patients' initial assessments significantly increased following the decision for abdominal and laparoscopic surgery (p < 0.001). According to the results of the SF-36 quality of life assessment, an increase was observed in all post-operative quality of life parameters in patients who underwent surgery with different methods due to VH (p < 0.05). Our comprehensive comparison of hysterectomy techniques demonstrated that VH, particularly when utilizing the Mujas technique, outperforms other hysterectomy methods regarding patient safety and post-operative satisfaction but also offers the benefit of minimal invasiveness. Notably, this is reflected in improved quality of life, enhanced sexual function, lower pain scores, and favorable cosmetic results. The success of a hysterectomy procedure depends on precise indications, surgical planning, proper patient selection, and effective communication. This study emphasizes the significance of these factors in achieving optimal outcomes. The development of specialized vascular closure devices can further enhance the feasibility of vaginal hysterectomy, making it a preferable choice in gynecological surgery. The study contributes valuable insights into selecting the most suitable hysterectomy method for patients and optimizing their recovery.

Abstract WP284: Assessment of Stroke Risk Following Hysterectomy: A Meta Analysis of Prospective Studies

Background: Hysterectomy is one of the most prevalent gynecological procedures in the United States. The risk of stroke following hysterectomy remains unclear. While some studies suggest a possible increase in stroke risk, others have shown inconsistent results. Aim: This meta-analysis aims to evaluate the risk of stroke following hysterectomy procedures. Methods: We systematically searched PubMed, Embase and Google Scholar to identify studies that evaluated the occurrence of stroke in hysterectomized patients using database-specific queries via combination of controlled vocabulary from the earliest available data to July, 2023. HRs (hazard ratios) and 95% CI were extracted from the included studies. The analysis was conducted using R (4.3.1). Extracted hazard ratios were log transformed, including their confidence intervals. The combined effect size was computed using the inverse variance pooling method. The random-effects models were utilized to assess the overall effect. I2 statistic evaluated the statistical heterogeneity, and the DerSimonian-Laird estimator quantified the between-study variance. Results: A total of 6 cohort studies were included, which evaluated the risk of stroke with a total of 772707 patients, out of which 138188 patients (17.88%) underwent hysterectomy procedures. The pooled aHR of hysterectomised patients was 1.21 (95% CI: 1.05-1.40; p &amp;lt 0.01). Significant heterogeneity was noted in the outcome (I2 = 82%). 2 studies that reported the data for each stroke subtype yielded a pooled aHR 0.98 (95% CI: 0.89-1.09; I2 = 67%; p = 0.08) for hemorrhagic stroke while a pooled aHR = 0.98; 95% CI: 0.89-1.20; I2 = 0%; p = 0.66) for ischemic stroke. Conclusion: Our analysis reveals an elevated stroke risk post-hysterectomy. While more prospective studies are required to strengthen the evidence for the same, this meta-analysis underscores monitoring for stroke risk factors in hysterectomised patients.

Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery: A systematic review and meta-analysis.

Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned. To provide up-to-date evidence by examining only studies investigating techniques currently in use for POP repair. MEDLINE and Embase databases were searched from inception to January 2023. We included randomized and non-randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded. A random effect meta-analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI). Thirty-eight studies were included. Hysterectomy and uterine-sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74-1.17), intraoperative major (OR 1.34; 95% CI 0.79-2.26) and minor (OR 1.38; 95% CI 0.79-2.4) complications, postoperative major (OR 1.42; 95% CI 0.85-2.37) and minor (OR 1.18; 95% CI 0.9-1.53) complications, and objective (OR 1.38; 95% CI 0.92-2.07) or subjective (OR 1.23; 95% CI 0.8-1.88) success. Uterine preservation was associated with a shorter operative time (-22.7 min; 95% CI -16.92 to -28.51 min), shorter hospital stay (-0.35 days, 95% CI -0.04 to -0.65 days), and less blood loss (-61.7 mL; 95% CI -31.3 to -92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups. No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors.

A Novel Approach for Conservative Management of Placenta Accreta Spectrum Disorder Cases: Experience of a Single Surgeon: PAS Disorders and Conservative Management.

Background: This study is aimed at evaluating the conservative surgical treatment of patients with placenta accreta spectrum (PAS) disorder and at presenting the experience of a single surgeon. Materials and Methods: This retrospective study included 245 patients with placenta previa accompanied by PAS disorders operated at a university hospital between June 2013 and December 2023. The diagnosis of PAS was made by a single perinatologist using a combination of transvaginal and transabdominal ultrasonography. All patients were operated with conservative surgical technique by the same surgeon. The demographic and clinical characteristics of the patients, the anesthesia and incision types used, and the details of the surgical technique were evaluated. Results: Of the patients, 165 were operated on at the scheduled time, 80 were operated on under emergency conditions, and 232 (94.69%) of them were operated on under spinal anesthesia. All patients were operated on with a Pfannenstiel incision followed by a transverse incision to the upper border of the placenta to enter into the uterus. An average of 0.52 units of red blood cells per patient was transfused to all patients. Spontaneous intra-abdominal bleeding developed in five patients, and surgical complications occurred in eight patients. No cesarean hysterectomy was performed, and no maternal mortality was detected in any of the cases. The mean time duration of surgery was 54.44 ± 11.37 (30-90) min, and the mean length of hospital stay was 1.71 ± 1.30 (1-9) days. Conclusions: We recommend this procedure as a novel technique and a robust and safe alternative to peripartum hysterectomy and other conservative surgical management procedures for cases with complete PP accompanied with PAS. This technique preserves the uterus as well as reduces blood loss, and transfusion requirement, and thus maternal morbidity and mortality in PAS cases.

Surgical management practice of pelvic organ prolapse among Ethiopian gynecologists, 2021: a descriptive study

IntroductionPelvic Organ Prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina. Surgical intervention addresses both anatomical defect and associated symptoms. The landscape of prolapse surgery has been evolving constantly over years. Emerging evidences either support or challenge existing surgical treatment options, making urogynecology a dynamic field. In Ethiopia, the surgical management of pelvic organ prolapse has transitioned from abdominal to vaginal hysterectomy, supplemented later by McCall’s culdoplasty. Disparities exist in the national uniformity of surgical approaches, linked to the establishment of Urogynecology centers in certain institutions.ObjectivesThis study was done to assess the surgical management practice of Ethiopian gynecologists on pelvic organ prolapse.MethodsA cross-sectional study encompassing all Gynecologists in Ethiopia took place between January to June 2021. Information was gathered through online Google forms crafted in English. Subsequently, the collected data underwent verification, coding, and entry into Epi info 7 before being exported to SPSS version 22 software for descriptive statistical analysis.ResultsWe reached 280 gynecologists out of the 450 practicing in the Ethiopia making 62% response rate. Anterior colporrhaphy (98.6%), vaginal hysterectomy with McCall’s cul-do-plasty (51.8%), and Posterior colporrhaphy (97.5%) were the most commonly performed surgical procedures for anterior vaginal wall prolapse, apical prolapse (uterine/cervical), and posterior vaginal wall prolapse respectively. Only 3.2% and 0.7% of the gynecologists conducted abdominal and vaginal paravaginal repair for anterior vaginal wall prolapse. Sacrospinous ligament fixation and sacrocolpopexy for apical prolapse were carried out by 32.9% and 9.3% of the gynecologists respectively. Site-specific posterior repair for posterior vaginal wall prolapse was performed only by 23.9% of the gynecologists. The main reasons mentioned not to perform paravaginal repair, sacrocolpopexy, sacrospinous ligament fixation, and site-specific posterior repair were lack of skill and lack of appropriate materials.Conclusion and recommendationMost gynecologists in Ethiopian continue to perform vaginal hysterectomy and colporrhaphy procedures for treatment of pelvic organ prolapse due primarily to lack of skill and appropriate materials to perform the alternative procedures. Implementing short term training on alternative surgical treatment options of pelvic organ prolapse with provision of suitable materials and increasing the number of urogynecologists in the country in the long run holds the potential to enhance the standard of care of women with the condition.

Maternal Risk Factors and Perinatal Outcome in Women with Abruptio Placenta

Background and objective: Abruptio placenta is a significant cause of antepartum hemorrhage associated with fetal and maternal morbidity and mortality. Our objective was to determine the maternal risk factors and subsequent fetal and maternal outcomes in women with abruption placenta. Methods: A cross-sectional study carried out at Maternity Teaching Hospital in Erbil city, Kurdistan Region, Iraq from 1st of August, 2020 until 1st of August, 2021. Sixty Women diagnosed with abruption placenta from 24 weeks of gestation and more were included. Maternal information was collected by a designed questionnaire to determine the risk factors associated with abruptio placentae and the mode of delivery with fetal and maternal outcomes. Results: Sixty pregnant women with abruptio placentae were included in the study. The main risk factors for abruption placenta were previous cesarean section, gestational hypertension, preeclampsia and smoking. The rates of stillbirth and early neonatal death were 15% and 1.7% respectively. Newborns with low birth weight were 30%. Adverse maternal outcome for those delivered by emergency cesarean section was 22.7%, and (hysterectomy or other surgical procedures) was significantly high 22.7% among women aged ? 35 years. Perinatal mortality rate was significantly high when the delivery was with both emergency cs and vaginal delivery. The Fetal mortality was low 4.8% among neonates whose weight was 2.5 Kg and above, and it was high among neonates of less than 1 Kg 83.3%. Conclusion: Abruptio placenta associated with adverse fetal and maternal outcomes. Previous Caesarian section, gestational hypertension, and smoking are the main risk factors.

Attitudes Toward Hysterectomy in Saudi Arabian Women Undergoing Evaluation for Uterovaginal Prolapse: A Cross-Sectional Study.

Hysterectomy isan effective management approach for uterovaginal prolapse. However, the decision to undergo hysterectomy is a complex matter, influenced not only by medical factors but also cultural beliefs, societal norms, and individual attitudes.In Saudi Arabia, a nation with its distinctive cultural and social norms, the understanding of women's attitudes toward hysterectomy is of utmost importance. Unfortunately, such related attitudes have not been explored. This first-ever study aimed to investigate the attitudes toward hysterectomy among Saudi Arabian women undergoing evaluation for uterovaginal prolapse, by exploring the factors influencing their decision-making process and treatment choices, with a particular focus on the potential impact of cultural beliefs and societal norms. A survey was conducted among 404 women referred for uterovaginal prolapse evaluation. The participants completed a self-administered questionnaire, which included demographic information, perceptions on hysterectomy's impact on well-being, and factors affecting decision-making. The mean ± standard deviation of participants was 51.07 ± 11.1 years. Most participants were currently married (n=327, 81%), were unemployed (n=309, 76.5%), and had an "excellent" self-rated general health status (n=138, 34%). Current prolapse management methods included Kegel exercises (n=103, 25.5%), pessary use (n=32, 8%), physical therapy (n=12, 3%), planned surgery (n=75, 18.5%), and no specific treatment (n=182, 45%). Overall, the study revealed diverse findings on the potential perceived impact of hysterectomy on different aspects of well-being. Notably, for pain symptoms, 152 participants (38%) reported potential improvement, while 123 participants (30%) predicted worsening, and 129participants (32%) anticipated no change. Moreover, the study unveiled insights into the factors influencing patients' decision-making between hysterectomy and uterine-sparing procedures. Remarkably, 97 respondents (24%) considered the doctor's opinion to be "very Important," while 91 respondents (22%) rated the impact on surgical complication risk as "very important." Furthermore, the desire to preserve all healthy organs was deemed "very important" by 106 respondents (26%). The resources of information women depended on when making a decisionto undergo hysterectomy varied and included a second opinion from another physician (n=68, 17%), social media (n=81, 20%), opinion from spouse/partner (21%), second opinion from female family members (n=99, 25%), and opinion from friends (n=70, 17%).Regarding preferences for decision-making, the responses varied substantially. Overall, 65 participants (16%) indicated a preference for their doctor to make the decision entirely, 81 participants (20%) preferred shared decision-making with their doctor, 89 participants (22%) wanted their doctor to make the decision after considering their input, 77 participants (19%) wished to make the final decision after discussing it with their doctor, and 93 participants (23%) expressed a preference for independently making the final decision. Lastly, correlations between women's responses and some demographic factors were identified. This pioneering study provides valuable insights into Saudi Arabian women's attitudes toward hysterectomy, emphasizing the need for patient-centered care and culturally sensitive approaches in managing uterovaginal prolapse.

Comparative study of tumor-free laparoscopic and open surgery in the treatment of early-stage cervical cancer.

Laparoscopic surgery for cervical cancer has the advantages of little blood loss and rapid recovery, but its therapeutic effect is still controversial. This study aims to analyze the surgical procedure and clinical efficacy of tumor-free laparoscopic radical hysterectomy without a uterine manipulator for early-stage cervical cancer, and to explore the indications of laparoscopic surgery for cervical cancer. This study was a retrospective study. The data of patients who underwent radical hysterectomy for early-stage cervical cancer admitted to Hunan Provincial Maternal and Child Health Care Hospital from July 2019 to December 2021 were collected. According to 2018 the International Federation of Gynecology and Obstetrics (FIGO) clinical staging, all patients were in IA1 with lymphovascular invasion, IA2, and IB1 stage. Among them, 45 patients underwent tumor-free laparoscopic radical hysterectomy without a uterine manipulator (laparoscopy group) and 16 patients underwent open surgery (open surgery group). Patients were followed up for 12-41 months. The differences between the 2 groups in terms of operative time, bleeding volume, extent of surgical resection, surgical complications, and prognosis were compared and analyzed. Compared to the open surgery group, the laparoscopy group had significantly shorter operation time and less intraoperative blood loss (both P<0.001). There were no significant differences between the 2 groups in terms of the length of excised uterosacral ligaments, cardinal ligaments, vagina, and the number of excised lymph nodes (all P>0.05). The incidence of postoperative complications did not differ significantly between the groups (P>0.05). No death or recurrence occurred in the 2 groups during the follow-up period. The overall survival rate and disease-free survival rate were both 100%. For early-stage cervical cancer with a diameter ≤2 cm, tumor-free laparoscopic radical hysterectomy without a uterine manipulator is safe and feasible, and the short-term outcomes is no less than that of open surgery.

A two-step approach to create and evaluate an optimization method for surgical instrument trays to reduce their environmental impact

ObjectiveThis study combines Integer Linear Programming (ILP) and carbon footprint analysis based on the Life Cycle Assessment (LCA) method to reduce the carbon footprint of surgical instrument trays and their use. Materials and methodsA case study was carried out quantifying the instrument usage during the radical hysterectomy procedure. Using LCA we modelled the carbon footprint of the instrument trays, cradle to grave. The resulting carbon footprint data were used as input for an ILP model. The ILP model aims for an environmentally optimized composition of surgical instrument trays, without influencing patient safety, and optimizes composition based on different utilization rates. ResultsInstrument usage for the radical hysterectomy procedure was 54%. The LCA showed that with 99.5% of the total carbon footprint, the use phase in which the surgical trays are cleaned and sterilized is the biggest contributor. The ILP showed that for the radical hysterectomy procedure, an annual reduction in emission of 230 kgCO2-eq (46%) can be achieved by optimizing the trays. DiscussionThe results of this study show that the carbon footprint of surgical instrument trays is mainly impacted by the surgical tray size and number of used trays. Implementing the proposed method and environmentally optimizing surgical trays requires a multidisciplinary team, including surgeons, OR scrub nurses and those who have knowledge of LCA and ILP. ConclusionA combined method of ILP and LCA is suitable to provide insights on how to optimize surgical instrument trays with the objective to reduce the carbon footprint of these trays.