Cases Of Total Abdominal Hysterectomy Research Articles

Evaluation of Various Indications of Total Abdominal Hysterectomy in Holy Family Red Crescent Medical College Hospital for Last 20 Months

Background: Total Abdominal Hysterectomy (TAH) is a common surgical procedure for treating various gynecological conditions. This study aims to evaluate the demographic characteristics, comorbidities, and clinical indications for TAH at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh. Methods: This retrospective study included all TAH cases performed from January 2018 to August 2019. Data on patient age, comorbidities (hypertension and diabetes), and indications for TAH were collected from hospital records. Descriptive statistics were used to analyze the data. Results: A total of 320 TAH cases were reviewed. The most common age group was 41-50 years (43.13%), followed by patients aged ≤40 years (31.56%). Hypertension was present in 36.25% of the patients, and diabetes was observed in 30.94%. The most frequent indication for TAH was fibroid uterus (55.63%), followed by adenomyosis (18.75%) and post-menopausal bleeding (14.38%). Other indications included ovarian cysts (5.63%), endometrial hyperplasia (5.00%), and pelvic mass (6.25%). Conclusion: The findings highlight uterine fibroids, adenomyosis, and post-menopausal bleeding as the primary indications for TAH, with a significant prevalence of hypertension and diabetes among the patients. Effective management strategies for these conditions and considerations of comorbidities are crucial in optimizing surgical outcomes. Further research into minimally invasive techniques may enhance patient care in gynecological surgery.

Audit of all cases of total abdominal hysterectomy (TAH) at a private hospital in Enugu, Nigeria: Indications and post-operative outcomes

Background: Hysterectomy is a major and one of the commonest gynaecological procedures performed by gynaecologists, world over. It is the surgical removal of the uterus either through the vagina or an abdominal incision. Being such a major procedure in gynaecological practice with consequences on reproduction and sexual performance, we undertook this audit in the private hospital to review its prevalence, indication and outcomes. Aim: The aim of this study was to review the indications and outcomes of all cases of TAH in a private hospital Methodology: This was a 3-year retrospective study in a private hospital in Enugu, south-east, Nigeria. Result: From the theatre register and case files of patients, it was found that a total of 58 patients had major gynaecological surgeries in the centre. Out of this total, 20 were TAH giving a prevalence of 34.5% of major gynaecological surgeries. The socio-demographic distribution of the patients shows that 12(60%) were aged between 46 and 55, 10(50%) were civil servants and 10(50%) had tertiary education. Majority of them 8(40%) were para 4, followed by para3 (20%). The major indications were symptomatic uterine fibroid, 9(45%) and abnormal uterine bleeding 8(40%). Conclusion: Total abdominal hysterectomy was a common gynaecological procedure and the major indications were symptomatic uterine fibroids and abnormal uterine bleeding. Majority of the cases were done with spinal anaesthesia and the only identifiable post-operative morbidity was anaemia.

Comparison of total laparoscopic hysterectomy and total abdominal hysterectomy cases

Amaç: Amacımız, benign endikasyonlarda yapılan total laparoskopik histerektomi ve total abdominal histerektomi operasyonlarının sonuçlarını literatür eşliğinde retrospektif olarak karşılaştırmaktır. Gereç ve Yöntem: Antalya Serik Devlet Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde Temmuz 2015 ve Ekim 2020 yılları arasında benign endikasyonlarda total histerektomi uygulanan 240 hastanın kayıtları literatür eşliğinde retrospektif olarak incelendi. Yaş aralığı 40-75 idi. Vakaların 120‘si total laparoskopik histerektomi (TLH Grup1) ve 120‘si total abdominal histerektomi (TAH Grup2) olarak sınıflandırıldı. Malignitesi olanlar, sezaryen sonrası histerektomiler, supraservikal histerektomi, laparoskopik asiste vajinal histerektomi, vajinal histerektomi yapılanlar ve kayıtları eksik olanlar çalışma dışı bırakıldı. Hastalardan operasyon öncesi yazılı onam formu alındı. Hastaların ortalama yaşı, parite, vücut kitle indeksi, çıkarılan ortalama uterus ağırlığı, geçirilmiş batın cerrahisi öyküsü, histerektomi endikasyonları, operasyon süresi, komplikasyon oranları, kan kaybı miktarı, post operatif hastanede yatış süresi iki grup arasında karşılaştırıldı. Bulgular: İki grup arasında demografik özellikler açısından, istatiksel olarak anlamlı fark yoktu. İki grupta da en sık saptanan endikasyonlar, fibromiyom ve tedaviye dirençli anormal uterin kanamaydı. grup 1’de ortalama ameliyat süresi grup 2 ye göre daha uzun olup istatiksel açıdan anlamlı bulundu. grup 1’de ortalama hastanede kalma süresi daha kısa saptandı ve istatiksel açıdan anlamlı bulundu. Operasyonla çıkarılan ortalama uterus ağırlığı grup 2 de daha ağır saptandı. Sonuç: Laparoskopik histerektomi, seçilmiş hastalar için operasyon süresinin daha uzun olması ve tecrübe gerektirmesi ile birlikte güvenli ve uygun bir minimal invaziv cerrahi işlemdir. Daha çabuk iyileşme, daha erken taburcu olma, daha az kan kaybı avantajı vardır.

Study of indications of hysterectomy among benign gynaecology cases

Objective: Prospective observational study of indications of hysterectomy and postoperative complications was done among benign gynaecology cases attending the outpatient department of Obstetrics and Gynaecology, Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, UP, India. Materials and Methods: Those women attending the outpatient department of Obstetrics and Gynaecology, Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, UP, India who had hysterectomy done were given questionnaire to fill or member of health care team filled questionnaires on their behalf if they were illiterate. The study duration was from July 2011 to June 2016. We included only those patients in whom hysterectomy was done at less than 30 years of age and total abdominal hysterectomy was done. Patients were asked regarding indication of hysterectomy, their understanding of their illness, postoperative recovery and current problem. Results: Total of 45 women gave information about their hysterectomy and their current health and they were all married. The 25-30 years age women were 93% in this observational study, 84% were from low socioeconomic status. In our questionnaire survey 71% of cases of Total Abdominal Hysterectomy (TAH) was done for the complaint of vaginal discharge. These women disliked the wetness of their undergarments (even if mild); they thought it as a harbinger of some severe illness. Fibroid was second most common cause (15%) in our group followed by heavy menstrual bleeding, then abdominal pain and prolapse. The most important observation of this study is presenting complain of the patients in this study. It is remarkable that 71% of women were operated for persistent vaginal discharge, while in 51% it was persisting at the time of presentation. When they were examined they had physiological discharge from the vaginal wall. 8% patients had persistent granuloma, which was causing post coital bleeding and discharge, and was treated. 15 % patients complained

Pre- and Postoperative Evaluation of Operated Myoma Uteri Patients: a 5-Year Tertiary Care Experience

Introduction: This study aims to evaluate the pre- and postoperative outcomes of myomas operated in a tertiary clinic.
 Method: We retrospectively evaluated data from a total of 378 cases operated for myomas between January 2014 and December 2018 in the Dicle University Medical Faculty Obstetrics and Gynecology Clinic. 
 Results: There were 169 cases of abdominal myomectomy (44.7%), 156 cases of total abdominal hysterectomy (41.3%), 15 cases of laparoscopic myomectomy (4%), 13 cases of total laparoscopic hysterectomy (3.4%), 12 cases of myomectomy during cesarean delivery (3.2%), 9 cases of hysteroscopic myomectomy (2.4%), and 4 cases of vaginal myomectomy (1.1%). Pathology results revealed 341 cases of leiomyoma (88.2%), 32 cases of concomitant leiomyoma and adenomyosis (8.4%), and 13 cases of STUMP (3.3%). There were 5 cases of intraoperative bowel injury, 1 case of bladder injury, and 1 case of postoperative wound infection.
 Conclusion: Myomas can be surgically treated with satisfactory outcomes and low complication rates. The preferred surgical treatment will majorly depend on the patient's fertility expectations.

Intrauterine Manipulator Use During Minimally Invasive Hysterectomy and Risk of Lymphovascular Space Invasion in Endometrial Cancer.

This study aimed to examine an association between intrauterine manipulator (IUM) use and frequency of lymphovascular space invasion (LVSI) in women with endometrial cancer undergoing minimally invasive hysterectomy. A retrospective case-control study was conducted among stage I-IV endometrial cancer patients who underwent hysterectomy between 2008 and 2015. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics. Women who underwent total laparoscopic hysterectomy (TLH) with IUM use were compared with women who underwent total abdominal hysterectomy (TAH). Review of archived medical record for data collection and propensity score matching were performed to adjust for background differences between TLH-IUM and TAH groups. A systematic literature review with pooled analysis was performed to examine frequency of LVSI. There were 687 women who underwent hysterectomy for endometrial cancer. Of those, 419 women underwent TLH with IUM use and 194 women underwent TAH. The most common type of IUM was VCare (89.5%). There was no statistically significant difference in the frequency of LVSI between the 2 groups: 15.1% for TLH-IUM vs 19.9% for TAH (P = 0.14). After propensity score matching, frequencies of LVSI were similar between the 2 groups: 21.2% for TLH-IUM vs 19.6% for TAH (P = 0.78). Systematic literature review identified 1371 cases of TLH-IUM and 1246 cases of TAH performed for endometrial cancer, and frequencies of LVSI were similar between the 2 groups (15.0% vs 13.6%, P = 0.31). Our study suggests that IUM use during TLH for endometrial cancer is not associated with increased frequency of LVSI.

Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery.

Objective:To examine variables associated with hysterectomy-related complications, relative to surgical approach and other variables, that lead to readmission within 90 days of surgery.Methods:We conducted an observational cohort study for which data were extracted from electronic health records. Data were extracted of all patients (n = 3106) who underwent hysterectomies at 10 Kaiser Permanente Southern California medical centers between June 2010 and September 2011. Patients who were pregnant or had a cancer diagnosis were excluded from the study. To identify univariate associations between examined variables and procedure type, chi-square tests for categorical variables and t-tests or analysis of variance for continuous variables were used. Generalized estimating equations methods were used to test associations between independent variables and primary outcomes of interest. Statistical significance was determined using a p-value <.05.Results:Of 3106 patients, 109 experienced 168 post-operative complications. The most common post-operative complications were related to pelvic abscesses, bowel obstruction, or severe ileus, and the vaginal cuff. Pelvic abscesses were most frequent among total laparoscopic hysterectomy and total abdominal hysterectomy cases (p = .002), and vaginal cuff complications were most frequent among total laparoscopic hysterectomy cases (p = .015). Patients who underwent total vaginal hysterectomy (odds ratio = 2.13, confidence interval = 1.15–3.92), laparoscopic supracervical hysterectomy (odds ratio = 3.11, confidence interval = 1.13–8.57), and total laparoscopic hysterectomy (odds ratio = 5.60, confidence interval = 2.90–10.79) experienced increased occurrence of post-operative complications resulting in readmission. Other variables associated with an increased risk for readmission included high estimated blood loss (201–300 mL and 301+ mL, relative to 0–50 mL; odds ratio = 2.28, confidence interval = 1.24–4.18 and odds ratio = 2.63, confidence interval = 1.67–4.14) and long length of stay of 3 days or more (relative to 0 days; odds ratio = 2.93, confidence interval = 1.28–6.69). Pelvic specimen weight in the 151–300 g and 501+ g ranges appeared protective (odds ratio = 0.40, confidence interval = 0.25–0.64 and odds ratio = 0.54, confidence interval = 0.33–0.90). In a sub-analysis of 1294 patients, 74 hospital operative complications directly related to hysterectomy were identified among 59 patients. The most common hospital operative complications were excessive bleeding associated with surgery or injury to nearby structures. Among the sub-sample of 1294 patients, those with hospital operative complications were more likely to experience post-operative complications that lead to readmission (odds ratio = 3.82, confidence interval = 1.55–9.43, p = .004).Conclusion:The observed increased risk of complications among patients of Black race, who underwent laparoscopic supracervical hysterectomy or total laparoscopic hysterectomy, who experienced more than 300 mL surgical blood loss, who suffered hospital operative complications, and those whose hospitalization was 3 days or greater, offers an opportunity for higher scrutiny and preventive measures during usual hysterectomy care to prevent later readmission.

Secondary hemorrhage after different modes of hysterectomy

Secondary hemorrhage after hysterectomy is rare but a life-threatening complication. The aim of this study is to estimate the cumulative incidence, patient characteristics, and potential risk factors of secondary hemorrhage after abdominal, vaginal, and laparoscopic hysterectomies. We did a retrospective observational study in which 1,623 cases of total laparoscopic hysterectomy (TLH), 963 cases of total abdominal hysterectomy (TAH), and 1,171 cases of vaginal hysterectomy (VH) were analyzed. Of the total 37 hemorrhages following hysterectomies, 23 were after TLH, 8 following VH, and 6 were after TAH. The cumulative incidence of secondary hemorrhage after any type of total hysterectomies was 0.98 %. TLH was associated with the highest risk of secondary hemorrhage (1.51 %) followed by VH (0.68 %) and TAH group (0.62 %). The relative risk of secondary hemorrhage following TLH compared to TAH and VH were 2.3 and 2.1, respectively. Both were statistically significant. The average size of the uterus in the TLH group was 516.7 g, and in the TAH and VH group, it was 140 and 142.5 g, respectively, which was statistically significant. The median time interval between hysterectomy and secondary hemorrhage was 11 days in TAH and VH group and 13 days in TLH group. Our data suggest that secondary hemorrhage is rare but may occur more often after TLH than after other hysterectomy approaches. Whether it is related to the application of thermal energy to tissues which cause more tissue necrosis and devascularization than sharp colpotomies in the TAH and VH groups is unclear. Large size of uteri, excessive use of energy source for uterine artery, and colpotomy may play a role.

MELF invasion in endometrial cancer as a risk factor for lymph node metastasis

To investigate whether the microcystic, elongated and fragmented (MELF) pattern of myometrial invasion encountered in certain endometrioid endometrial carcinomas can be considered as a risk factor for lymph node metastasis. A total of 351 cases of total abdominal hysterectomy and bilateral salpingo-oophorectomy with/without lymphadenectomy or lymph node sampling, performed for endometrioid endometrial adenocarcinoma, were included in this study. The existence of MELF invasion, vascular invasion, fibromyxoid stromal reaction and lymph node metastasis were recorded. Immunohistochemistry for endothelial and epithelial markers was performed on selected cases. MELF invasion was identified in 20 (10.81%) and 13 cases (13.13%) treated without and with lymphadenectomy, respectively. All these cases were either well or moderately differentiated carcinomas, stages IA-II (without considering lymph node status). Positive lymph nodes were detected in seven of 13 MELF-positive (53.84%) and six of 86 MELF-negative cases (6.97%) This observation was statistically significant. Of the seven MELF-positive tumours with lymph node metastasis, three cases exhibited intravascular tumour emboli while four showed a fibromyxoid stromal reaction. MELF pattern invasion was found to be related statistically to lymph node metastasis. Nevertheless, further studies are needed in order to evaluate the clinical significance of this observation.

Morbidity of total abdominal hysterectomy at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Total abdominal hysterectomy is a commonly performed gyneacological procedure. Although it is safe, it can still be associated with development of complication. The aim of this study was to determine morbidity associated with total abdominal hysterectomy in our environment. All cases of total abdominal hysterectomy done over a five-year period (January 2003-December 2006) at the University of Maiduguri Teaching Hospital (UMTH) were reviewed. Information was obtained from the patients' case notes, gynaecology ward, and theatre records. The complications of the procedure were determined. Multiple logistic regression was used to find the factors that were independently associated with development of complications. During the study there were 101 cases of total abdominal hysterectomy out of 729 gynaecological operations, a rate of 13.8%. In majority of the cases 56 (68.3%) the indication of the hysterectomy was uterine fibroid (symptomatic). Overall 37 (45.1%) experience some form of complication out of which 26 (70.3%) was febrile morbidity Finding enlarged uterus intraoperatively {OR (95% CI) = 14.5 (1.84-114.6), p = 0.011}, blood transfusion {OR (95% CI) = 31.1(1.35-718.8), p = 0.032}and postoperative PCV < 30% {OR (95%CI) = 9.63 (1.14-81.3) p = 0.037} were found to be significantly associated with development of complication. conclusions: Total abdominal hysterectomy was associated with development of complications and enlarged uterus, increasing parity independent risk factors for development of the complication.

The clinical analysis of eighty cases of laparoscopic classic intrafascial SEMM hysterectomy

目的 探讨腹腔镜鞘膜内全子宫切除术的实用价值.方法将2000年5月至2004年8月我院进行的腹腔镜鞘膜内全子宫切除(CISH)80例与同期术前临床状况相似的常规全子宫切除术(TAH)80例比较.结果 CISH组手术时间比TAH组稍长,但出血明显少于TAH组,术后并发症、平均术后住院日、1～6个月随访结果明显优于TAH组,CISH全过程在腹腔镜下完成,具有创伤小、痛苦轻、并发症少、术后恢复快、并保留器官功能的优点.结论 CISH是一种较理想的子宫切除术,值得临床推广应用。

Abdominal hysterectomy for the enlarged myomatous uterus compared with vaginal hysterectomy with morcellation

Objective The purpose of this study was to compare intraoperative and postoperative complications of abdominal hysterectomy for the enlarged, myomatous uterus with vaginal hysterectomy with morcellation. Study design Medical records of 139 patients who underwent vaginal hysterectomy with morcellation and 244 patients who underwent total abdominal hysterectomy for an enlarged, myomatous uterus between August 1990 and July 2001 were reviewed. Uterine weights of >982 g were excluded because this was the largest uterus removed vaginally, which left 208 evaluable cases of total abdominal hysterectomy. The perioperative and postoperative course of the two groups was compared. The Student t test was used for continuous variables, and the Fisher exact test was used for binary or categoric data. Results There were no significant differences between the two groups in surgical or anesthetic risk factors ( P > .05). Operative time was similar between the groups ( P > .05). Length of hospital stay was increased significantly with total abdominal hysterectomy (mean, 3.9 days vs 2.6 days; P<.001). Perioperative complications were increased with the abdominal route (10% vs 25%, P<.001). Conclusion In this large series, uterine morcellation at the time of vaginal hysterectomy is safe and facilitates the removal of moderately enlarged and well-supported uteri and is associated with decreased hospital stay and perioperative morbidity rate compared with the abdominal route.

The use of the harmonic scalpel to reduce morbidity during open total abdominal hysterectomies with bilateral salpingo-oophorectomy (TAH/BSO)

Purpose The ultrasonic scalpel (USS) is a hemostatic surgical instrument used for incising and dissecting tissues. It works by using ultrasonic waves to denature collagen forming a coagulum. This study was designed to examine the effectiveness of the ultrasonic scalpel in open total abdominal hysterectomies with bilateral salpingo-oophrectomies. Methods This study was a nonrandomized study, with 16 cases of total abdominal hysterectomy with bilateral salpingo-oophorectomy being done with the ultrasonic scalpel, and 21 cases being done with the traditional methods of dissection and ligation. The 2 groups were compared in terms of intraoperative blood loss, time, and cost, as well as in terms of postoperative complication and length of stay. Results Demographically, no significant differences in age or weight existed among the patients in the 2 operative groups. (p = 0.71, p = 0.64, respectively). A statistically significant reduction did occur in the estimated blood loss with the use of the harmonic scalpel (p = 0.05). No significant differences existed between the 2 patient groups in terms of operative time (p = 0.77), intraoperative costs (p = 0.11), or length of hospital stay (p = 0.45). However, 52% of the patients in the traditional method group suffered from postoperative complications that included acute myocardial infarction (N = 1), ileus (N = 5), urinary retention (N = 1), urinary incontinence (N = 1), respiratory failure (N = 1), and failure to thrive (N = 1). Only 25% of the patients undergoing the USS resection suffered from complications. These complications included urinary retention (N = 2), respiratory failure (N = 1), and ileus (N = 1). Conclusion A statistically significant reduction occurred in estimated blood loss with the use of the USS (p < 0.05). There is also decreased intraoperative time, as well as decreased postoperative complications and length of stay in this same group; however, these differences were not statistically significant. Also, more complications are reported in the traditional resection group (62% compared with 31%). It would be beneficial to accrue a higher patient population and study the use of the USS in this procedure as well as other open abdominal procedures.

Utilization Review of Laparoscopic Assisted Vaginal Hysterectomy and Strategies for Cost Reduction in a Canadian Model

The costs of laparoscopic assisted vaginal hysterectomy (LAVH) were analyzed and compared with total abdominal hysterectomy (TAH) procedures in the same fiscal period (April 1993 to March 1994). The analysis of Case Mix Group (CMG) 580®* and the reference to a peer comparator, among the surgeons performing LAVH, led to the calculation of potential cost savings. Furthermore, an assessment of the cost effect of converting selected cases from TAH to LAVH was undertaken.We examined such factors as the existence of comorbidities and/or compilations, average length of stay, average variable direct cost per case, and projected cost variance. Analyzing these key components enabled us to formulate cost saving opportunities. The analysis showed that ward nursing and the disposable kits are the major costs associated with LAVH. The conversion of selected TAH cases to LAVH would, at present, save hospital days but would result in increased expenses. It is important, however, to examine not only the institutional costs of a surgical procedure but also to consider the societal benefits. A short period of hospitalization and rapid recuperation are only two of the patient benefits associated with LAVH.