Total Abdominal Hysterectomy Patients Research Articles

Comparison of the Female Sexual Function Index, Beck Depression Inventory, and Patient Satisfaction Scale in Patients Undergoing Total Abdominal Hysterectomy and Single-Port Laparoscopic Hysterectomy for Benign Conditions

Aim: The uterus is widely accepted as a sexual organ, children-making body, secretory organ, youth, charm, or power supply by women. By hysterectomy, psychosocial problems such as fear of losing sexual identity occur, and depression may arise as a result of this. In this study, we investigated the effects of surgery on female sexual function and psychosocial situation according to the methods of Total Abdominal Hysterectomy (TAH) and Single Port Laparoscopic Hysterectomy (SPLH). Method: This prospective surgical study included 60 patients, including 30 SPLH and 30 TAH patients with benign reasons. The demographic data of patients, Female Sexual Function Inventory (FSFI) score, Beck Depression Questionnaire Scale, and Patient Evaluation Measurement (PEM) results were all assessed according to TAH and SPLH methods. Results: In the FSFI questionnaire, significant differences were found between SPLH and TAH groups for all "desire frequency," "desire level," "stimulation frequency," "stimulation level," and "stimulation trust" subquestions (p=0.004, p=0.0001, p=0.003, p=0.011 and p=0.011, respectively). In the Beck depression questionnaire, the TAH score (4.4±3.25) was significantly higher than the SPLH score (2.77±2.97) (p:0.047). TAH had 7.97±3.6 points, and SPLH had 3.73±1.1 points regarding treatment results (p:0.00017). Similarly, TAH had 14±4.4 points, while SPLH had 6.1±1.3 points regarding the functionality of hysterectomy (p

Comparison Of Ketorolac Versus Ibuprofen For Postoperative Pain Management In Total Abdominal Hystrectomy Surgeries

Background - Postoperative pain management is crucial for ensuring patient comfort and promoting faster recovery. Pharmacological interventions, such as NSAIDs, play an essential role in reducing pain intensity while minimizing opioid-related side effects. Ketorolac, a potent NSAID, and ibuprofen are both commonly used for pain relief. This study focuses on comparing the efficacy of these two drugs for pain management in total abdominal hysterectomy surgeries. Aim -To assess and compare the effects of intravenous ketorolac and intravenous ibuprofen on postoperative pain management in total abdominal hysterectomy patients. Materials and Methods: A randomized single-blind study was conducted on 30 patients, divided into two groups (Group K: ketorolac, Group I: ibuprofen). Various parameters, including VAS pain scores, sedation, time for rescue analgesia, and the number of rescue analgesics, were compared. Participants: 30 patients undergoing total abdominal hysterectomy, randomized into two groups (Group K: ketorolac, Group I: ibuprofen). Inclusion Criteria: Patients between 18 and 65 years of age undergoing elective surgery, ASA grade I or II. Exclusion Criteria: Patients with NSAID hypersensitivity, coagulation disorders, bronchial asthma, hepatic or renal failure, and peptic ulcers. Methodology: Patients received lumbar subarachnoid block, followed by either 30 mg of ketorolac or 800 mg of ibuprofen postoperatively. Rescue analgesics were provided if needed. Results: The postoperative pain scores were significantly lower in the ibuprofen group. Time for first rescue analgesia and the total number of rescue analgesics required were also lower in the ibuprofen group

Nursing process for post total abdominal hysterectomy patients in the gynecology service of a hospital in Arequipa

Myomas are benign smooth muscle tumors of the uterus, whose main sign is bleeding. The objective was to manage the nursing care process in a post total abdominal hysterectomy patient. The study had a qualitative approach, single case type, the methodology was the nursing care process, which included 40-year-old patient, in which all stages of the nursing care process were followed: the assessment stage, was performed through the assessment framework of the 11 functional patterns of Maryori Gordon, 10 altered patterns were found, prioritizing three: infection risk criterion, convenience and comfort, education diagnosis and adaptation improvement, the diagnostic stage was elaborated based on NANDA I taxonomy II, ten nursing diagnoses were identified, prioritizing three of them: risk of operative wound infection, acute pain and anxiety, according to the SSPFR format (signs and symptoms, problem, related factor/risk factor/associated to); likewise the planning stage was carried out taking into account the Taxonomy NOC, NIC, in the execution stage the care was administered, and the evaluation was given by the difference of final and baseline scores respectively. In the results, a score of +1, +1, +1 change was obtained. In conclusion, the nursing care process was managed in the patient which allowed providing quality care to the patient

Dexmedetomidine vs Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomies.

In the postoperative period, open total abdominal hysterectomy (TAH) surgeries induce considerable pain. Multimodal strategies are being used to alleviate pain. This study aimed to examine the efficacy and safety of dexamethasone and dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided transversus abdominis plane (TAP) blocks for postoperative pain in TAH patients. A total of 72 patients with ASA grade I and grade II were randomly and equally assigned to two groups. After the completion of surgery with a subarachnoid block (SAB), patients in group 1 received a mixture of 20 mL of 0.25% levobupivacaine and 4 mg of dexamethasone on each side of the TAP block. Patients in group 2 received a mixture of 20 mL of 0.25% levobupivacaine and dexmedetomidine, with a total dose of 1 µg/kg body weight evenly distributed bilaterally in the TAP block. Patients were evaluated for pain using the Visual Analog Scale (VAS), total tramadol consumption as rescue analgesia, time to first rescue analgesia, any adverse effects, and patient satisfaction. When comparing VAS scores for pain assessment, we observed that the mean VAS score was initially comparable between the two groups for the first hour. However, at 6, 9, and 12 h, VAS scores were significantly lower in group 2. The mean total tramadol consumption was higher in group 1 than in group 2 (213.33 ± 44.08 vs 161.11 ± 37.93 mg, P-value 0.027). The time to the first rescue analgesia after the TAP block in the postoperative period was significantly longer in group 2 (47.5 ± 62.76 vs 77.22 ± 56.14 min, P-value 0.002). No significant side effects were noted, and a greater proportion of patients in group 2 expressed satisfaction with their overall pain treatment. The addition of dexmedetomidine to levobupivacaine is superior to the addition of dexamethasone, as it prolongs the duration of the block in the dexmedetomidine group. However, the use of dexamethasone as an adjuvant is a good alternative option, particularly due to its lower cost and reduced incidence of adverse effects such as postoperative nausea and vomiting.

COMPARISON OF PERCUTANEOUS AND INTRAABDOMINAL BLOCKADES OF ILIOHYPOGASTRIC AND ILIOINGUINAL NERVES FOR POSTOPERATIVE PAIN MANAGEMENT OF TOTAL ABDOMINAL HYSTERECTOMY PATIENTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Study Objective: In this study we aimed to determine whether iliohypogastric and ilioinguinal nerve blockade from intraabdominal approach for the postoperative pain management of total abdominal hysterectomy patients could be a reliable and effective alternative compared to percutaneous block of IHII nerves.
 Design: This study is a randomised controlled double blind prospective clinical trial. 
 Setting: This study was conducted in operating room, and recordings were performed in postoperative recovery unit and gynaecology clinic.
 Patients: Eighty seven women undergoing total abdominal hysterectomy were enrolled in this study but 82 completed the study. Patients were divided into three groups (n=29 in each), as control group (group C), percutaneous IHII block group (group PB) and intraabdominal IHII block group (group IB). 
 Interventions: Group C patients received no block procedure. The percutaneous bilateral IHII nerves block was performed after abdominal closure to group PB and intraabdominal IHII block was performed before abdominal closure to group IB. 
 Measurements: Mean arterial pressure, heart rate, pain scores, satisfaction scores, morphine consumptions and side effects were recorded at the 2nd, 6th, 12th and 24th postoperative hours.
 Main Results: Postoperative MAP, HR results of control group were found similar in all groups. VAS scores at all postoperative hours were found to be significantly lower in the block groups PB an IB than control group. There were no significant differences in pain scores between group PB and IB at any time point. Morphine consumption data were found to be significantly lower in the PB and IB groups than in the control group.
 Conclusions: Intraabdominal IHII blockade just before closure of the abdomen for relieving postoperative pain in total abdominal hysterectomy patients is as effective and safe method as conventional percutaneous IHII blockade without adverse effects.

BUPIVACAINE WITH MAGNESIUM SULPHATE VS BUPIVACAINE ALONE IN TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN TOTALABDOMINAL HYSTERECTOMY PATIENTS: A RANDOMISED CONTROL TRIAL.

Background: Postoperative (PO) pain relief following major surgeries had been a challenging task. Adequate pain control is essential for early mobilisation and wellbeing of surgical patients. Incidence of PO pain following abdominal surgeries is higher when transverse lower abdominal incisions are done as in Total Abdominal Hysterectomy (TAH). Performing Transversus Abdominis Plane (TAP) block reduces the PO pain. Various adjuvants like clonidine, epinephrine and magnesium sulphate have been added to local anaesthetics to prolong the duration of TAPblock. The aim of this study was to investigate the effects of adding MgSO4 as an adjuvant to bupivacaine in TAP block for PO analgesia in patients undergoing TAH under spinal anaesthesia. Methods: 100 patients belonging to ASA1 or 2 scheduled for TAH under Sub Arachnoid Block (SAB) were randomly assigned into two groups- BM and B. All patients were given SAB with 15 mg of 0.5% hyperbaric Bupivacaine and TAH was done. USG guided TAPblock was given once SAB sensory level regressed to T8 dermatome. Group BM received 16ml 0.25% Bupivacaine (40mg) with 150 mg magnesium sulphate injected on each side while Group B received 16 ml 0.25% Bupivacaine only. Patients were asked to rate their pain on a 10 cm VAS scale at time 0 (time of completion of TAPblock),2,4,6,12 and 24 hours. Rescue analgesia with Inj. morphine was provided whenever VAS score was > 3. Results: Patients in magnesium sulphate group had prolonged analgesia as compared to the control group. The heart rate and blood pressure response were signicantly lower in that group. Morphine requirement for PO analgesia was also signicantly reduced in group BM. No complications were seen in either group. Conclusion: Adding Magnesium sulphate to Bupivacaine in TAP block in TAH patients prolonged the duration of PO analgesia.

Preemptive Ketamine in Abdominal Hysterectomy Patients, Does the Route of Administration Affect Analgesia and Hemodynamics? A Prospective Randomized Controlled Trial

Introduction: Hysterectomy is a common procedure and postoperative pain is a considerable problem. Preemptive analgesia includes analgesic administration prior to surgical stimulus. Ketamine is a short acting anesthetic drug with analgesic and anti-inflammatory properties, reducing central sensitization of pain pathway and hyperalgesia. Objectives: This study aimed to assess the efficacy of preemptive use of ketamine as an analgesic drug, either by intravenous route or by subcutaneous infiltration at the incisional site, regarding perioperative hemodynamics, postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 60 patients were enrolled in this study, divided into two equal groups (30 each) according to route of preemptive ketamine administration. Group (V) received 0.5 mg.kg-1 intravenously while group (S) received 0.5 mg.kg-1 subcutaneously at incisional site. Postoperative pain assessment for 24 H. using visual analogue score (VAS) was adapted as primary outcome objective, while secondary outcomes included hemodynamic parameter and postoperative nausea and vomiting (PONV). Results: Data were analysed. VAS score showed significant difference among studied groups in early 2 postoperative hours. VAS0 (V 2.40±0.62, S 1.96±0.92, P 0.038), VAS1 (V 3.96±1.21, S 2.86±0.89, P 0.001), VAS2 (V 4.00±0.94, S 3.33±0.88, P 0.007). Also, first time to pethidine intake (V 1.50±0.93 H, S 2.36±1.27 H, P 0.004). Other study objectives were comparable. Conclusion: Preemptive use of ketamine with subcutaneous infiltration at incisional site in total abdominal hysterectomy patients provided better analgesia in early postoperative hours rather than intravenous route with comparable hemodynamic parameter and side effects.

Effectiveness of Transversus Abdominis Plane Block as part of a Multimodal Analgesia to Reduce Opioid Consumption among Total Abdominal Hysterectomy Patients: A Randomized Control Trial

Background:Generally patients after total abdominal hysterectomy have suffered from moderate tosevere postoperative pain. Multimodal approach are using to reduce this pain. Objective:The purpose of the present study was to observe the effectiveness of transversus abdominisplane block as part of amultimodal analgesia to reduce opioid consumption among total hysterectomypatients. Methodology:This randomized control trial was conducted in Department of Anaesthesia, Analgesia,Palliative and Intensive Care Medicine of Dhaka Medical College and Hospital, Dhaka, Bangladeshfrom March 2016 to September 2018 for a period two years and six months. Women planned for anelective total abdominal hysterectomy under general anesthesia were selected as study population.Participants were selected and randomly divided into two groups designed as group I and group II.Patient of both group were given general anesthesia. Group I patient received 20 ml 0.25% bupivacaineand group II patient received 20 ml normal saline as placebo. Then dressing was done. The TAP blockwas performed after taking all aseptic precaution in the flank palpated between the 12th rib (Costalmargin) and the iliac crest. After confirmation of correct position, 20 ml 0.25% bupivacaine was given togroup I patient and 20 ml normal saline was given to group II patient within the fascial layer whichwas confirmed by ultrasound. Result:A total number of 40 patients were recruited for this study and were equally divided into twogroups. Thus 20 patients were in the group I and the rest 20 patients were in group II. The mean age ofgroup I were 53.08 ±4.25 and group II were 51.5±4.97 (p= 0.286).In this study 5(25.0%) patients hadnausea in group I and 8(40.0%) in group II, 3(15%) patients had vomiting in group I and 4(20.0%) ingroup II (p>0.05). The mean first analgesic demand was 8.39±1.85 hours in group I and 1.59±0.21 hoursin Group II (p=0.001).The mean total morphine consumption was 14.78±3.56 in group I and 26.30±5.9in group II (p<0.05). Conclusion:TAP block effectively reduced the total postoperative morphine consumption. JBSA 2020; 33(1): 16-21

Comparison of TAP block with Bupivacaine and Magnesium as an adjunct to bupivacaine in total abdominal hysterectomy patients

Comparison of TAP block with Bupivacaine and Magnesium as an adjunct to bupivacaine in total abdominal hysterectomy patients

A Comparison of Patient-Controlled Analgesia with Oxycodone and Morphine After Total Abdominal Hysterectomy Surgery

We compared the analgesic profile between patient-controlled analgesia (PCA) using oxycodone and morphine in post total abdominal hysterectomy patients. Eighty-four ASA I or II patients, aged 18 to 65 years who underwent total abdominal hysterectomy were recruited into this prospective, double blind, randomised controlled study. They were randomised to receive either PCA oxycodone 0.7 mg per bolus or PCA morphine 1 mg per bolus for postoperative pain relief. At the end of surgery, all patients received IV morphine 0.1 mg/kg and skin incision was infiltrated with 20 mls of bupivacaine 0.25%. Post-operative pain scores, opioids consumptions, sedation scores and side effects were assessed upon arrival and at 30 minutes after arrival to recovery area, as well as at 6 hours and 24 hours after the operation in the ward. Patients’ overall satisfaction was also assessed 24 hours postoperatively.No significant differences were observed in terms of postoperative pain scores, opioids consumption, sedation scores, side effects as well as patient’s overall satisfaction between the PCA oxycodone and PCA morphine group. Oxycodone was comparable to morphine as PCA in terms of total opioid consumption, pain scores and satisfaction level for patients undergoing total abdominal hysterectomy and therefore may be an alternative to morphine in postoperative pain management as PCA.

Comparison of cost-effectivenes and clinical outcomes of abdominal, vaginal and total laparoscopic hysterectomy in a selected group

Objective: The aim was to compare the perioperative and postoperative outcomes of total laparoscopic hysterectomy(TLH), total abdominal hysterectomy(TAH), and vaginal hysterectomy(VH) in a selected group of patients.Materials and Methods: Two hundred twenty-three hysterectomies were included in this study. The patients were separated into three groups. Group1 included patients with TLH(n=63); TAH patients were placed in Group 2(n=133), and Group 3 was made up of patients who underwent VH(n=37). All three groups had similar ages, parities, and uterine sizes. The main outcome measures were operation time, fever, need for analgesia, duration of hospital survellience, return to work time, perioperative and postoperative complications, the number of blood transfusions, and costs of the surgery.Results: The total operation time was the shortest in the VH group. There was no significant difference in the hospital survellience duration between the three groups. The VH was found to be the cheapest type of hysterectomy. When the VH group was compared with the TLH group, there was no difference in the use of analgesics for postoperative pain or the time return to work. The VH group patients required more blood transfusions in contrast with the TAH(p=0.001) and TLH groups(p<0.001). Conclusion: VH had similar operative and postoperative outcomes but the shortest duration of operation and the lowest surgical cost compared with the other two techniques.

Risk factors for surgical site infection after hysterectomy.

The aim of the study was to define the clinical and laboratory characteristics of patients who had surgical site infection (SSI) after hysterectomy. This study was a retrospective cohort study. The patient data of 840 subjects who had undergone any type of hysterectomy and reported SSI after surgery were obtained from the archives of a tertiary referral center. The different types of hysterectomy procedures performed on these patients included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH), and vaginal hysterectomy (VH). In addition, age, body mass index (BMI), preoperative and postoperative blood parameters, gravidity, and parity were also documented. TAH, LH, and VH were performed on 63.2% (n = 531), 21.6% (n = 181), and 15.2% (n = 128) of patients, respectively. Overall, SSIs were observed in 3.7% (n = 31) of all hysterectomy patients. Among them, 4.5% of TAH patients, 1.7% of LH patients, and 3.1% of VH patients had SSIs after the hysterectomy operation. Analysis of the data revealed that the patients with SSIs had significantly higher BMIs, lower preoperative hemoglobin, lower postoperative hemoglobin and hematocrit, and higher postoperative platelet counts compared to patients who did not have any SSIs. High BMI, blood loss during surgery, low hematocrit levels, and resulting anemia increased the incidence of SSI after hysterectomy. Among the different types of hysterectomy, LH was found to be relatively better than TAH and VH in preventing the occurrence of SSI.

A novel approach of iliohypogastric and ilioinguinal nerve block for postoperative pain management of total abdominal hysterectomy patients: a randomized controlled clinical trial

Duger, C.; Isbir, A. C.; Kol, Ozdemir I.; Kaygusuz, K.; Gursoy, S.; Mimaroglu, C. Author Information

Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer Treated by Open versus Laparoscopic Surgery: Results from the Randomised LACE Trial

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n = 353) or TLH (n = 407) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, P < 0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%, P = 0.09), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%, P < 0.0001), 6–14 days (35% versus 15%, P < 0.0001), and 15–60 days (15% versus 9%, P = 0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, P < 0.0001) and four weeks (0.89 versus 0.63, P = 0.01) following surgery. Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.

Laparoscopic Versus Abdominal Hysterectomy for Endometrial Cancer

To compare the demographics, cancer characteristics, and hospital outcomes of endometrial cancer patients undergoing a laparoscopically assisted vaginal hysterectomy (LAVH) versus a total abdominal hysterectomy (TAH). Two California population databases (Office of Statewide Health Planning and Development and the California Cancer Registry) were linked using patient identifiers. Patients who underwent endometrial cancer surgery from 1997 to 2001 were identified. The combined database was queried for type of surgery, patient demographics, hospital outcomes, comorbidities, and cancer characteristics. Statistical analyses included the t test, chi2 test, and logistic regression. In this study, 978 endometrial cancer patients (7.7%) had an LAVH and 11,765 (92.3%) had a TAH. The mean ages for the 2 groups were 63.3 and 64.8 years, respectively. Lymphadenectomy was performed more frequently in LAVH patients compared with TAH patients (45.6 vs 41.1%; P = 0.006). Patients undergoing LAVH were more likely to be younger and healthier and have stage I or grade 1 disease (P < 0.0001). Total abdominal hysterectomy patients were more likely to have significant medical comorbidities. Mean length of stay for LAVH was 2.40 versus 4.36 days for TAH (P < 0.001), but mean hospital charges were comparable. Perioperative complications such as vascular and bowel injuries, pulmonary embolism, wound problems, and transfusions were significantly more common in TAH patients. Surgeons seem to carefully select endometrial cancer patients for laparoscopic surgery. Although surgical staging was performed in less than 50% of endometrial cancer patients, the rate was not worse in laparoscopic procedures. Short-term hospital complications were less common in the laparoscopy group.

Pretreatment with Lornoxicam, a Cyclooxygenase Inhibitor, Relieves Postoperative Immuno-Suppression after Total Abdominal Hysterectomy

Total abdominal hysterectomy (TAH) is most commonly performed for benign lesions and malignant diseases of the uterus. Postoperative immuno-suppression caused by TAH has become a serious clinical problem, due to the high incidence of infectious complications after this operation. Lornoxicam (LOR) is a member of non-steroidal anti-inflammatory drugs and a cyclooxygenase inhibitor. In this study, 45 patients undergoing TAH for uterine myoma were enrolled and given intravenous injection of normal saline (untreated patients) or LOR (8 or 16 mg) preoperatively (15 patients/group). We studied the effects of LOR on postoperative immuno-suppression by determining the serum levels of three cytokines, RANTES, monocyte chemotactic protein-1 (MCP-1), and stromal cell-derived factor 1alpha (SDF-1alpha). MCP-1 and RANTES are involved in the pathophysiology of acute and chronic inflammatory processes, and SDF-1alpha is considered as an inflammatory chemoattractant. Following TAH, the serum levels of RANTES were reduced in the untreated patients, but were significantly higher in the patients treated with LOR. In addition, the levels of MCP-1 and SDF-1alpha were significantly elevated in the untreated patients, but were significantly lower in the patients treated with LOR. Furthermore, preoperative treatment with LOR 16 mg could regulate the serum levels of these three chemokines more effectively, compared to that with LOR 8 mg. In conclusion, preoperatively intravenous injection of LOR may effectively restrain the decreased serum levels of RANTES and the increased expression of MCP-1 and SDF-1alpha in TAH patients. LOR may help to maintain the stability of immune function of TAH patients.

Improving the Analgesic Efficacy of Intrathecal Morphine with Parecoxib After Total Abdominal Hysterectomy

The addition of parecoxib to intrathecal morphine and bupivacaine may improve analgesia and reduce morphine's opioid-related side effects. In this prospective, double-blind, randomized, placebo-controlled trial, total abdominal hysterectomy patients received either IV normal saline or parecoxib 40 mg before receiving intrathecal bupivacaine and morphine 0.2 mg. Twelve hours later, this administration was repeated. Patients were observed for 48 h. The addition of parecoxib to intrathecal morphine and bupivacaine significantly reduced cumulative morphine consumption, Visual Analog Pain scores, and increased patient satisfaction for 24 h postoperatively without an obvious decrease of adverse side effects. Perioperative parecoxib enhanced the postoperative analgesia of intrathecal morphine and bupivacaine and improved patient satisfaction.

Patterns of Gastrointestinal Recovery after Bowel Resection and Total Abdominal Hysterectomy: Pooled Results from the Placebo Arms of Alvimopan Phase III North American Clinical Trials

Postoperative ileus (POI), a transient cessation of coordinated bowel motility, occurs to some extent after all major abdominal operations. This analysis examines gastrointestinal (GI) recovery and hospital discharge history in patients undergoing partial bowel resection (BR) or total abdominal hysterectomy (TAH) by laparotomy in the placebo arms of recent phase III alvimopan trials. This was a pooled post hoc analysis of placebo groups from randomized, double-blind, parallel-group, multicenter trials. All patients were uniformly managed with a standardized accelerated postoperative care pathway to facilitate GI recovery. Of the 727 BR patients and 140 TAH patients included in this analysis, POI as an adverse event was reported in approximately 14.7% of BR patients and 2.9% of TAH patients, and postoperative nasogastric tube insertion was required in 11.5% of BR patients and 0.8% of TAH patients. Time to first toleration of solid food was almost 2 days longer for BR patients than for TAH patients (BR, 4.1 days; TAH, 2.5 days). Approximately 34.4% of BR patients and 4.2% of TAH patients had discharge orders written 7 days or more after operation. Nearly half (40%) of patients undergoing TAH were discharged from the hospital before GI recovery was complete. Mean postoperative lengths of hospital stay after BR and TAH were 6.6 days and 3.4 days, respectively. Despite the relatively fast recovery observed with standardized accelerated postoperative care pathway use, POI as an adverse event was still reported in approximately 15% of BR patients and 3% of TAH patients. This analysis provides important clinical insight into the differences in GI recovery patterns and the incidence and impact of POI after BR and TAH.

Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in endometrial cancer

Objective To see whether laparoscopy provides exact staging and effective treatment of endometrial cancer patients, compared with total abdominal hysterectomy, with shorter hospital stay, prompter recovery, and better quality of life. Method This retrospective study identified 110 patients scheduled for surgery for early-stage endometrial cancer. Fifty-five (50%) were treated by laparoscopic-assisted vaginal hysterectomy (LAVH) and 55 (50%) by total abdominal hysterectomy (TAH). All patients underwent pelvic lymphadenectomy. The majority of patients (79%) had stage I disease. Results The mean number of lymph nodes removed was 17 for the LAVH group and 18.5 for the TAH group ( p = 0.294). Compared with TAH, LAVH required a significantly longer operating time (220 vs. 175 min; p < 0.01); but shorter hospital stay (4 vs. 8.5 days; p < 0.001) and less estimated blood loss (177 cm 3 vs. 285 cm 3; p = 0.02). Overall, there were fewer post-operative complications in the LAVH group (6 vs. 11 cases; p < 0.001). Three TAH patients (5.4%) had recurrence of disease. No LAVH patients had recurrences and all are currently disease-free. Conclusion These findings suggest LAVH gives correct staging of endometrial disease, like TAH, but with fewer complications and a slightly longer operating time.

Supracervical hysterectomy versus total abdominal hysterectomy: perceived effects on sexual function.

BackgroundOur investigation sought to compare changes in sexual function following supracervical hysterectomy (SCH) and total abdominal hysterectomy (TAH).MethodsA retrospective chart review was performed to identify all patients who underwent supracervical hysterectomy or total abdominal hysterectomy at a tertiary care center. Patients who met criteria for participation were sent a one page confidential, anonymous questionnaire to assess sexual function experienced both pre- and postoperatively. A total of 69 patients in each group were eligible for participation. A multiple logistic regression model was used to analyze measured variables.ResultsForty-eight percent (n = 33) of women undergoing a SCH returned the questionnaire, while 39% (n = 27) of those undergoing a TAH chose to participate. There were no significant demographic differences between the two groups. Patients who underwent TAH reported worse postoperative sexual outcome than SCH patients with respect to intercourse frequency, orgasm frequency and overall sexual satisfaction (P = 0.01, 0.03, and 0.03, respectively). Irrespective of type of hysterectomy, 35% of patients who underwent bilateral salpingoophorectomy (BSO) with hysterectomy experienced worse overall sexual satisfaction compared to 3% of patients who underwent hysterectomy alone (P = 0.02).ConclusionsOur data suggest that TAH patients experienced worse postoperative sexual function than SCH patients with respect to intercourse frequency and overall sexual satisfaction. Irrespective of type of hysterectomy, patients who underwent bilateral salpingoophorectomy experienced worse overall sexual satisfaction.