Total Abdominal Hysterectomy Research Articles

Evaluation of lignocaine and dexmedetmdine infusion on recovery profile, quality of recovery and postoperative analgesia in patient undergoing total abdominal hysterectomy

Evaluation of lignocaine and dexmedetmdine infusion on recovery profile, quality of recovery and postoperative analgesia in patient undergoing total abdominal hysterectomy

From the archives of MD Anderson Cancer Center. EBV-positive fibrin-associated large B-cell lymphoma in an ovarian leiomyoma with cystic degeneration: A case report and discussion of differential diagnosis

Fibrin-associated large B-cell lymphoma (FA-LBCL) is a rare type of lymphoma usually associated with Epstein-Barr virus (EBV) infection. We report a case incidentally detected in a right ovarian mass of a 53-year-old woman. The patient presented with bloating and weight gain over 8 months. Imaging studies showed a 20.7 cm, complex right adnexal mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Macroscopic examination revealed a 25 × 18.5 × 9.5 cm predominantly cystic right ovarian mass with focal solid areas. Microscopically, most of the mass was a leiomyoma with hyaline necrosis and extensive cystic degeneration. In areas, the cyst showed focally necrotic, fibrinous material associated with small aggregates of round and atypical lymphoid cells with prominent karyorrhexis and mitotic activity These large cells were confined within the cystic spaces. Immunohistochemical analysis showed that the atypical cells were positive for CD20, CD30, CD79a and MUM1/IRF4, and were negative for CD3, CD10 and BCL6 supporting B-cell lineage. In situ hybridization for Epstein-Barr virus-encoded RNA (EBER ISH) was also positive in the atypical cells supporting the diagnosis of EBV-positive fibrin-associated large B-cell lymphoma. The patient subsequently received four cycles of chemotherapy using rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). Computed tomography (CT) scan of the neck, chest, abdomen and pelvis 5 months after the last chemotherapy cycle showed no evidence of disease. After a follow-up of 37 months, the patient is alive with no evidence of disease. This report is being used to discuss the salient features of this rare entity and its differential diagnosis.

Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial.

Effective postoperative pain management after total abdominal hysterectomy is crucial for patient recovery and satisfaction. This study compared the efficacy of the erector spinae plane block (ESPB) and quadratus lumborum block (QLB) in reducing postoperative opioid consumption and pain in patients with total abdominal hysterectomy. In this prospective, randomized controlled trial, 90 patients undergoing total abdominal hysterectomy were divided into 3 groups: ESPB, QLB, and control. The primary outcome was postoperative opioid consumption. Secondary outcomes included pain scores assessed by the visual analog scale at predetermined times and the incidence of postoperative nausea and vomiting. Statistical significance was determined using analysis of variance, the Mann-Whitney U test, and the Kruskal-Wallis test. The ESPB and QLB groups showed a significant reduction in postoperative opioid consumption compared with the control group (P < .001 for both comparisons). Pain scores were significantly lower in the ESPB and QLB groups than in the control group at 2, 6, and 24 hours postoperatively (P < .001 at each time point). The incidence of postoperative nausea and vomiting was lower in the ESPB and QLB groups than that in the control group; however, this difference was not statistically significant (P = .029). No significant differences were observed in opioid consumption or pain scores between the 2 groups. Both the erector spinae plane and quadratus lumborum blocks effectively reduced postoperative opioid consumption and pain in patients with total abdominal hysterectomy. These techniques offer a promising approach for postoperative pain management, potentially reducing the need for opioids.

Clinical features and survival rate of patients with ovarian granulosa cell tumor in Iran; a 10-year retrospective study

IntroductionOvarian granulosa cell tumor (OGCT) is a rare female pathology with few available demographic data. Besides, there are no comprehensive clinical characteristics regarding the OGCT in Iran. Thus, this study aimed to assess the clinical features and survival rate of OGCT patients in Iran to expand the scope of knowledge in this field.Materials and methodsIn this 10-year retrospective study (2013–2023), the cases were gathered from the oncologic clinic of women (Imam Khomeini Hospital, Tehran, Iran). The patients with definite OGCT diagnosis were selected based on the inclusion and exclusion criteria including medical history, interfering backgrounds, demographic data, histopathological assessment, clinical and para-clinical features, survival rates, and all previous medical reports for definite diagnosis of OGCT along with approved pathology samples.ResultsThe median age and BMI values of Iranian patients were 45 (19 ~ 83) years and 28.04 (19.4 ~ 48.0), respectively. The most common symptom was abdominal pain (56%) and 69.2% of cases were menopause. In 81.3% of cases, ovarian tumors were detected and metastasis was rare. Most patients (40.6%) underwent total abdominal hysterectomy and OGCT relapsing cases were seen in 13.2% of patients. The median of overall survival (OS) value using the Kaplan-Meier estimate was 52 months (95%CI:37.47–66.53), and the median of disease-free survival (DFS) was 45 months (95%CI: 28.88–61.12). There was a significant (p < 0.05) relation between chemotherapy and left oophorectomy with OS. A significant (p < 0.05) correlation was also detected among the OGCT stage and left oophorectomy with DFS.ConclusionOS and DFS values showed that the OGCT in Iranian patients can be treated in most cases using two main procedures of chemotherapy and oophorectomy. Parallel application of both procedures and associated outcomes are suggested for future studies.

Uterine fibroid metastasis as the initial manifestation of lobular breast cancer

The occurrence of breast cancer metastasis in a uterine leiomyoma is exceptional, and its diagnosis prior to detection of the primary tumor is even rarer. We describe at case of a 52-year-old female patient with a large fast growing uterine fibroid that caused pelvic pain and abdominal distention. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology of the surgical specimen showed a characteristic pattern of invasive breast lobular carcinoma in the leiomyoma. A magnetic resonance image of the breast was then performed, which reveled primary and bilateral breast cancer. She subsequently underwent neoadjuvant endocrine therapy plus cyclin inhibitors, breast-conserving surgery, and radiotherapy. To date, the patient is alive and asymptomatic after 3 years of follow-up.

Does a Tuberculosis Peritonitis Imitate an Advanced Ovarian Cancer?: A Case Report at Iringa Regional Referral Hospital in Tanzania

Tuberculosis (TB) Peritonitis is unexpected tuberculosis that happens in less than 2% of the patients worldwide. The incident rates are higher in the developing countries as a result of the inadequate diagnostic equipment. The mimicking of the tuberculosis peritonitis with an advanced ovarian cancer affects the decision of the gynecologist even after coming up with the confirmatory investigation of image findings. A 34-year-old female presented with progressive abdominal distension for 2 months, discomfort, abnormal vaginal discharge, which was foul smell and yellowish in color, painful sex intercourse, and denied history of diarrhea or constipation. Furthermore, present the history of passing black stool, but she denied history of vomiting blood or epigastric pain. A pelvic scan revealed the adnexal masses and ascites, with a conclusion of advanced ovarian cancer. A laparotomy was done; total abdominal hysterectomy and bilateral salpingoophorectomy were done. A specimen sent for histopathology, which revealed tuberculosis peritonitis and not ovarian cancer. A patient was administered anti-tuberculosis drugs, and on follow-up, the patient showed an improvement. Therefore, in this case, the gynecologist should think of tuberculosis peritonitis as a differential diagnosis of advanced ovarian cancer, and this can be confirmed by the laparoscope and histopathology of the specimen hence preventing unnecessary total abdominal hysterectomy.  Implication for policy makers: The diagnostic tools in the health care facilities should be readily accessible and available for such rare cases hence more on job training to equip the gynecologists with updated knowledge and skills.  Implication for public: The public health should be emphasized in the community by offering health promotion, encouraging screening, and prevention of diseases so as to prevent the consequences which affects the life of an individual.

Krukenberg tumour in a 46-year-old black African woman with a background of ovarian fibroma- A case report

BackgroundTumours that metastasize to the ovary can occur in conjunction with other ovarian lesions, including benign sex cord stroma tumours like fibroma or fibrothecoma. This case report presents a unique instance of metastatic signet ring carcinoma involving the ovary in a background of fibroma in a Black African woman.Patient presentationA 46-year-old gravida 3, para 0 (2 alive), patient was referred from the general outpatient clinic to the gynecology clinic due to progressive abdominal swelling over the past eight months. Abdominal examination revealed marked distension with massive ascites. Physical examination of the chest demonstrated dullness to percussion over both lung bases, with increased dullness noted on the right. Auscultation revealed decreased air entry in the right middle and lower lung zones, with normal to increased air entry in the remaining lung fields. Abdominopelvic ultrasound revealed a large irregularly marginated homogeneous solid mass in the right adnexa measuring 16.4 × 11.7 × 12.7 cm. An abdominal CT scan revealed bilateral pleural effusion, which was more pronounced on the right, ascites, and evidence of pulmonary and hepatic metastasis. Serum chemistry revealed abnormal levels of several analytes, including elevated CA 125 at 1,108.8 (normal range 0–35) U/L and CA 19–9 at 63.8 (normal range 0–35) U/L. She subsequently underwent staging laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy, without any postoperative complications. The histologic sections of the right and left ovaries revealed a moderately cellular lesion composed of intersecting bundles of spindle cells in a fascicular and storiform pattern. Additionally, pockets of small round to oval-shaped cells with intracytoplasmic clear vacuoles pushing the nucleus to the periphery (signet ring cells) were identified in a few foci. These cells were initially thought to be ovarian stroma or theca cells. Microscopic examination revealed signet ring cells with cytoplasmic positivity for periodic acid-Schiff (PAS) staining. The histopathological diagnosis was metastatic signet ring cell carcinoma involving the ovary, with an underlying ovarian fibroma.ConclusionsOvarian metastatic signet ring carcinoma in a background of fibroma can pose a significant diagnostic challenge, as signet ring cells can mimic the ovarian stroma or theca cells, especially if they are only observed in a few foci of the sections.

Struma Ovarii- Association with Pseudo-Meigs Syndrome and Raised S. CA-125: A Case Report

The monodermal mature teratoma known as Struma Ovarii is a rare and uncommon form of ovarian tumours. It is primarily composed of thyroid tissue and is associated with hyperthyroidism, increased levels of S. CA-125 (Cancer Antigen-125), and pseudo-Meigs syndrome. Because the symptoms of this tumour are nonspecific, other extremely frequent ovarian lesions may be misdiagnosed and ignored. The majority of the time, incidental imaging and symptoms are used to make the first diagnosis of the cancer; histopathology is used to confirm the diagnosis. A good prognosis and successful curative treatment can result from surgically removing the tumour. The tumour's rarity makes misdiagnosis frequent. Nonetheless, a total abdominal hysterectomy combined with a bilateral salpingo-oophorectomy may be indicated in premenopausal patients in order to eradicate all symptoms. Ascites, hyperthyroidism, high S. CA-125 levels, and hydrothorax are all rare outcomes of struma ovarii. In this uncommon syndrome with negative cytology, individuals with ascites and pleural effusion should be examined for a differential diagnosis. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 50-55

Metastatic Carcinosarcoma with a Sarcomatous Predominance?

Abstract Introduction/Objective Uterine carcinosarcoma (CS), also known as Malignant Mixed Müllerian Tumor, is a malignancy characterized by mixed epithelial and mesenchymal components. It is rare and aggressive, most frequently occurring in elderly, postmenopausal women with a median age of 65 years. CS has a tendency to metastasize with an overall poor prognosis. Fine needle aspiration can be useful in identifying metastatic disease, however, demonstration of both sarcomatous and carcinomatous components can be difficult. Methods/Case Report Our patient is a 68 year old female who was first diagnosed with endometrial carcinosarcoma on an endometrial biopsy in 2022. She subsequently underwent a total abdominal hysterectomy with radical dissection, bilateral salpingo-oophorectomy, upper vaginectomy, sentinel lymph node dissection as well as chemotherapy. Immunohistochemistry for MLH1, MSH2, MSH6 and PMS2 all showed intact nuclear expression. Remission was achieved for about a year, after which she was found to have a moderate right sided pleural effusion with right lower lung infiltrates. Also, a right upper lobe mass was reported on chest CT scan. Paracentesis was performed and cytology was consistent with predominantly atypical spindle cells accompanied by a mixed inflammatory infiltrate. Immunohistochemical stains were performed on the cell block, tumor cells were positive for smooth muscle actin, vimentin and negative for desmin, S-100, SOX-10, CD34, P63, TTF-1 and pancytokeratin. Cytology diagnosis was rendered as malignant cells present, consistent with metastatic CS. A subsequent lung mass core biopsy also confirmed the diagnosis. Results (if a Case Study enter NA) NA Conclusion The cytomorphological features in effusion samples from metastatic CS have the carcinomatous component readily identifiable, and only a minority of effusion samples show additional sarcomatous component. The exact diagnosis of CS may not be possible due to the absence of sarcomatous components. Alternatively, as we present in this rare case of metastatic CS, the sarcomatous component in the form of abundant atypical oval to spindle cells with hyperchromatic nuclei may be the only form of malignant cells present in the specimen. Careful morphological assessment of architectural patterns, a good past medical history, availability of cell blocks and immunohistochemistry are vital in providing an accurate diagnosis in such rare cases of metastatic CS.

Exploring Immunohistochemical Profiling in High-Grade Endometrial Stromal Sarcoma - A Case Study

Abstract Introduction/Objective High grade endometrial stromal sarcoma (HGESS) is a rare and aggressive tumor of endometrial stromal origin comprising about 0.2% of all uterine malignancies. It is often misdiagnosed preoperatively as uterine leiomyoma, leiomyosarcoma or endometrial carcinoma due to lack of well defined clinical and radiological features. We present an unusual case of HGESS with fibroid uterus and abnormal vaginal bleeding. Methods/Case Report A 73-year-old female with a past medical history of uterine fibroids presented with abnormal vaginal bleeding for 6 months. Her MRI uterus revealed enlarged uterus measuring 6.8 X 9.9 X 9.3 cm, multiple fibroids, and endometrial thickness of 4 mm. Hysteroscopic dilation and curettage revealed endometrial polyp and submucosal fibroid. Histopathology of submucosal fibroid revealed loosely cohesive tumor cells with high nuclear/cytoplasmic ratio, scant cytoplasm, and large prominent nucleoli, arranged in solid sheets with myxoid stroma. No glandular formation was identified. Tumor cell necrosis, bizarre tumor cells, and markedly increased mitotic activity, including atypical mitotic figures were present. Immunohistochemistry (IHC) revealed tumor cells diffusely positive for smooth muscle actin, CD10, p53, negative for AE1/AE3, CK7, cam5.2, EMA, ER, PR, desmin, and caldesmon. Ki-67 labels close to 50% of the tumor cells. Combined morphologic and IHC features favored the diagnosis of high-grade sarcoma, including leiomyosarcoma and HGESS. However, the possibility of carcinosarcoma (CS) could not be ruled out. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Final histopathological diagnosis revealed HGESS, pT1b. Lack of carcinomatous component and negative IHC staining for CK7, CAM 5.2, AE1/AE3 ruled out CS. IHC showed tumor cells diffusely positive for CD10, actin, desmin and CD 56, focally positive for caldesmon, cyclin D1 and CD 117 and negative for DOG 1, further supporting the diagnosis for HGESS over leiomyosarcoma. Results (if a Case Study enter NA) NA Conclusion Definitive diagnosis of HGESS is achieved through histology and IHC. An appropriate panel of IHC markers is essential to differentiate between endometrial stromal tumors from leiomyosarcoma and CS. Accurate diagnose of this rare clinical entity is critical especially in its initial stages owing to its poor prognosis and aggressive nature.

Comparison of Frozen and Final Pathology Results in Patients Operated for Endometrial Hyperplasia

OBJECTIVE: Our study aimed to determine the frequency of endometrial cancer in patients undergoing surgery with a diagnosis of endometrial hyperplasia and to evaluate the concordance between preoperative diagnosis, frozen section examination, and final pathology results. STUDY DESIGN: The clinical findings, imaging results, and all pathology reports of patients who underwent total abdominal hysterectomy for endometrial hyperplasia (atypical or non-atypical) between January 2020 and January 2023 at our hospital were retrospectively evaluated. Demographic and clinical characteristics (age, menopausal status, parity, body mass index, presence of diabetes and hypertension) and pathology results were recorded from patient records. RESULTS: 144 patients diagnosed with endometrial hyperplasia were included in the study. The frozen section and final pathology results of all patients diagnosed with non-atypical endometrial hyperplasia were reported as benign lesions. In the atypia group, the intraoperative frozen section results of 80.7% of the patients were classified as benign lesions, while the results of 19.3% were reported as malignant pathology. A statistically significant difference was found between the benign and malignant lesion groups, which were classified based on the final pathology results, with respect to age, menopausal status, and average endometrial thickness before biopsy. CONCLUSION: In cases of endometrial hyperplasia with atypia, the possibility of cancer appearing in the final pathology results should be taken into consideration. In the preoperative evaluation of patients, characteristics such as endometrial thickness, age, and menopausal status may suggest the likelihood of encountering endometrial cancer during surgery in this patient group.

8162 A Unique Presentation of Ovarian Steroid Cell Tumor Causing Hyperandrogenism in a Postmenopausal Woman

Abstract Disclosure: A. Rehan: None. M. Pandey: None. I. Goyal: None. E. Punni: None. N. Shakir: None. Background:­­­ Steroid cell tumors of the ovary are a rare entity, constituting less than 0.1% of all ovarian tumors. These tumors can present with diverse endocrine and paraneoplastic effects, including androgen excess and polycythemia. Hyperandrogenism in females can lead to hirsutism, virilization, alopecia, menstrual irregularities, acne, and emotional changes, with complications including hyperlipidemia and insulin resistance. There are various causes of androgen excess in a female including polycystic ovary syndrome (PCOS), androgen-secreting tumors, Cushing’s syndrome, and congenital adrenal hyperplasia. In a postmenopausal woman displaying signs of androgen excess, one must consider androgen-secreting tumors, and even the rare ovarian steroid cell tumor as a possible cause. Clinical Case: A 62-year-old female with type 2 diabetes mellites, obstructive sleep apnea, anxiety and depression initially presented to her primary care provider with fatigue, light-headedness, and weight loss. Initial blood work done revealed a hemoglobin greater than 20 g/dL (NR 12-16) and hematocrit greater than 60% (NR 36-48), requiring several sessions of phlebotomy. Symptoms persisted and she was finally referred to a hematologist who noted physical exam findings of hirsutism and virilization, including temporal hair loss and excess facial/body hair growth. Other concerning signs included clitoromegaly, decrease in chest size, and deepening voice. Menopause had occurred at age 50, and the patient did not have any issues with fertility during her reproductive years. Biochemical evaluation revealed testosterone level of greater than 1500 ng/dL (NR 19-82) with normal sex hormone binding globulin level, DHEA-S 652 ug/dL (NR 29-220), appropriately suppressed FSH/ LH, and normal salivary cortisol levels. Tumor markers showed normal CEA, and alpha fetoprotein but elevated CA 125 to 80.5 U/ml (NR &amp;lt; 38.1). Pelvic ultrasound demonstrated a 12 cm heterogeneously echoic, vascular right adnexal mass concerning for ovarian malignancy. Pelvic MRI showed a 9.8 cm right sided cystic and solid adnexal mass. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal biopsies, and omentectomy. Pathology revealed a stage IA steroid cell tumor measuring 11.4 cm. After resection, the patient reported improvement in facial hair and fatigue. Labs showed normalization of hemoglobin, hematocrit, and testosterone levels. Conclusion: This rare case highlights the importance of considering steroid cell tumor as a cause of polycythemia with hyperandrogenism. Timely diagnosis and intervention play a critical role in preventing irreversible virilization, mitigating malignant risks, and, in certain instances, preserving fertility. Generally, the prognosis is favorable, and symptom and lab normalization is often achieved through surgical resection. Presentation: 6/2/2024

Role of blood urea nitrogen to creatinine ratio in the assessment of hypovolemia who have undergone major surgeries- a cross-sectional study

BackgroundMajor surgeries are being carried for certain ailments. Surgeries can be major or minor depending on the extent of intervention. Major surgeries are prone to cause lots of complications such as shock, haemorrhage, wound infection, deep vein thrombosis, pulmonary complications, organ rejection, reactions to anaesthetics etc. Early identification of complications could reduce morbidity and mortality. Laboratory variables used in the assessment of hypovolemia include blood urea nitrogen, sodium, osmolality, hematocrit, and arterial blood gas. This study was undertaken to assess the utility of blood urea nitrogen: creatinine ratio (BCR) in the utility of assessment of hypovolemia in the first post-operative day in individuals who had major surgeries.Methods and materialsThe retrospective cross-sectional study included participants from the Departments of Orthopedic Surgery, Obstetrics and Gynecology, General Surgery and Cardiothoracic Surgery. Patients who underwent major surgeries between January 2019 and January 2020 were included. Study participants of 30 to 60 years of both genders were recruited into the study. Data were collected from the Medical Records of a tertiary care hospital in Chennai, India. Ethics approval was obtained, the institutional ethics committee (Ref: CSP/21/SEP/99/479 dated 30–12-2021). Waiver of consent was obtained since the patients were treated and discharged from the hospital. The data were analyzed by SPSS version 16. P value ≤ 0.05 was taken to be significant.ResultsBCR showed statistically significant difference across the groups with P = 0.02. BCR showed statistically significant difference between cardiac patients with total knee replacement and total abdominal hysterectomy surgeries. BCR showed positive correlation with age, fluids intake and negative correlation with pulse rate and respiratory rate.ConclusionBCR is a simple diagnostic tool for identifying hypovolemia in individuals who undergo major surgeries especially in the first postoperative day. It is significantly altered across the groups with highest value in individuals who have undergone knee replacement surgeries. BCR has high specificity and positive predictive value.

Navigating Hysterectomy Choices: A Retrospective Study On Non-Descent Vaginal And Total Abdominal Hysterectomy In Rural Women

Background The aim of the study is to compare the results of non-descent vaginal and total abdominal hysterectomy procedures done in women in a tertiary care hospital. A retrospective study done by collecting the data from medical records who underwent non-descent vaginal and total abdominal hysterectomy done in women with fibroids, adenomyosis, endometrial atypical hyperplasia and abnormal uterine bleeding. Materials and Methodology This was a retrospective study done by collecting the data from medical record department of the hospital for the period of 6 months from April 2024 to September 2024. The total record of the study consisted of 400 patients out of which 200 patients underwent total abdominal hysterectomy and the rest 200 underwent non-descent vaginal hysterectomy. Those patients were pre-operatively assessed by physical, clinical, radiological evaluations as well as biochemical tests. Results The data of a total of 200 NDVH patients and 200 TAH patients was analysed which showed that NDVH patients had lower parity and BMI, smaller uterine sizes, and were more likely to have surgery for abnormal uterine bleeding. Intraoperative outcome was found to be better for NDVH, with less blood loss and shorter operative duration. The post-operative complications were significantly lower in the NDVH group, resulting in shorter hospital stays. Overall, NDVH outcomes were found to be superior to TAH. Conclusion: The non-descent vaginal hysterectomy has much advantages when compared to total abdominal hysterectomy

Recurrent Vaginal Vault Leiomyoma following Total Abdominal Hysterectomy and Bilateral Adnexectomy

Recurrent Vaginal Vault Leiomyoma following Total Abdominal Hysterectomy and Bilateral Adnexectomy

Abdominal Gynecologic Procedures in Pancreas Transplant Recipients.

With the growing population of pancreas transplant recipients followed long-term, some female recipients are going to require surgical intervention for gynecologic symptoms and pathologies. Currently, there is a lack of literature describing how to approach this population and whether pelvic gynecologic procedures (GYN) can be performed safely given the proximity of the pancreatic (and possibly renal) allograft. In this single-center retrospective analysis, all pancreas transplant recipients that subsequently underwent GYN were reviewed. Subjects were identified by cross-referencing all pancreas transplants performed between January 2003 and December 2022 for any subsequent GYN. Demographics at transplant and GYN, indications and procedure performed, operative time, presence and involvement of a transplant surgeon, complications length of stay, and readmissions were reviewed. Seventeen patients who underwent a total of 19 GYN after pancreas transplantation were identified. Operations performed included tubal ligation (n=2), total abdominal hysterectomy with (n=6) or without bilateral salpingectomy (n=2), oophorectomy versus cyst drainage (n=2), bilateral oophorectomy (n=1), and unilateral (n=4) versus bilateral (n=2) salpingectomy. Four were performed through an open laparotomy and 15 were performed laparoscopically. In 11 cases, a transplant surgeon was involved intra-operatively. Eight of the 17 patients developed post-operative complications including post-operative fevers, fluid overload, neutropenia, elevated creatinine (n=2), nephrolithiasis, urinary tract infection, and incisional hernia. Five required readmission. GYN can be performed safely following pancreas transplantation, but careful planning and the involvement of the transplant surgery team are advised.

Comparative Study of Bipolar Vessel Sealing Against Standard Suturing in Total Abdominal Hysterectomy

Comparative Study of Bipolar Vessel Sealing Against Standard Suturing in Total Abdominal Hysterectomy

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

Buprenorphine with Bupivacaine 0.5% Heavy Versus Clonidine with Bupivacaine 0.5% Heavy Versus Bupivacaine 0.5% Heavy Alone in Patients Undergoing Total Abdominal Hysterectomy: A Comparative Study

Background and Aims: This research aimed to determine which of three spinal anaesthetic medication combinations—clonidine–bupivacaine, buprenorphine–bupivacaine and bupivacaine alone—is the most effective for total abdominal hysterectomy. Material and Methods: In this prospective study, approved by the Institutional Ethical Committee, 120 patients aged 35–60 years scheduled for elective total abdominal hysterectomy under spinal anaesthesia were included, following informed consent. Comprehensive pre-anaesthetic assessments, including detailed medical histories, clinical examinations and routine surgical investigations, were conducted. The study, spanning 24 months, utilised purposive sampling and a cross-sectional design. The inclusion criteria encompassed ASA I and II patients aged 35–60 years, undergoing elective total abdominal hysterectomy with a weight exceeding 45 kg, height over 150 cm, and valid informed consent. Exclusion criteria involved ASA Class III or higher, patient unwillingness for spinal anaesthesia, gross spinal deformities, bleeding diathesis, known allergy to the test drug, history of cardiac, respiratory, or central nervous system disease, hepatic or renal dysfunction and elevated intracranial pressure. Results: The onset time of sensory blockade was faster in the Bupivacaine + Buprenorphine group than in the Clonidine + Bupivacaine group, with the Bupivacaine group exhibiting the slowest onset. The Bupivacaine + Buprenorphine group had a significantly faster onset of motor block than the Clonidine + Bupivacaine and Bupivacaine groups. The total duration of motor block was shorter in both the Bupivacaine + Buprenorphine and Bupivacaine groups than in the Clonidine + Bupivacaine group. The Clonidine + Bupivacaine group showed higher incidences of bradycardia and hypotension than the other groups. The Bupivacaine + Buprenorphine group reported more side effects, including chest pain, cough, nausea and vomiting, than the other groups. Conclusion: This study found that spinal clonidine, in comparison to bupivacaine alone, gives better post-operative analgesia and sensory and motor blockage over a longer period of time.

Comparative Analysis of Epidural Dexamethasone and Epidural Morphine (EM) for Postoperative Pain Control After Total Abdominal Hysterectomy: A Randomized Clinical Trial

Background: Epidural anesthesia is commonly utilized for pain management following lower abdominal surgeries; however, the search for an optimal analgesic additive continues. Objectives: This study aimed to compare the efficacy of epidural dexamethasone versus epidural morphine (EM) in managing postoperative pain after total abdominal hysterectomy. Methods: This randomized controlled trial enrolled patients undergoing total abdominal hysterectomy (TBAH) and assigned them to two groups: Group D (Dexamethasone), which received epidural dexamethasone (8 mg) with bupivacaine, and Group M (Morphine), which received epidural morphine (10 mg) with bupivacaine. Marcaine (bupivacaine) 0.25% was used in both groups. Baseline characteristics, surgical outcomes, physiological parameters, pain management, adverse effects, and blood sugar levels were analyzed and compared between the groups. Results: The groups exhibited similar initial characteristics and surgical outcomes. Vital signs, including heart rate (HR), mean arterial pressure, respiratory rate, and oxygen saturation, remained consistent before and after surgery. The Dexamethasone group (Group D) demonstrated superior pain control compared to the Morphine group (Group M). Patients in Group D required pain medication for a significantly shorter duration (24 hours vs. 36 hours, P &lt; 0.05), representing a 50% reduction in medication duration. Additionally, Group D patients required fewer rescue analgesics (1.2 doses vs. 2.1 doses, P &lt; 0.05), indicating a 43% decrease in the need for additional medication. The time to a visual analog scale (VAS) score exceeding 4 was significantly longer in Group D, indicating less intense pain for an extended period. Although no significant differences were observed in common postoperative side effects, Group D exhibited a lower incidence of these effects, albeit not statistically significant. Furthermore, Group D showed a significantly lower incidence of hyperglycemia at the 8th hour post-surgery compared to Group M (P &lt; 0.05), suggesting a potential benefit of epidural dexamethasone in mitigating hyperglycemia risk. Conclusions: Epidural dexamethasone appears to offer superior analgesic efficacy compared to epidural morphine in postoperative pain management after total abdominal hysterectomy. The findings suggest that Group D (Dexamethasone) experienced improved pain management, reduced medication requirements, and a lower incidence of hyperglycemia. Further research with larger cohorts and extended follow-up is warranted to validate these findings and guide clinical practice.