Vault Haematoma Research Articles

F08Real‐time intraoperative ultrasound guidance; the transrectal approach

BackgroundThe aim of this study was to assess the role of real‐time transrectal ultrasound (RT‐TRUS) guidance in complicated gynecological procedures.MethodDuring the study period RT‐TRUS was utilized to direct and assist the gynecological surgeon in two complicated gynecological procedures: Completing the evacuation of the uterine cavity after identification of uterine wall perforation during termination of pregnancy and drainage of posthysterectomy infected vault hematomas.ResultsIn all, 11 patients were treated by this fashion (6 abortions and 5 infected vault hematomas). All procedures were completed without any further complications and the patients were discharged the following day with uneventful follow‐up.ConclusionRT‐TRUS is an effective tool that can provide on‐line assistance to the gynecological surgeon in various pelvic procedures.

Vault haematoma and febrile morbidity after vaginal hysterectomy.

Vaginal hysterectomy is associated with significant risk of vaginal vault haematoma (40%) and febrile morbidity (30%). Numerous interventions have been used to try and avoid these complications but very few have been shown to be effective.

Incidence of vault haematoma after vaginal hysterectomy and its correlation with post operative morbidity

International Journal of Gynecology & ObstetricsVolume 70, Issue S3 p. C29-C29 Free communication Current topics in general gynecology Incidence of vault haematoma after vaginal hysterectomy and its correlation with post operative morbidity A.H. Khosla, A.H. KhoslaSearch for more papers by this authorJ. Sen, J. SenSearch for more papers by this authorS. Kumari, S. KumariSearch for more papers by this author A.H. Khosla, A.H. KhoslaSearch for more papers by this authorJ. Sen, J. SenSearch for more papers by this authorS. Kumari, S. KumariSearch for more papers by this author First published: 01 January 2017 https://doi.org/10.1016/S0020-7292(00)81503-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume70, IssueS32000Pages C29-C29 RelatedInformation

Posthysterectomy vaginal vault prolapse: primary repair in 693 patients

Objective: To examine the results of primary repair of posthysterectomy vaginal vault prolapse in a current, large series of patients with long-term follow-up. Methods: From January 1976 to December 1987, 693 patients underwent primary repair of vault prolapse at the Mayo Clinic. The Mayo culdoplasty technique was used in 95% of these patients. Patients were followed up by reference to their Mayo Clinic medical records, a specifically designed questionnaire, and pelvic examination in a subgroup of patients. Results: The median age at operation was 66 years. Abdominal hysterectomy had been performed on 49.5% of patients and vaginal hysterectomy on 43.4% (hysterectomy type was not documented on 7.1%). The median number of years to vault prolapse repair after hysterectomy was 15.8 (range 0.4–48.4). Information about prolapse after primary repair was available for 504 patients (72.7%) and 80 had evidence or complaint (bulge, protrusion) of recurrent prolapse. Thirty-six of 693 patients (5.2%) had subsequent prolapse repair. Eighty-two percent of patients indicated satisfaction with the result. Complications of operation included entry into the bladder or rectum (2.3% of patients), vault hematoma (1.3%), cuff infection (0.6%), and ureteral complications (0.6%). The number of patients presenting for vault prolapse repair increased during the study interval. Conclusion: The Mayo culdoplasty can be performed with minimal morbidity. It achieved an anatomic restoration of upper vaginal support in a high percentage of patients with long-term follow-up.

Ultrasound detection of vault haematoma following vaginal hysterectomy.

To assess whether ultrasound detection of vault haematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy. Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994. Two hundred and twenty-three women having undergone vaginal hysterectomy. All women had transvaginal ultrasound examination by an independent observer on the third post-operative day. Routine observations and clinical assessments were made by established management protocol, by staff blinded to the ultrasound findings. Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re-admission rate and length of stay. Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31% vs 7%), post-operative haemoglobin drop (2.5 g/dL vs 1.6 g/dL), need for blood transfusion (14.5% vs 1.2%), representation to hospital (25.5% vs 5.4%) and length of hospital stay (8.87 days vs 6.25 days) were seen in the haematoma group. Ultrasound detection of vault haematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, need for blood transfusion, longer hospital stay and higher re-admission rate. In view of increasing demand for early discharge, driven by purchasers and patients, post-operative ultrasound identifies a high risk population and is both convenient and noninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trial of prophylactic antibiotics in this identified subset.

Vault haematoma following laparoscopic hysterectomy.

Thirty consecutive patients underwent transabdominal ultrasound scanning on day 2 postoperatively in order to provide data on the incidence of vaginal vault haematoma following laparoscopic hysterectomy. Details of postoperative morbidity, both inpatient and after discharge, were recorded. Results support the view that there is no significant association between the presence of vaginal vault haematoma (73%) and the incidence of posthysterectomy febrile morbidity (16.7%). Furthermore the incidence of vault haematoma after laparoscopic hysterectomy is comparable to literature figures for both abdominal and vaginal hysterectomy, whilst that of febrile morbidity is at least equivalent if not reduced for the laparoscopic approach. We believe this provides further evidence confirming the safety of the laparoscopic approach to hysterectomy.

Is laparoscopically-assisted vaginal hysterectomy associated with low operative morbidity?

Seventy-one consecutive patients undergoing laparoscopically-assisted vaginal hysterectomy were prospectively evaluated with particular emphasis on the operative morbidity. Bipolar desiccation was the mainstay for haemostasis. Fibroids accounted for two-thirds of the uterine pathology and the average uterine weight was 238.0 g (SD 134.6). Mean operating time was 126.3 minutes (SD 36.9) and decreased with experience despite the progressive increase in uterine weight. The mean blood loss was 432 mL (SD 288) with a mean haemoglobin change of 2.3 g/dL (SD 1.5). Intraoperative complications occurred in 5 patients (7.0%), 2 with inferior epigastric artery injuries and 3 serosal bladder injuries. Postoperative complications occurred in 45 patients (63.4%). Febrile morbidity was the major complication and occurred some 50% of patients, 45% of whom had no underlying cause identified. Vault haematoma was the second most common complication and occurred in 31.0%. The mean hospital stay was 5.4 days (SD 2.7) and the readmission rate was 10%. Our results of laparoscopically-assisted vaginal hysterectomy did not conform with the benefits of reduced blood loss, shorter hospital stay and reduced postoperative complications reported in the literature. The true complication rate of laparoscopically-assisted vaginal hysterectomy should be carefully assessed before this can be considered as the approach of choice to hysterectomy.

Cervico‐isthmic Pregnancy with Placenta Percreta Ending in a Livebirth

EDITORIAL COMMENT: We accepted this case for publication not because of a morbid interest in placenta percreta, irrespective of whether the fetus is above the placenta or below it, as it usually is in cases of cervical pregnancy, but because this rare condition provides the most serious obstetric complication of all requiring massive resuscitation and expert surgery. We have commented before that when Caesarean section is performed in these cases it is wise to have a competent gynaecological oncologist scrubbed‐up assisting as he will rightly become the senior surgeon if the operation proves difficult. In the Editor's experience, it is probably wise to electively open the bladder to facilitate removal of the friable lower uterine segment and cervix in these women. As shown by this case, bilateral internal iliac ligation does not guarantee haemostasis ‐ blood coagulation failure often occurs during surgery in the more difficult cases and should be anticipated.Previous Editorial Comments on placenta praevia accreta/cervical pregnancy are: Woolcott RJ, Nicholl M, Gibson JS. A Case of Placenta Percreta Presenting in the First Trimester of Pregnancy. Aust NZ J Obstet Gynaecol 1987; 27:258. Altintas A, Ozgunen FT, Doran S, Doran F. Placenta Percreta Invading the Urinary Bladder. Aust NZJ Obstet Gynaecol 1991; 31:371. Sanders RR. Placenta Praevia Percreta Invading the Urinary Bladder. Aust NZ J Obstet Gynaecol 1992; 32:375. Author's response to editorial comment:We did have a gynaecological oncologist (Mr John Wittaker) assisting who performed the internal iliac artery ligation as well as 2 consultant anaesthetists (Drs E Hughes and G Crooks). The blood loss was phenomenal; we measured 14 litres of blood loss and estimated there was another 3 on the table and floor. We had planned for a significant degree of blood loss but the actual amount caught all of the team by surprise.We attempted to aspirate the vault haematoma as there were recurrent febrile episodes which did not respond rapidly to antibiotics in the postoperative period. We presumed the 2 × 2 cm collection was either a separate haematoma or inflammatory mass.

Ultrasound Guidance for Vaginal Drainage of Postoperative Pelvic Hematoma: A Case Report

Background: Postoperative pelvic fluid collection is almost a universal consequence of gynecologic surgery. At one end of the spectrum are minimal collections of peritoneal fluid or blood that are clinically inconsequential. At the other end are hematomas and abscesses requiring active intervention for the patient to recover. Case: This case report describes a symptomatic vaginal vault hematoma occurring after vaginal hysterectomy. Ultrasonography was used to accurately identify the hematoma and guide intraoperative drainage. The patient fully recovered without complication. Conclusion: Accurate visual guidance of instrumentation to decompress postoperative retroperitoneal hematomas is a marked improvement over non-visual techniques utilizing palpation only. The hematoma cavity can be more easily entered and the hematoma or abscess more completely drained, expediting the recovery of the patient affected by this problem.

Stapling technique for abdominal hysterectomy

SummaryTwenty patients undergoing abdominal hysterectomy using an automatic stapling machine were evaluated, and details of the instrument, technique and pitfalls are presented. The staples themselves are novel in that they are composed of a modification of a lactic acid polymer and are totally reabsorbable. The complications encountered included initial difficulty and clumsiness using the instrument; vault closure was a problem in two patients and there was one case of vault haematoma due to inadequate haemostasis. Follow up to 6 weeks after the operation was uneventful.This is a safe speedy and easily learnt technique which is an excellent adjunct in gynaecological surgery and has decided advantages over traditional methods of suture ligation.

Vault haematoma after vaginal hysterectomy: an invariable sequel?

Fifty consecutive patients undergoing vaginal hysterectomy were studied prospectively by ultrasound to determine the incidence of vault haematoma and the relationship between its size and the development of postoperative pyrexia; 49 patients (98%) had a vault haematoma and 35 (70%) were febrile postoperatively. Large vault haematomas (mean diameter greater than 5 cm) were invariably associated with significant febrile morbidity, whilst 1 in 3 patients with a small haematoma was afebrile. Colporrhaphy did not influence the likelihood of haematoma formation.