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African Health Sciences Sep 2018Hysterectomy is the most commonly performed major gynecological operation for both benign and malign gynecologic conditions. After hysterectomy, although some...
OBJECTIVES AND BACKGROUND
Hysterectomy is the most commonly performed major gynecological operation for both benign and malign gynecologic conditions. After hysterectomy, although some investigators have declared an increased incidence of urinary and anorectal dysfunction, some others could not show any connection.
METHODS
The voluntary patients were divided in two groups: abdominal hysterectomy (Group 1) and vaginal hysterectomy (Group 2). Anal manometry and all the other examinations of the patients were performed at the Department of General Surgery Endoscopy Unit of Ankara University, Faculty of Medicine.
RESULTS
When the quality of life of the patients was assessed before the operation and on the 12 post-operative month via the SF-36 form; it can be seen that body pain parameters of the patients in Group 1 had significantly improved and there is no statistical difference in other parameters. When the effect of hysterectomy on the quality of life of the patients was evaluated by the "Cleveland Clinic Global Quality of Life" form, the statistically significant improvement in the quality of life of the patients in Group 2 was observed.
CONCLUSION
If the type of operation (vaginal or abdominal) is performed due to benign causes, it does not affect the urinary and anorectal functions of the patients. Depending on the decrease of complaints of the patients, it has a positive effect on the quality of life.
Topics: Adult; Aged; Anal Canal; Female; Genital Diseases, Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Middle Aged; Prospective Studies; Quality of Life; Rectal Diseases; Rectum
PubMed: 30602994
DOI: 10.4314/ahs.v18i3.19 -
JSLS : Journal of the Society of... 2011To compare the feasibility of total laparoscopic hysterectomy (TLH) and laparoscopy-assisted vaginal hysterectomy (LAVH) in the treatment of benign gynecologic diseases... (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVES
To compare the feasibility of total laparoscopic hysterectomy (TLH) and laparoscopy-assisted vaginal hysterectomy (LAVH) in the treatment of benign gynecologic diseases and to determine the selection criteria for each technique.
METHODS
This was a retrospective medical records review of 168 patients who underwent TLH or LAVH performed by one surgeon. A chi-square test was used to compare the difference between the TLH and LAVH groups. Pearson's correlation coefficient was calculated for the relationship between the clinico-demographic factors of the patients.
RESULTS
There were no differences between the 2 groups with respect to age, parity, history of abdominal delivery, body mass index, and indication for hysterectomy. The operative time was similar between the 2 groups (P>.99). The uterine weight was greater in the LAVH group compared to the TLH group (P<.01). Ten patients were converted from TLH to LAVH, because of a large uterus and/or a lower segmental mass on the uterus, making it difficult to expose the Koh cup rim contour.
CONCLUSIONS
TLH and LAVH are safe, feasible methods by which to perform a hysterectomy. LAVH is preferred in patients with a mass involving the lower segment or a relatively large uterus.
Topics: Adult; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Male; Middle Aged; Uterine Diseases; Uterine Neoplasms; Uterine Prolapse
PubMed: 21902979
DOI: 10.4293/108680811X13071180406394 -
Acta Obstetricia Et Gynecologica... Sep 2011To describe the use of vaginal, abdominal and laparoscopic hysterectomy in Denmark from 1999 to 2008, the influence of national guidelines and the patient and...
OBJECTIVE
To describe the use of vaginal, abdominal and laparoscopic hysterectomy in Denmark from 1999 to 2008, the influence of national guidelines and the patient and procedure-related characteristics associated with the choice of vaginal hysterectomy. Design. Nationwide register-based cohort study.
SETTING
Danish Hysterectomy Database and Danish National Patient Registry.
POPULATION
All women with a hysterectomy for benign indications in Denmark from 1999 to 2008.
METHODS
The incidence rate/100,000 women was used to describe the route of surgery in hysterectomies of 50,755 women. A multiple logistic regression analysis was done to examine the association between patient- and procedure-related characteristics and choice of surgical procedure including 20,486 women.
MAIN OUTCOME MEASURES
Trends in surgical approach from 1999 to 2008. Patient- and surgery-related characteristics associated with vaginal hysterectomy from 2004 to 2008.
RESULTS
There was an overall increase in the use of vaginal hysterectomies from 12 to 34%, a decrease in the use of abdominal hysterectomies and a consistent number of laparoscopic hysterectomies. The number of vaginal hysterectomies varied between regions, ranging from 2 to 86%. The use of vaginal hysterectomy was not dependent on the total number of hysterectomies performed at the hospital. The characteristics associated with vaginal hysterectomy were higher age, smaller uterus size, indications for surgery (genital prolapse and severe uterine bleeding), less smoking and moderate alcohol intake.
CONCLUSIONS
Vaginal hysterectomy has replaced abdominal hysterectomy increasingly but cannot be directly correlated to the implementation of national guidelines as there was large national variation. Several characteristics are significantly associated with vaginal hysterectomy.
Topics: Adult; Aged; Aged, 80 and over; Denmark; Female; Humans; Hysterectomy, Vaginal; Incidence; Laparoscopy; Middle Aged; Practice Guidelines as Topic; Prospective Studies; Registries; Uterine Diseases
PubMed: 21623739
DOI: 10.1111/j.1600-0412.2011.01199.x -
Gynecology and Minimally Invasive... 2022The aim of this study was to compare operative data and postoperative complications among nondescent vaginal hysterectomy (NDVH), laparoscopy-assisted vaginal...
A Comparative Analysis of Nondescent Vaginal Hysterectomy, Laparoscopy-Assisted Vaginal Hysterectomy, and Total Laparoscopic Hysterectomy for Benign Uterine Diseases at a Rural Tertiary Care Center.
OBJECTIVES
The aim of this study was to compare operative data and postoperative complications among nondescent vaginal hysterectomy (NDVH), laparoscopy-assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) at a rural tertiary care center.
MATERIALS AND METHODS
This is a prospective analytical study, of 145 hysterectomies for benign conditions with or without salpingo-oophorectomy in women from 30 to 60 years, over 3 years from January 2016 to December 2019, with 60 cases of NDVH, 46 cases of LAVH, and 39 cases of TLH. The three groups were compared intraoperatively in terms of blood loss, operating time, and intraoperative complications and postoperative complications and postoperative duration of hospital stay.
RESULTS
There was no significant difference between the three groups in terms of age, parity, body mass index, and indications for hysterectomies. The mean operative time was significantly shorter ( = 0.000) in the NDVH group (54.67 ± 15.67 min) as compared to the LAVH (102.45 ± 10.53 min) and TLH (126.79 ± 8.7 min) groups. Intraoperative blood loss was greater ( = 0.000) in the TLH group (111.025 mL ± 20.8) as compared to the NDVH (59.50 mL ± 16.7) and LAVH (91.85 mL ± 10.66) groups. The intraoperative complications and postoperative complications were higher in the TLH group as compared to the LAVH and NDVH groups. The duration of hospital stay was almost similar in all the groups.
CONCLUSION
NDVH may be the preferred approach for experienced surgeons, as it is less time-consuming, has a small amount of blood loss, and is a scarless surgery, whereas LAVH and TLH may be the preferred approaches in the cases of presence of adnexal masses and adhesions or whenever salpingo-oophorectomy is indicated.
PubMed: 36158288
DOI: 10.4103/GMIT.GMIT_111_20 -
BMJ Clinical Evidence May 2007Between 5-77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, infertility, or... (Review)
Review
INTRODUCTION
Between 5-77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, infertility, or recurrent pregnancy loss. Risk factors for fibroids include obesity, having no children, and no long-term use of the oral contraceptive pill. Fibroids tend to shrink or fibrose after the menopause.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: medical treatment alone; preoperative medical treatments for women scheduled for surgery; and surgical treatments in women with fibroids? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 41 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: gonadorelin analogues (with progestogen, raloxifene, tibolone, or combined oestrogen-progestogen); hysterectomy (plus oophorectomy); hysteroscopic resonance-focused ultrasound; laparoscopic myomectomy; laparoscopically assisted vaginal hysterectomy; rollerball endometrial ablation; thermal balloon ablation; thermal myolysis with laser; total abdominal hysterectomy; total abdominal myomectomy; total laparoscopic hysterectomy; total vaginal hysterectomy.
Topics: Humans; Hysterectomy; Hysterectomy, Vaginal; Leiomyoma; Uterine Neoplasms
PubMed: 19454074
DOI: No ID Found -
The Cochrane Database of Systematic... Oct 2013Cervical cancer is the second most common cancer among women and is the most frequent cause of death from gynaecological cancers worldwide. Standard surgical management... (Comparative Study)
Comparative Study Review
BACKGROUND
Cervical cancer is the second most common cancer among women and is the most frequent cause of death from gynaecological cancers worldwide. Standard surgical management for selected early-stage cervical cancer is radical hysterectomy. Traditionally, radical hysterectomy has been carried out via the abdominal route and this remains the gold standard surgical management of early cervical cancer. In recent years, advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery.
OBJECTIVES
To compare the effectiveness and safety of laparoscopically assisted radical vaginal hysterectomy (LARVH) and radical abdominal hysterectomy (RAH) in women with early-stage (1 to 2A) cervical cancer.
SEARCH METHODS
We searched the Cochrane Gynaecological Cancer Group Trials Register, and Cochrane Register of Controlled Trials (CENTRAL) Issue 7, 2013, MEDLINE, and EMBASE up to July 2013. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that compared laparoscopically assisted radical hysterectomy and radical abdominal hysterectomy, in adult women diagnosed with early (stage 1 to 2A) cervical cancer.
DATA COLLECTION AND ANALYSIS
Two review authors independently abstracted data and assessed risk of bias.
MAIN RESULTS
We found one RCT, which included 13 women, that met our inclusion criteria and this trial reported data on LARVH versus RAH.Women who underwent LARVH for treatment of early-stage cervical cancer appeared to have less blood loss compared with those who underwent RAH. The trial reported a borderline significant difference between the two types of surgery (median blood loss 400 mL (interquartile range (IQR): 325 to 1050) and 1000 mL (IQR: 800 to 1025) for LARVH and RAH, respectively, P value = 0.05). RAH was associated with significantly shorter operation time compared with LARVH (median: 180 minutes with LARVH versus 138 minutes with RAH, P value = 0.05).There was no statistically significant difference in the risk of perioperative complications in women who underwent LARVH and RAH. The trial reported two (29%) and four (57%) cases of intraoperative and postoperative complications, respectively, in the LARVH group and no (0%) reported cases of intraoperative complications and five (83%) cases of postoperative complications in the RAH group. There were no reported cases of severe perioperative complications.Bladder and bowel dysfunction of either a transient or chronic nature remain major morbidities after radical hysterectomy, and the one included study showed that there may be significantly less after LARVH.
AUTHORS' CONCLUSIONS
The included trial lacked statistical power due to the small number of women in each group and the low number of observed events. Therefore, the absence of reliable evidence, regarding the effectiveness and safety of the two surgical techniques for the management of early-stage cervical cancer, precludes any definitive guidance or recommendations for clinical practice. The trial did not report data on long-term outcomes, but was at moderate risk of bias due to very low numbers of included women.
Topics: Adult; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Neoplasm Staging; Randomized Controlled Trials as Topic; Uterine Cervical Neoplasms
PubMed: 24085528
DOI: 10.1002/14651858.CD006651.pub3 -
Journal of Clinical and Diagnostic... Apr 2016
PubMed: 27190823
DOI: 10.7860/JCDR/2016/16505.7531 -
Translational Cancer Research May 2021Cervical cancer is a common malignant tumor in women. This study aims to explore the clinical effects of traditional laparotomy, extensive vaginal hysterectomy and...
Clinical value of traditional laparotomy, extensive vaginal hysterectomy, and laparoscope-assisted vaginal hysterectomy in the treatment of patients with cervical intraepithelial neoplasia III.
BACKGROUND
Cervical cancer is a common malignant tumor in women. This study aims to explore the clinical effects of traditional laparotomy, extensive vaginal hysterectomy and laparoscope-assisted vaginal hysterectomy in the treatment of patients with cervical intraepithelial neoplasia III (CIN III).
METHODS
A total of 79 cases with CIN III who were treated in our hospital from July 2015 to February 2017 were selected as the study participants. According to the different surgical methods employed, patients were divided into a laparotomy group (n=21), a vaginal group (n=26), and a laparoscope-assisted vaginal group (n=32). The operative indicators in the three groups were compared, as well as the operative complications, quality of life, and female sexual function.
RESULTS
The operation time, intraoperative blood loss, and hospitalization time in the laparotomy group were all significantly greater than those in the vaginal and laparoscope-assisted vaginal groups (P<0.05), and the operative time was the shortest in the vaginal group. There was no significant difference in postoperative recovery time, drainage tube removal time, and time to out-of-bed activation between the vaginal group and the laparoscope-assisted vaginal group (P>0.05). After surgery, the main complications were poor wound healing, infection, vaginal discharge, and neoplasms of the vagina, and the total incidence of complications in the laparotomy group was 19.04%, which was significantly higher than that in the vaginal group (3.84%) and the laparoscope-assisted vaginal group (3.12%) (P<0.05). Three months after surgery, the physical and emotional function scores of patients in the laparoscope-assisted vaginal group were significantly higher than those in the laparotomy and vaginal groups (P<0.05). Six months after surgery, there were no significant differences among the three groups in scores of libido, sexual intercourse pain, orgasm, or difficulty in sexual intercourse (P>0.05).
CONCLUSIONS
Laparoscope-assisted vaginal hysterectomy has a short recovery time and a low incidence of complications in patients with early cervical cancer . Compared with laparotomy and vaginal hysterectomy, laparoscope-assisted vaginal hysterectomy is more conducive to improving the postoperative quality of life of patients.
PubMed: 35116556
DOI: 10.21037/tcr-21-679 -
Journal of the Turkish German... Dec 2017This book presents a step-by-step surgical description of vaginal hysterectomy, abdominal hysterectomy, conventional laparoscopic hysterectomy, and robotic-assisted...
This book presents a step-by-step surgical description of vaginal hysterectomy, abdominal hysterectomy, conventional laparoscopic hysterectomy, and robotic-assisted hysterectomy. It brings into balance theoretical background, clinical experience, and scientific findings in a readily comprehensible form with numerous illustrations and tables. The book contains a large proportion of interdisciplinary aspects that make a substantial contribution to meeting the growing requirements of interdisciplinary medical treatment. It offers related disciplines the opportunity to describe areas of common overlap and how these can be treated. Verschiedene chirurgische Verfahren einschließlich vaginaler Hysterektomie, abdominaler Hysterektomie, konservativer laparoskopischer Hysterektomie und roboterassistierter Hysterektomie werden in diesem englischsprachigen Lehrbuch schrittweise beschrieben. In ausgewogener Art und Weise werden theoretische Hintergründe, klinische Erfahrungen und wissenschaftliche Erkenntnisse in leicht verständlicher Form mit zahlreichen Abbildungen und Tabellen dargestellt. Indem es verschiedene interdisziplinäre Aspekte behandelt, wird das Buch den wachsenden Anforderungen der interdisziplinären medizinischen Therapie gerecht. Benachbarte medizinische Fachbereiche kommen zu Wort und haben die Möglichkeit, überlappende Krankheitsbilder und deren Behandlung zu erläutern.
PubMed: 29278237
DOI: 10.4274/jtgga.2017.0097 -
Deutsches Arzteblatt International Dec 2014Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum... (Review)
Review
BACKGROUND
Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum of available treatments has been widened by the introduction of new drugs and interventional procedures.
METHODS
Selective literature review on the treatment of uterine fibroids, including consideration of several Cochrane Reviews.
RESULTS
Fibroids can be treated with drugs, interventional procedures (uterine artery embolization [UAE] and focused ultrasound treatment [FUS]), and surgery. The evidence regarding the various available treatments is mixed. All methods improve symptoms, but only a few comparative studies have been performed. A meta-analysis revealed that recovery within 15 days is more common after laparoscopic enucleation than after open surgery (odds ratio [OR], 3.2). A minimally invasive hysterectomy, or one performed by the vaginal route, is associated with a shorter hospital stay and a more rapid recovery than open transabdominal hysterectomy. UAE is an alternative to hysterectomy for selected patients. The re-intervention rates after fibroid enucleation, hysterectomy, and UAE are 8.9-9%, 1.8-10.7%, and 7-34.6%, respectively. The main drugs used to treat fibroids are gonadotropin-releasing hormone analogs and selective progesterone receptor modulators.
CONCLUSION
Multiple treatment options are available and enable individualized therapy for symptomatic fibroids. The most important considerations in the choice of treatment are the question of family planning and, in some cases, the technical limitations of the treatments themselves.
Topics: Antineoplastic Agents; Combined Modality Therapy; Evidence-Based Medicine; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Minimally Invasive Surgical Procedures; Organ Preservation; Treatment Outcome; Ultrasonography; Uterine Neoplasms
PubMed: 25597366
DOI: 10.3238/arztebl.2014.0877