hysterectomy Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):749-751
DOI 10.1590/S0100-72032003001000009
Fallopian tube prolapse is a rare complication after hysterectomy, with approximately 80 cases described in the literature. The symptoms are nonspecific including vaginal bleeding, dyspareunia and chronic pelvic pain. The differential diagnosis must be done with granulation tissue of the vaginal cuff and vaginal carcinoma. The treatment should be individualized, and is possible to be done by vaginal, abdominal or laparoscopic approach. We report a case of a 47-year-old woman with myoma who was submitted to a vaginal hysterectomy and evolved with fallopian tube prolapse 11 months after surgery. Specular examination showed a fungating, friable and bleeding lesion at the vaginal cuff. The clinical findings suggested the diagnosis of fallopian tube prolapse. The patient was submitted to a new surgical intervention with resection of the left fallopian tube. The histologic examination confirmed the diagnosis and the patient evolved with complete remission of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):749-751
DOI 10.1590/S0100-72032003001000009
Fallopian tube prolapse is a rare complication after hysterectomy, with approximately 80 cases described in the literature. The symptoms are nonspecific including vaginal bleeding, dyspareunia and chronic pelvic pain. The differential diagnosis must be done with granulation tissue of the vaginal cuff and vaginal carcinoma. The treatment should be individualized, and is possible to be done by vaginal, abdominal or laparoscopic approach. We report a case of a 47-year-old woman with myoma who was submitted to a vaginal hysterectomy and evolved with fallopian tube prolapse 11 months after surgery. Specular examination showed a fungating, friable and bleeding lesion at the vaginal cuff. The clinical findings suggested the diagnosis of fallopian tube prolapse. The patient was submitted to a new surgical intervention with resection of the left fallopian tube. The histologic examination confirmed the diagnosis and the patient evolved with complete remission of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):443-448
DOI 10.1590/S0100-72032000000700007
Purpose: to determine the main factors associated with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP). Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414). The frequency of surgical site infection (defined according to the CDC criteria, 1998) was 10% (42 cases). Prevalence risk (PR) of infection (dependent variable) and its 95% confidence interval (CI) were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94), obesity (PR = 3.2, 95% CI = 1.83-5.59), duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21) and diabetes (PR = 6.0, 95% CI = 3.41-10.57). On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68). Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):443-448
DOI 10.1590/S0100-72032000000700007
Purpose: to determine the main factors associated with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP). Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414). The frequency of surgical site infection (defined according to the CDC criteria, 1998) was 10% (42 cases). Prevalence risk (PR) of infection (dependent variable) and its 95% confidence interval (CI) were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94), obesity (PR = 3.2, 95% CI = 1.83-5.59), duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21) and diabetes (PR = 6.0, 95% CI = 3.41-10.57). On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68). Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):371-376
DOI 10.1590/S0100-72032001000600005
Purpose: to evaluate the results of the first 104 hysteroscopic polypectomies in a teaching hospital. Methods: a retrospective descriptive study was designed. Medical records of the first 136 operative hysteroscopies - 104 of which polypectomies - were reviewed. Patient characteristics such as age, parity, period of reproductive function and symptoms; number and size of polyps and results concerning complications and symptom relief were evaluated. Results: the average age of patients was 52.7 years. Three quarters of them were multiparous. Fifty-seven percent of the patients were menopaused. About half of the patients had symptoms related to polyps. Abnormal bleeding was the most frequent symptom (47.1%). In 16.3% of the patients more than 1 polyp were detected and 84% of the polyps were larger than 1 cm. The only immediate complication was a uterine perforation. Late complications were rare and mild. The follow-up period was 9 months on average. In 82% of teh patients the symptoms were controlled. Hysterectomy was necessary in 8.2% of the patients, all of them with other uterine diseases such as leiomyomas, adenomyosis and atypical endometrial hyperplasia in one patient). Conclusion: hysteroscopic polypectomy is a simple, safe and effective method for the treatment of endometrial polyps. Selection of patients must be rigorous to avoid further operative procedures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(6):371-376
DOI 10.1590/S0100-72032001000600005
Purpose: to evaluate the results of the first 104 hysteroscopic polypectomies in a teaching hospital. Methods: a retrospective descriptive study was designed. Medical records of the first 136 operative hysteroscopies - 104 of which polypectomies - were reviewed. Patient characteristics such as age, parity, period of reproductive function and symptoms; number and size of polyps and results concerning complications and symptom relief were evaluated. Results: the average age of patients was 52.7 years. Three quarters of them were multiparous. Fifty-seven percent of the patients were menopaused. About half of the patients had symptoms related to polyps. Abnormal bleeding was the most frequent symptom (47.1%). In 16.3% of the patients more than 1 polyp were detected and 84% of the polyps were larger than 1 cm. The only immediate complication was a uterine perforation. Late complications were rare and mild. The follow-up period was 9 months on average. In 82% of teh patients the symptoms were controlled. Hysterectomy was necessary in 8.2% of the patients, all of them with other uterine diseases such as leiomyomas, adenomyosis and atypical endometrial hyperplasia in one patient). Conclusion: hysteroscopic polypectomy is a simple, safe and effective method for the treatment of endometrial polyps. Selection of patients must be rigorous to avoid further operative procedures.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):153-157
DOI 10.1590/S0100-72032001000300004
Purpose: to evaluate the clinical and therapeutic aspects of septic abortion, and to identify a group at high risk for complications. Methods: a retrospective study of 224 cases of patients with septic abortion was conducted. Age, parity, clinical and ultrasonographic diagnosis, and therapeutic data were collected from medical charts. The information about induced abortion was provided by the patients and/or their relatives and accompanying persons. Septic abortion was diagnosed based on clinical data, leukocyte count, adnexal and uterine pain, and purulent cervical discharge. Results: the average age of patients was 21.4 ± 6.2 years. Forty-five (20.1%) patients were 19 years old or less. Sixty-six (29.5%) were primiparous and 55 (24.5%) were secundiparous. In 143 (63.8%) women it was the first abortion. The most common clinical signs were hemorrhage (83.9%) and fever (61.1%). Of the total of patients, 37.9% declared that they had an induced abortion, 33.9% declared spontaneous abortion and 28.2% did not inform. Hysterectomies were performed in five cases. No hysterectomy was performed in the group with spontaneous abortion (2.2%), which had a reduced number of complications: (3.9% versus 11.8% in the group with induced abortion), p<0.05. Conclusion: septic abortion is a more serious problem in patients who declared induced abortion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):153-157
DOI 10.1590/S0100-72032001000300004
Purpose: to evaluate the clinical and therapeutic aspects of septic abortion, and to identify a group at high risk for complications. Methods: a retrospective study of 224 cases of patients with septic abortion was conducted. Age, parity, clinical and ultrasonographic diagnosis, and therapeutic data were collected from medical charts. The information about induced abortion was provided by the patients and/or their relatives and accompanying persons. Septic abortion was diagnosed based on clinical data, leukocyte count, adnexal and uterine pain, and purulent cervical discharge. Results: the average age of patients was 21.4 ± 6.2 years. Forty-five (20.1%) patients were 19 years old or less. Sixty-six (29.5%) were primiparous and 55 (24.5%) were secundiparous. In 143 (63.8%) women it was the first abortion. The most common clinical signs were hemorrhage (83.9%) and fever (61.1%). Of the total of patients, 37.9% declared that they had an induced abortion, 33.9% declared spontaneous abortion and 28.2% did not inform. Hysterectomies were performed in five cases. No hysterectomy was performed in the group with spontaneous abortion (2.2%), which had a reduced number of complications: (3.9% versus 11.8% in the group with induced abortion), p<0.05. Conclusion: septic abortion is a more serious problem in patients who declared induced abortion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(7):445-448
DOI 10.1590/S0100-72032001000700006
Purpose: to evaluate the results of 64 hysteroscopic endometrial ablations using a resectoscope in women with abnormal uterine bleeding of benign etiology and nonresponsive to clinical measures and to describe the failures and their associated conditions. Methods: sixty-four patients with abnormal uterine bleeding were submitted to the intervention between April 1994 and February 2000. The mean age was 42.9 years and the mean parity, 2.6 deliveries. Diagnostic hysteroscopy and endometrial biopsy were performed preoperatively. Before surgery, two women received gestrinone, six danazol and 44 GnRH analogue. During the surgery electric cauterization of the fundus uteri and cornual regions was made. Afterwards, with a resectoscope, the endometrium was removed as far as 1 cm above the internal ostium, and as deep as 2 to 3 mm into the myometrium. The uterine distension was obtained with 1.5% glycine and since two years ago with 3% manitol. The average follow-up was 11.5 months. After six months of endometrial ablation, the patients with persistence of symptoms were submitted to hysterectomy. Results: amenorrhea occurred in 31.2% of the patients and hypomenorrhea in 45.3%. The abnormal bleeding was maintained in 23.5%. There was one uterine perforation during the dilatation of the cervix. Results were better in the higher age and parity ranges and in the women who received GnRH analogues (p=0.03). Where the method was not successful there was a statistically significant frequency of submucous myoma (p=0.04) and a nonsignificant increase of secretory endometrium (p=0.12). Conclusions: the method is useful for the management of abnormal uterine bleeding of benign etiology. Previous administration of GnRH analogue is recommended. We suggest a special follow-up for the younger, low parous women, and those with submucous myoma, because they are the group with the poorest results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(7):445-448
DOI 10.1590/S0100-72032001000700006
Purpose: to evaluate the results of 64 hysteroscopic endometrial ablations using a resectoscope in women with abnormal uterine bleeding of benign etiology and nonresponsive to clinical measures and to describe the failures and their associated conditions. Methods: sixty-four patients with abnormal uterine bleeding were submitted to the intervention between April 1994 and February 2000. The mean age was 42.9 years and the mean parity, 2.6 deliveries. Diagnostic hysteroscopy and endometrial biopsy were performed preoperatively. Before surgery, two women received gestrinone, six danazol and 44 GnRH analogue. During the surgery electric cauterization of the fundus uteri and cornual regions was made. Afterwards, with a resectoscope, the endometrium was removed as far as 1 cm above the internal ostium, and as deep as 2 to 3 mm into the myometrium. The uterine distension was obtained with 1.5% glycine and since two years ago with 3% manitol. The average follow-up was 11.5 months. After six months of endometrial ablation, the patients with persistence of symptoms were submitted to hysterectomy. Results: amenorrhea occurred in 31.2% of the patients and hypomenorrhea in 45.3%. The abnormal bleeding was maintained in 23.5%. There was one uterine perforation during the dilatation of the cervix. Results were better in the higher age and parity ranges and in the women who received GnRH analogues (p=0.03). Where the method was not successful there was a statistically significant frequency of submucous myoma (p=0.04) and a nonsignificant increase of secretory endometrium (p=0.12). Conclusions: the method is useful for the management of abnormal uterine bleeding of benign etiology. Previous administration of GnRH analogue is recommended. We suggest a special follow-up for the younger, low parous women, and those with submucous myoma, because they are the group with the poorest results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(7):417-422
DOI 10.1590/S0100-72032001000700002
Purpose: to investigate risk factors associated with accretion in placenta previa (PP) patients. Methods: this was a retrospective case-control study of all the records of patients who delivered between 1986-1998 at Maternidade Escola de Vila Nova Cachoeirinha (São Paulo) with a diagnosis of placenta previa. The groups with and without accretion were compared regarding age, parity, previous history of miscarriage, curettage and cesarean section, type of PP and predominant area of placental attachment. Possible associations between the dependent (accretion) and independent (maternal and placental characteristics) variables were evaluated using the chi² test, univariate and multivariate analyses. Results: reviewing 245 cases of PP, two risk factors were significantly associated with accretion: central placenta previa (odds ratio (OR): 2.93) and two or more previous cesarean sections(OR: 2.54). Based on these data, a predictive model was constructed, according to which a patient with central PP and two more previous cesarean sections has a 44.4% risk for accretion. Conclusions: results of the current study may help obstetricians in the classification of their patients with PP in different risk categories for accretion. This could be useful in preparing for possible delivery complications in those patients considered at a higher risk for accretion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(7):417-422
DOI 10.1590/S0100-72032001000700002
Purpose: to investigate risk factors associated with accretion in placenta previa (PP) patients. Methods: this was a retrospective case-control study of all the records of patients who delivered between 1986-1998 at Maternidade Escola de Vila Nova Cachoeirinha (São Paulo) with a diagnosis of placenta previa. The groups with and without accretion were compared regarding age, parity, previous history of miscarriage, curettage and cesarean section, type of PP and predominant area of placental attachment. Possible associations between the dependent (accretion) and independent (maternal and placental characteristics) variables were evaluated using the chi² test, univariate and multivariate analyses. Results: reviewing 245 cases of PP, two risk factors were significantly associated with accretion: central placenta previa (odds ratio (OR): 2.93) and two or more previous cesarean sections(OR: 2.54). Based on these data, a predictive model was constructed, according to which a patient with central PP and two more previous cesarean sections has a 44.4% risk for accretion. Conclusions: results of the current study may help obstetricians in the classification of their patients with PP in different risk categories for accretion. This could be useful in preparing for possible delivery complications in those patients considered at a higher risk for accretion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):579-584
DOI 10.1590/S0100-72032002000900003
Purpose: to evaluate the sensitivity, specificity, positive and negative predictive values of a clinical and an ecographic method for adenomyosis diagnosis. Methods: a transversal study of validation of the diagnostic method was done, including 95 women in menacme submitted to hysterectomy for various causes. Adenomyosis was diagnosed through a clinical method in women aged 40 years or older, with 2 or more deliveries, increased menstrual bleeding associated with dysmenorrhea. The ecographic diagnosis was established if at least one myometrial ill defined area of abnormal ecotexture was found, which could be hypoechoic, hyperchoic, heterogeneous or cystic. Gold standard was histopathology, defined as the finding of endometrial glands or stroma more than 2.5 cm above the endomiometrial junction. Results: the clinical method had 68.2% sensitivity, 78.1% specificity, 48.4% positive predictive value and 89.1% negative predictive value. For the echographic method this figures were, respectively, 45.5%, 84.9%, 47.6% and 83.8%. Likelihood ratio was 3.11 for the clinical and 3.03 for the echographic method. Considering only those simultaneously positive cases by both methods, sensitivity was below 30% and specificity was near 100%. Considering all positive cases by one or the other method or concomitanty by both, the sensitivity reached 86% and specificity was 60%. Conclusion: the echographic method was not better than the clinical for the diagnosis of adenomyosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):579-584
DOI 10.1590/S0100-72032002000900003
Purpose: to evaluate the sensitivity, specificity, positive and negative predictive values of a clinical and an ecographic method for adenomyosis diagnosis. Methods: a transversal study of validation of the diagnostic method was done, including 95 women in menacme submitted to hysterectomy for various causes. Adenomyosis was diagnosed through a clinical method in women aged 40 years or older, with 2 or more deliveries, increased menstrual bleeding associated with dysmenorrhea. The ecographic diagnosis was established if at least one myometrial ill defined area of abnormal ecotexture was found, which could be hypoechoic, hyperchoic, heterogeneous or cystic. Gold standard was histopathology, defined as the finding of endometrial glands or stroma more than 2.5 cm above the endomiometrial junction. Results: the clinical method had 68.2% sensitivity, 78.1% specificity, 48.4% positive predictive value and 89.1% negative predictive value. For the echographic method this figures were, respectively, 45.5%, 84.9%, 47.6% and 83.8%. Likelihood ratio was 3.11 for the clinical and 3.03 for the echographic method. Considering only those simultaneously positive cases by both methods, sensitivity was below 30% and specificity was near 100%. Considering all positive cases by one or the other method or concomitanty by both, the sensitivity reached 86% and specificity was 60%. Conclusion: the echographic method was not better than the clinical for the diagnosis of adenomyosis.
