scholarly journals Basic Standard Procedure of Abdominal Hysterectomy: Part 1

2019 ◽  
Vol 05 (S 01) ◽  
pp. S2-S10
Author(s):  
Yuji Hiramatsu
Keyword(s):  
Standard Procedure ◽  
Outer Wall ◽  
Total Abdominal Hysterectomy ◽  
Ureteral Injury ◽  
Abdominal Hysterectomy ◽  
Second Step ◽  
Bladder Injury ◽  
Intestinal Damage ◽  
Cardinal Ligament ◽  
Basic Standard

Total abdominal hysterectomy (TAH) is commonly referred to as extrafascial hysterectomy. This article explains the basic surgical procedure of TAH as taught to residents. TAH is an operation to remove the uterus with the outer wall of the uterus, and is a fundamental operation that gynecologists must master. Possible complications during TAH include ureteral injury, intestinal damage, and bladder injury. To avoid operative complications, it is important to follow the correct release layer procedure and ensure that “the uterus has been naturally removed.”The two most important points of the authors' method to avoid complications are as follows: (1) cut sequentially from the ligament away from the ureter which moves the ureter further away from the cervix with each transection stage; (2) cut the parametrial tissue along the circumference of the cervix in the next three steps:First step: clamping and cutting the uterine artery and upper part of the cardinal ligament; second step: clamping and cutting the sacrouterine ligament and the posterior half of the cardinal ligament; third step: clamping and cutting the vesicouterine ligament and anterior half of the cardinal ligament.

scholarly journals Iatrogenic bladder injury: A single institution’s ten-year experience in treatment and outcome 1999-2009, Kuala Lumpur, Malaysia

2011 ◽  
pp. 215-218
Author(s):  
Christopher CK Ho ◽  
Hans Alexander ◽  
Praveen Singam ◽  
Lee Boon Cheok ◽  
Zulkifli MD Zainuddin
Keyword(s):  
Caesarean Section ◽  
Retrospective Review ◽  
Enterocutaneous Fistula ◽  
Case Series ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Caesarian Section ◽  
Bladder Injury ◽  
Absorbable Sutures ◽  
Bladder Injuries

Introduction: This case series is a retrospective review of iatrogenic bladder injuries treated at our institution Universiti Kebangsaan Malaysia, Medical Centre, over a ten-year period, from 1999 to 2009. Materials and methods: A retrospective review of the operating theater database yielded the names and registration numbers of patients who underwent operative repair of bladder injuries. Patients who sustained bladder injuries due to non-surgical reasons (such as traumatic bladder injuries due to pelvic fractures, blunt trauma or penetrating injuries to the pelvis) were excluded. Results: There were 12 cases of iatrogenic bladder injury treated during this time. A total of eight injuries occurred during gynaecological surgery. Five injuries occurred during lower segment caesarean section, two injuries during total abdominal hysterectomy and bilateral salpingo-oopherectomy, and a single injury during Burch colposuspension. Four out of the five injuries during caesarian section had a history of previous caesarian section. Of the four remaining non-gynaecological related injuries, two injuries occurred during hernioplasty, one during exploration of an enterocutaneous fistula and the other was during laparoscopic appendicectomy. Conclusion: Iatrogenic bladder injury should be anticipated in patients undergoing caesarean section who have had multiple previous caesarean sections. Iatrogenic injuries should be identified intra-operatively to enable early repair and the best outcome. These injuries were adequately assessed by ascending cystography. Continuous repair with absorbable sutures together with perivesicle drainage and bladder catheterization produces good outcome.

scholarly journals Indications and Prevalence of Hysterectomy for Benign Conditions at a Tertiary Care Hospital in Rural South India–A Descriptive Study

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 1788-1793
Author(s):  
Chanakya C ◽  
Padmashri P
Keyword(s):  
Surgical Management ◽  
Rural Women ◽  
Tertiary Care ◽  
Total Abdominal Hysterectomy ◽  
Descriptive Study ◽  
Abdominal Hysterectomy ◽  
Bladder Injury ◽  
Care Hospital ◽  
Standard Type ◽  
Excessive Bleeding

This study aims to assess the indications and prevalence often various types of hysterectomy done for benign diseases. It was a retrospective descriptive study conducted at the Department of Obstetrics and Gynaecology in Saveetha Medical College and Hospital, Thandalam. Data about the hysterectomies done for benign conditions were obtained from January 2019 till December 2019 from the in-hospital medical registry. Demographics, presenting complaints, indications, history, type of hysterectomy and complications were analysed. Amongst the two hundred (200) cases of hysterectomy performed in the year 2019, total abdominal hysterectomy (69%) was the most standard type and Leiomyoma uterus (73.5%) being the most common indication. Bilateral Salphingo-Oophorectomy (55%) was done in most patients, along with hysterectomy. Due to the advent of safer surgical practices, the extent of complications have drastically reduced, excessive bleeding (13.5%) being the most common, surgical site infection (1.5%) and bladder injury (1.5%) were recorded. This study demonstrates that though the incidence of hysterectomy done for benign conditions is decreasing with increasing popularity to go for medical management, women in rural India are still opting for surgical management. This necessitates the need for studies to analyse the psychological aspect governing the acceptance of surgical management in preference to conservative management in these rural women.

scholarly journals Pre- and Postoperative Evaluation of Operated Myoma Uteri Patients: a 5-Year Tertiary Care Experience

2019 ◽  
Vol 1 (1) ◽  
pp. 8-12
Author(s):  
Hıdır Budak ◽  
Rezan Buğday ◽  
Mehmet Şükrü Budak ◽  
Ahmet Yalınkaya ◽  
Adnan Budak ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Bladder Injury ◽  
Complication Rates ◽  
Hysteroscopic Myomectomy ◽  
Care Experience ◽  
Abdominal Myomectomy ◽  
Fertility Expectations

Introduction: This study aims to evaluate the pre- and postoperative outcomes of myomas operated in a tertiary clinic. Method: We retrospectively evaluated data from a total of 378 cases operated for myomas between January 2014 and December 2018 in the Dicle University Medical Faculty Obstetrics and Gynecology Clinic.   Results: There were 169 cases of abdominal myomectomy (44.7%), 156 cases of total abdominal hysterectomy (41.3%), 15 cases of laparoscopic myomectomy (4%), 13 cases of total laparoscopic hysterectomy (3.4%), 12 cases of myomectomy during cesarean delivery (3.2%), 9 cases of hysteroscopic myomectomy (2.4%), and 4 cases of vaginal myomectomy (1.1%). Pathology results revealed 341 cases of leiomyoma (88.2%), 32 cases of concomitant leiomyoma and adenomyosis (8.4%), and 13 cases of STUMP (3.3%). There were 5 cases of intraoperative bowel injury, 1 case of bladder injury, and 1 case of postoperative wound infection. Conclusion: Myomas can be surgically treated with satisfactory outcomes and low complication rates. The preferred surgical treatment will majorly depend on the patient's fertility expectations.

scholarly journals Subinvolution of the placental site as the cause of hysterectomy in young woman

2021 ◽  
Vol 14 (2) ◽  
pp. e238945
Author(s):  
Olga Triantafyllidou ◽  
Stavroula Kastora ◽  
Irini Messini ◽  
Dimitrios Kalampokis
Keyword(s):  
Young Woman ◽  
Young Women ◽  
Postpartum Haemorrhage ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Fertility Sparing ◽  
Placental Site ◽  
Retained Products

Subinvolution of placental sites (SPSs) is a rare but severe cause of secondary postpartum haemorrhage (PPH). SPS is characterised by the abnormal persistence of large, dilated, superficially modified spiral arteries in the absence of retained products of conception. It is an important cause of morbidity and mortality of young women. In this study, we present a case of secondary PPH in a young woman after uncomplicated caesarean delivery who was deemed clinically unstable, and finally, underwent emergent total abdominal hysterectomy. We reviewed the literature with an emphasis on the pathophysiology of this situation. Treatment of patients with SPS includes conservative medical therapy, hysterectomy and fertility-sparing percutaneous embolotherapy.

scholarly journals Placenta Previa Accreta Spectrum: Cesarean Hysterectomy

2021 ◽  
Author(s):  
Satoru Takeda ◽  
Jun Takeda ◽  
Yoshihiko Murayama
Keyword(s):  
Blood Flow ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Autologous Blood ◽  
Vaginal Wall ◽  
Balloon Occlusion ◽  
Bladder Injury ◽  
Ureteric Injury ◽  
Cardinal Ligament ◽  
Cesarean Hysterectomy

AbstractWhen cesarean hysterectomy is scheduled in cases of placenta previa accreta/increta/percreta, it is necessary that the departments of obstetrics, anesthesiology, blood transfusion, urology, and radiology hold a preoperative conference to assure full preparation for the surgery. A ureteral stent inserted just before cesarean section serves as a marker. A uterine incision should be made at a site free of placental contact. The presence/absence of bladder invasion by villi, adhesions, and the degree of vascularization greatly influence the amount of bleeding, and bleeding control is a key point. For prevention of massive hemorrhage, methods of blood flow blockage, such as balloon occlusion catheterization of the aorta or common iliac artery, should be considered. Stored autologous blood and Cell Saver should be prepared. When hysterectomy is performed with the placenta left in situ, handling of the elongated cardinal ligament, ureteric injury, and bladder injury are important issues because the lower uterine segment is enlarged with the placenta. If blood flow is not blocked, separation of the bladder at the area of placenta percreta should be performed as the last step, to reduce bleeding (Pelosi's method). At this time, after handling of the cardinal ligament, bladder separation can be performed more safely if the posterior vaginal wall is incised and exposed first.In cases of placenta accreta or partial placenta accreta/increta/percreta, a diagnosis of morbidly adherent placenta may not be obtained until separation of the placenta is performed. If bleeding from the placental separation surface cannot be controlled, total hysterectomy should be performed without hesitation.

scholarly journals Large cervical fibroid: a rare case report

2019 ◽  
Vol 8 (8) ◽  
pp. 3414
Author(s):  
Sunanda N.
Keyword(s):  
Uterine Fibroids ◽  
Total Abdominal Hysterectomy ◽  
Large Mass ◽  
Abdominal Hysterectomy ◽  
Reproductive Age ◽  
Pelvic Tumors ◽  
Rare Case Report ◽  
Tender Mass ◽  
Restricted Mobility ◽  
Reproductive Age Group

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases. 

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