6. Why Did he say so about
Hysterectomy ?
• Second most frequent
surgical procedure in
women of reproductive
age group
• 90% for benign reasons
• Promptly offered
following a
diagnosis.
• Hysterectomy should not
be taken up lightly.
7. BIG FACT !!
Women AGE early even if
ovaries
are retained
At
Hysterectomy
All Elders endorse this fact
8. KJ Carlson, NEJM 328:856,
1993
DisadvantagesDisadvantages
• Performed under general or regional
anesthesia
• Long hospitalization and recovery time
• Mortality 0.6-1/1,000
• Major complications 3%
• Morbidity 24-43%
• Psychological 25-35%
• Long period of convalescence
Hysterectomy is
Not 100% safe
9. Do You want to guess
the
Number
of
HYSTERECTOMY
done in India ?
10. USA 5.9 lac
UK 1.3 lac
Russia 3.12 lac
India 23.2 lac
CDC
Numbers of
Hysterectomies Per year
14. DUB 20%DUB 20%
FibroidsFibroids 30%30%
Endometriosis/Endometriosis/
Adenomyosis 20%Adenomyosis 20%
(Pre) cancer(Pre) cancer
10%10%
Chronic pelvic pain 10%Chronic pelvic pain 10%ProlapseProlapse 15%15%
Indications of HysterectomyIndications of Hysterectomy
In USAIn USA
Indications of HysterectomyIndications of Hysterectomy
In USAIn USA
1990 - 2000
21. Who has Caused this
Menace in India ?
Gynaecologists
&
Surgeons
22. How western world has
↓↓↓ Hysterectomy Rate?
Big Question
ACOG / Royal College
23.
24. February, 2000, Vol 95,February, 2000, Vol 95,
No. 2, Pages 199-205No. 2, Pages 199-205
The Appropriateness of RecommendationsThe Appropriateness of Recommendations
for Hysterectomyfor Hysterectomy
Michael S. Broder, MD, David E. Kanouse, PhD,Michael S. Broder, MD, David E. Kanouse, PhD,
Brian S. Mittman, PhD, and Steven J. Bernstein, MD, MPHBrian S. Mittman, PhD, and Steven J. Bernstein, MD, MPH
25. 76%76% of the patients who were takenof the patients who were taken
up for hysterectomyup for hysterectomy did not meetdid not meet
ACOGACOG
criteria for hysterectomycriteria for hysterectomy
*Obstet Gynecol 2000;95:199-205*Obstet Gynecol 2000;95:199-205
The Appropriateness of
Recommendations for Hysterectomy*
Michael S. Broder, MD, David E. Kanouse,
PhD,
Brian S. Mittman, PhD, and Steven J.
Bernstein MD, MPH
26. ““The most common reasons for whichThe most common reasons for which
hysterectomies were consideredhysterectomies were considered
inappropriate wereinappropriate were
• lack of adequate diagnostic evaluationlack of adequate diagnostic evaluation
• failure to try alternative treatmentsfailure to try alternative treatments
before hysterectomy.”before hysterectomy.”
*Obstet Gynecol 2000;95:199-205*Obstet Gynecol 2000;95:199-205
27. KJ Carlson, NEJM 328:856,
1993
HYSTERECTOMY
as Treatment
Should be last resort
39. • Mirena provides most effective medical
treatment with least side effects
• It can replace in about 50 % cases the need for
endometrial ablation or hysterectomy
• Especially useful when presently contraception
is required but future fertility is desired
Conclusions about Mirena
40. We have largest Number of
cases
of MIRENA
in Delhi & NCR
(2013 upto 30th
June)
41. •
SuccessSuccess isis 8080 toto 90%90%
•Repeat procedure / HysterectomyRepeat procedure / Hysterectomy ––
10 to 20%10 to 20%
Amenorrhea, ↓↓ bleeding in overAmenorrhea, ↓↓ bleeding in over 90%90%
GLOBAL ENDO.GLOBAL ENDO.
ABLATIONABLATION TECHNIQUESTECHNIQUES
(10-15 years)(10-15 years)
48. ° Think rationally yourself.
° Vow yourself &
° Join the Movement for
motivating 10 other
gynaecologists to do the
same
Let us come forward to stop this
menace of uterus removal.
49. No way should
SURGEONS be
allowed to do
hysterectomy in
India ……
Such practices
should become
history !!
WHY SHOULD’NT A HYSTERECTOMY BE AVOIDED IF THE BENEFIT CAN BE PROVIDED TO A GOOD NO, OF PATIENTS BY A SAFER ALTERNATIVE TT MODALITY COZ HYSTERECTOMY DOES CARRY RISKS OF ANAESTHESIA ETC
As u can see from thslide that 20 % of all hystrec are done for dub alone so if we take that chunk out of the pie and treat a lot of these patients with newer modalities you can understand the impact IT WOULD HAVE on the morbidity and financial implications.
The rcog issued evidence based clinical guidelines in 1998 on initial management of menorrhagia and were subsequently updated.
THERE HAVE BEEN SEVERAL STUDIES PUBLISHED IN VARIOUS JOURNALS QUESTIONING THE APPROPRIATENESS OF HYSTERECTOMY
Why would hysterectomies be performed inappropriately BECAUSE OF
WHY SHOULD’NT A HYSTERECTOMY BE AVOIDED IF THE BENEFIT CAN BE PROVIDED TO A GOOD NO, OF PATIENTS BY A SAFER ALTERNATIVE TT MODALITY COZ HYSTERECTOMY DOES CARRY RISKS OF ANAESTHESIA ETC
THE SECOND SESSION WILL HAVE A DETAILED PRESENTATION BY DR SHARDA JAIN AS WELL AS THE PATIENTS OWN EXPEREINCES REGARDING THE UTERINE BALLOON THERAPY
