Hysterectomy is a common surgery but has risks and downsides. There are often alternatives to removing the uterus that can treat conditions like fibroids without surgery. Non-surgical options include medications, uterine artery embolization, MRI-guided focused ultrasound, and other procedures to destroy or remove fibroids. While hysterectomy may be necessary in some cases, it should not be the default option and removing just the disease rather than the whole organ is preferable when possible.
Radical hysterectomy is a surgical procedure for treating cervical cancer. It involves removing the uterus, cervix, part of the vagina, and nearby lymph nodes and tissue. There are different classifications of radical hysterectomy based on the extent of tissue removed. Complications can include bleeding, infection, injury to nearby organs like the bladder or ureters. Radical hysterectomy is indicated for early stage cervical cancer and may provide better survival outcomes than radiation alone for some patients.
Radiotherapy plays a major role in treating gynecological cancers. New technologies like 3D planning and IMRT allow radiation oncologists to restrict dose to the tumor while sparing normal tissues. The addition of chemotherapy to radiotherapy has improved outcomes for locally advanced cervical cancer. Radiation causes cell death primarily through DNA damage from free radicals. Fractionation allows normal tissue repair between doses. Factors like oxygenation and cell cycle phase influence radiosensitivity. Combining radiotherapy with surgery or chemotherapy can further improve local control and survival. Careful treatment planning is needed to balance tumor control with risks to surrounding organs.
This document summarizes a presentation given by Dr. Rajni Singh on vaginal hysterectomy techniques. Key points include:
- Vaginal hysterectomy is the safest and most cost-effective surgical route for conditions like fibroids and abnormal bleeding, with less complications and faster recovery compared to abdominal hysterectomy.
- Evaluation of pelvic support and anatomy is important prior to the surgery.
- Techniques like bladder dissection, use of curved scissors and hemostatic systems like Ligasure can aid in performing a bloodless procedure.
- Post-operative care includes catheter removal after 12 hours and discharge usually within 24-36 hours. Potential complications include vault hematoma, infections and urinary tract injuries
The document discusses the lymphatic drainage patterns of the vulva and vagina and describes vulval cancer. It notes that the vulva has dense lymphatic plexuses that drain to the superficial and deep inguinal lymph nodes and external iliac nodes. Vulval cancer is rare and usually occurs in postmenopausal women. Risk factors include conditions like lichen sclerosus. Diagnosis is by biopsy and treatment involves radical vulvectomy with bilateral lymph node dissection or radiotherapy depending on the stage of cancer. Prognosis depends on lymph node involvement, with 5-year survival rates ranging from 90-100% without node involvement to below 20% with positive pelvic nodes.
Fertility Preservation for Gynecologic Cancer PatientsJibran Mohsin
This document discusses fertility preservation options for young women diagnosed with gynecologic cancers. It covers cervical, endometrial, and ovarian cancers. For early-stage cervical cancer, conization or radical trachelectomy can allow fertility preservation. For early-stage endometrial cancer, hormonal treatment with progesterone may induce remission and allow attempted pregnancy. For early-stage ovarian cancers including borderline tumors and germ cell tumors, fertility-sparing surgery such as unilateral salpingo-oophorectomy may be an option. Patient selection is crucial to balance oncologic and fertility outcomes.
fertililty sparing surgeries in gynecological cancersSreelasya Kakarla
- Fertility preservation is important for cancer patients of childbearing age to maintain their quality of life. Advances in cancer treatment like chemotherapy and radiation can impact fertility.
- For early stage cervical cancers like stage 1A1, 1A2, and 1B1, fertility sparing surgeries like conization or radical trachelectomy combined with lymph node dissection may be options to preserve fertility while treating the cancer.
- For early stage ovarian and endometrial cancers, fertility sparing surgeries like cystectomy or tumor resection with lymph node sampling can be considered to treat the cancer and spare fertility in select cases.
Cervical cerclage is a surgical procedure where stitches are placed around the cervix to help prevent preterm birth. There are different types of cerclage indicated for various high-risk situations like previous preterm births, cervical insufficiency, or short cervix found on ultrasound. Cerclage can be placed transvaginally or transabdominally depending on the situation. Risks include infection or early rupture of membranes, but cerclage has been shown to delay delivery by 5 weeks on average in rescue situations. The cerclage is usually removed between 36-37 weeks to allow for normal vaginal delivery. Cervical pessaries are a non-surgical alternative that can also help support the
Radical hysterectomy is a surgical procedure for treating cervical cancer. It involves removing the uterus, cervix, part of the vagina, and nearby lymph nodes and tissue. There are different classifications of radical hysterectomy based on the extent of tissue removed. Complications can include bleeding, infection, injury to nearby organs like the bladder or ureters. Radical hysterectomy is indicated for early stage cervical cancer and may provide better survival outcomes than radiation alone for some patients.
Radiotherapy plays a major role in treating gynecological cancers. New technologies like 3D planning and IMRT allow radiation oncologists to restrict dose to the tumor while sparing normal tissues. The addition of chemotherapy to radiotherapy has improved outcomes for locally advanced cervical cancer. Radiation causes cell death primarily through DNA damage from free radicals. Fractionation allows normal tissue repair between doses. Factors like oxygenation and cell cycle phase influence radiosensitivity. Combining radiotherapy with surgery or chemotherapy can further improve local control and survival. Careful treatment planning is needed to balance tumor control with risks to surrounding organs.
This document summarizes a presentation given by Dr. Rajni Singh on vaginal hysterectomy techniques. Key points include:
- Vaginal hysterectomy is the safest and most cost-effective surgical route for conditions like fibroids and abnormal bleeding, with less complications and faster recovery compared to abdominal hysterectomy.
- Evaluation of pelvic support and anatomy is important prior to the surgery.
- Techniques like bladder dissection, use of curved scissors and hemostatic systems like Ligasure can aid in performing a bloodless procedure.
- Post-operative care includes catheter removal after 12 hours and discharge usually within 24-36 hours. Potential complications include vault hematoma, infections and urinary tract injuries
The document discusses the lymphatic drainage patterns of the vulva and vagina and describes vulval cancer. It notes that the vulva has dense lymphatic plexuses that drain to the superficial and deep inguinal lymph nodes and external iliac nodes. Vulval cancer is rare and usually occurs in postmenopausal women. Risk factors include conditions like lichen sclerosus. Diagnosis is by biopsy and treatment involves radical vulvectomy with bilateral lymph node dissection or radiotherapy depending on the stage of cancer. Prognosis depends on lymph node involvement, with 5-year survival rates ranging from 90-100% without node involvement to below 20% with positive pelvic nodes.
Fertility Preservation for Gynecologic Cancer PatientsJibran Mohsin
This document discusses fertility preservation options for young women diagnosed with gynecologic cancers. It covers cervical, endometrial, and ovarian cancers. For early-stage cervical cancer, conization or radical trachelectomy can allow fertility preservation. For early-stage endometrial cancer, hormonal treatment with progesterone may induce remission and allow attempted pregnancy. For early-stage ovarian cancers including borderline tumors and germ cell tumors, fertility-sparing surgery such as unilateral salpingo-oophorectomy may be an option. Patient selection is crucial to balance oncologic and fertility outcomes.
fertililty sparing surgeries in gynecological cancersSreelasya Kakarla
- Fertility preservation is important for cancer patients of childbearing age to maintain their quality of life. Advances in cancer treatment like chemotherapy and radiation can impact fertility.
- For early stage cervical cancers like stage 1A1, 1A2, and 1B1, fertility sparing surgeries like conization or radical trachelectomy combined with lymph node dissection may be options to preserve fertility while treating the cancer.
- For early stage ovarian and endometrial cancers, fertility sparing surgeries like cystectomy or tumor resection with lymph node sampling can be considered to treat the cancer and spare fertility in select cases.
Cervical cerclage is a surgical procedure where stitches are placed around the cervix to help prevent preterm birth. There are different types of cerclage indicated for various high-risk situations like previous preterm births, cervical insufficiency, or short cervix found on ultrasound. Cerclage can be placed transvaginally or transabdominally depending on the situation. Risks include infection or early rupture of membranes, but cerclage has been shown to delay delivery by 5 weeks on average in rescue situations. The cerclage is usually removed between 36-37 weeks to allow for normal vaginal delivery. Cervical pessaries are a non-surgical alternative that can also help support the
The document describes the Pelvic Organ Prolapse Quantification (POP-Q) system for evaluating and documenting pelvic organ prolapse. The POP-Q system uses specific anatomical points of reference to measure the degree of prolapse in centimeters in relationship to the hymen. It is the standard system used internationally for quantifying and comparing prolapse. The POP-Q allows for objective assessment of prolapse, comparison of surgical outcomes, and consistency in medical documentation and research.
This document discusses the management of endometrial carcinoma. It covers diagnosis through clinical examinations and investigations. Surgical staging is now standard practice to better guide adjuvant therapy. Prognostic factors include stage, grade, depth of invasion and nodal involvement. Treatment involves surgery, with radiation therapy and chemotherapy used for more advanced or high risk cases. Ongoing follow up is also recommended.
This document discusses Mirena, a levonorgestrel-releasing intrauterine system, as an alternative to hysterectomy for treating heavy menstrual bleeding. It provides evidence that Mirena is as effective as endometrial ablation and more effective than oral medications in reducing bleeding. Mirena has additional benefits of reversible contraception and poses fewer risks than hysterectomy. The document outlines counseling points for addressing common patient concerns with Mirena like initial irregular bleeding or amenorrhea. It promotes Mirena as a cost-effective first-line treatment that can prevent unnecessary hysterectomies in many cases.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
1) Adnexal masses are common gynecological findings that are usually benign. Differential diagnosis includes physiologic cysts, endometriomas, fibroids, and malignancies.
2) Evaluation involves history, physical exam, ultrasound, and tumor markers like CA-125. Ultrasound can identify features suggestive of malignancy such as solid components, blood flow, thick septations, large size, and ascites.
3) For premenopausal women, small unilateral cystic masses may be followed with ultrasound in a few months. Larger or complex masses require surgery. Postmenopausal women with cysts under 10cm may also be followed, but require close monitoring for changes that
1) Endometrial cancer is the most common gynecologic cancer in developed countries, with a lifetime risk of 1 in 35 women. It occurs most often in postmenopausal women.
2) Diagnosis involves endometrial biopsy or dilation and curettage to obtain tissue samples. Staging involves total abdominal hysterectomy and bilateral salpingo-oophorectomy.
3) For low-risk early-stage disease, no additional treatment is typically needed. For high-risk early-stage disease, adjuvant pelvic radiation with or without chemotherapy is recommended based on trials such as PORTEC-3.
Management of ovarian cysts in postmenopausal womenHesham Gaber
This case study describes the management of an ovarian cyst in a 54-year-old postmenopausal woman. To assess the risk of malignancy, transvaginal sonography and CA125 levels should be used to calculate a Risk of Malignancy Index (RMI). For this patient, the RMI was 75, indicating a high risk. Management of ovarian cysts should be carried out in a gynecological cancer unit or cancer center, depending on the RMI risk level. Options include conservative management, laparoscopy, or laparotomy with staging procedures performed by a multidisciplinary team. Aspiration is not recommended for managing postmenopausal ovarian cysts.
This document provides information on managing abnormal Pap smear results according to the Bethesda system. It discusses the categories of Pap smear results including within normal limits, benign cellular changes, and epithelial cell abnormalities. It describes what constitutes an adequate versus inadequate sample. Abnormal results can be due to issues with the sample, inflammation, infection, or dysplastic changes. Management depends on the specific result and may include treating any infections, repeating the Pap smear, or proceeding to colposcopy and/or biopsy. The document outlines recommendations for various abnormal results including low grade and high grade squamous intraepithelial lesions, atypical squamous cells, glandular abnormalities and more.
Postmenopausal bleeding (PMB) refers to bleeding from the genital tract at least one year after menopause. It can indicate underlying malignancy and should be promptly evaluated. The most common causes are atrophic vaginitis (60-80% of cases) and hormone therapy (15-25% of cases). Evaluation of a patient with PMB includes history, exam, endometrial biopsy, and further tests if needed. Common pathologies found are polyps, hyperplasia, and cancer. Treatment depends on diagnosis but may include hormone therapy, surgery, or other options.
The document describes the Manchester Repair procedure, which is designed to correct uterine prolapse while preserving the uterus. The key steps are: 1) preliminary dilation and curettage of the uterus, 2) amputation of the cervix, 3) plication of the Mackenrodt's ligaments in front of the cervix, 4) anterior colporrhaphy, and 5) colpoperineorrhaphy. Additional details provided include techniques for covering the amputated cervix with vaginal flaps and suturing the Mackenrodt's ligaments to the cervix to elevate it. Potential complications of the surgery are also outlined.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
This pilot study examines myomectomy as an alternative to hysterectomy for women who have completed childbearing. The study found that myomectomy is a feasible option that resulted in significant relief of symptoms for most patients, with average blood loss comparable to hysterectomy when using appropriate techniques. The conclusions suggest that a randomized study directly comparing hysterectomy to myomectomy in this patient population is warranted to further evaluate myomectomy as a conservative treatment alternative to hysterectomy.
The document discusses peripartum hysterectomy, including its definition, history, incidence and trends, risk factors, types, indications, complications, and techniques. A key point is that a sequence of conservative measures should be attempted before hysterectomy to control uterine hemorrhage, as indecisiveness can lead to fatal excessive bleeding. The "Triple-P procedure" is also summarized as a three-step conservative approach involving obstetric, anesthesia and interventional radiology teams to prevent hemorrhage and need for hysterectomy in high-risk cases.
1. Shirodkar's sling surgery is a conservative surgical procedure for uterine prolapse that involves attaching a tape to the cervix and passing it through the broad ligaments and behind the sigmoid colon to attach to the sacral promontory, creating a hammock of support.
2. It was developed by Dr. V.N. Shirodkar in the 1960s as one of several sling procedures established in India to address high rates of uterine prolapse among young, anemic women after childbirth.
3. The procedure involves making an abdominal incision, attaching a tape to the cervix, passing it through the broad ligaments and retroperitoneum on each side
Endometrial cancer is the most common gynecologic cancer. It has a lifetime risk of 2.4% in white women. Risk factors include obesity, late menopause, diabetes, and unopposed estrogen exposure. Diagnosis is usually made with endometrial biopsy. Treatment involves hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection. Adjuvant radiation and/or chemotherapy may be used in high risk cases. With early stage diagnosis, endometrial cancer has a good prognosis.
Management of Early Stage Carcinoma CervixSubhash Thakur
This presentation covers the management of early stage carcinoma cervix (FIGO stage I to IIA). A brief introuduction to different surgical procedures and the radiation treatment techninques have been described.
This document provides information on operative hysteroscopy, including prerequisites, contraindications, instrumentation, anaesthesia, distension media, indications, and techniques for various procedures like endometrial ablation, uterine septum resection, myomectomy, and adhesiolysis. It discusses the advantages and disadvantages of hysteroscopic morcellators. Complications of hysteroscopic myomectomy and post-operative care are also outlined. Various classifications for submucous fibroids and intrauterine adhesions are presented.
The document discusses the pelvic ureter and prevention of ureteric injuries during pelvic surgery. It provides details on the anatomy of the pelvic ureter and sites where it is vulnerable to injury. Ureteric injuries can occur during abdominal or vaginal hysterectomy or other pelvic operations, with an incidence ranging from 0.4-2.5% for benign conditions and up to 30% for malignancies. Preventive measures include adequate exposure of the ureter during surgery, identification of its location using surrounding structures as guides, and avoidance of blind clamping or coagulation near the ureter. Early diagnosis and management of any ureteric injuries is important to reduce morbidity.
Hypertrophic elongated cervix (elongation of cervix)Yapa
This document discusses the anatomy and causes of cervical elongation. The normal cervix is approximately 2.5cm in length. Elongation can occur in the supravaginal or vaginal portions. Supravaginal elongation is commonly associated with uterine prolapse and puts strain on the cervix. Vaginal elongation is usually congenital and can cause symptoms like feeling of something coming down and dyspareunia. Physical exam can distinguish the two by determining if the elongation is in the uterine canal or vaginal portion. Treatment depends on the cause, with supravaginal elongation addressed like prolapse and congenital elongation requiring cervical amputation or cervicopexy.
The document discusses various gynecological procedures including:
1. Dilatation and curettage which is used to dilate the cervix for procedures like hysteroscopy or IUD insertion and to curette the uterine cavity to diagnose or treat conditions.
2. Anterior and posterior colporrhaphy which are used to repair cystocele and rectocele by incising and suturing the anterior and posterior vaginal walls.
3. Fothergill's operation which is used to treat combined vaginal and uterine prolapse and involves cervical amputation and shortening of ligaments.
4. Various myomectomy and hysterectomy techniques for removing fibroids and
The document describes the Pelvic Organ Prolapse Quantification (POP-Q) system for evaluating and documenting pelvic organ prolapse. The POP-Q system uses specific anatomical points of reference to measure the degree of prolapse in centimeters in relationship to the hymen. It is the standard system used internationally for quantifying and comparing prolapse. The POP-Q allows for objective assessment of prolapse, comparison of surgical outcomes, and consistency in medical documentation and research.
This document discusses the management of endometrial carcinoma. It covers diagnosis through clinical examinations and investigations. Surgical staging is now standard practice to better guide adjuvant therapy. Prognostic factors include stage, grade, depth of invasion and nodal involvement. Treatment involves surgery, with radiation therapy and chemotherapy used for more advanced or high risk cases. Ongoing follow up is also recommended.
This document discusses Mirena, a levonorgestrel-releasing intrauterine system, as an alternative to hysterectomy for treating heavy menstrual bleeding. It provides evidence that Mirena is as effective as endometrial ablation and more effective than oral medications in reducing bleeding. Mirena has additional benefits of reversible contraception and poses fewer risks than hysterectomy. The document outlines counseling points for addressing common patient concerns with Mirena like initial irregular bleeding or amenorrhea. It promotes Mirena as a cost-effective first-line treatment that can prevent unnecessary hysterectomies in many cases.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
1) Adnexal masses are common gynecological findings that are usually benign. Differential diagnosis includes physiologic cysts, endometriomas, fibroids, and malignancies.
2) Evaluation involves history, physical exam, ultrasound, and tumor markers like CA-125. Ultrasound can identify features suggestive of malignancy such as solid components, blood flow, thick septations, large size, and ascites.
3) For premenopausal women, small unilateral cystic masses may be followed with ultrasound in a few months. Larger or complex masses require surgery. Postmenopausal women with cysts under 10cm may also be followed, but require close monitoring for changes that
1) Endometrial cancer is the most common gynecologic cancer in developed countries, with a lifetime risk of 1 in 35 women. It occurs most often in postmenopausal women.
2) Diagnosis involves endometrial biopsy or dilation and curettage to obtain tissue samples. Staging involves total abdominal hysterectomy and bilateral salpingo-oophorectomy.
3) For low-risk early-stage disease, no additional treatment is typically needed. For high-risk early-stage disease, adjuvant pelvic radiation with or without chemotherapy is recommended based on trials such as PORTEC-3.
Management of ovarian cysts in postmenopausal womenHesham Gaber
This case study describes the management of an ovarian cyst in a 54-year-old postmenopausal woman. To assess the risk of malignancy, transvaginal sonography and CA125 levels should be used to calculate a Risk of Malignancy Index (RMI). For this patient, the RMI was 75, indicating a high risk. Management of ovarian cysts should be carried out in a gynecological cancer unit or cancer center, depending on the RMI risk level. Options include conservative management, laparoscopy, or laparotomy with staging procedures performed by a multidisciplinary team. Aspiration is not recommended for managing postmenopausal ovarian cysts.
This document provides information on managing abnormal Pap smear results according to the Bethesda system. It discusses the categories of Pap smear results including within normal limits, benign cellular changes, and epithelial cell abnormalities. It describes what constitutes an adequate versus inadequate sample. Abnormal results can be due to issues with the sample, inflammation, infection, or dysplastic changes. Management depends on the specific result and may include treating any infections, repeating the Pap smear, or proceeding to colposcopy and/or biopsy. The document outlines recommendations for various abnormal results including low grade and high grade squamous intraepithelial lesions, atypical squamous cells, glandular abnormalities and more.
Postmenopausal bleeding (PMB) refers to bleeding from the genital tract at least one year after menopause. It can indicate underlying malignancy and should be promptly evaluated. The most common causes are atrophic vaginitis (60-80% of cases) and hormone therapy (15-25% of cases). Evaluation of a patient with PMB includes history, exam, endometrial biopsy, and further tests if needed. Common pathologies found are polyps, hyperplasia, and cancer. Treatment depends on diagnosis but may include hormone therapy, surgery, or other options.
The document describes the Manchester Repair procedure, which is designed to correct uterine prolapse while preserving the uterus. The key steps are: 1) preliminary dilation and curettage of the uterus, 2) amputation of the cervix, 3) plication of the Mackenrodt's ligaments in front of the cervix, 4) anterior colporrhaphy, and 5) colpoperineorrhaphy. Additional details provided include techniques for covering the amputated cervix with vaginal flaps and suturing the Mackenrodt's ligaments to the cervix to elevate it. Potential complications of the surgery are also outlined.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
This pilot study examines myomectomy as an alternative to hysterectomy for women who have completed childbearing. The study found that myomectomy is a feasible option that resulted in significant relief of symptoms for most patients, with average blood loss comparable to hysterectomy when using appropriate techniques. The conclusions suggest that a randomized study directly comparing hysterectomy to myomectomy in this patient population is warranted to further evaluate myomectomy as a conservative treatment alternative to hysterectomy.
The document discusses peripartum hysterectomy, including its definition, history, incidence and trends, risk factors, types, indications, complications, and techniques. A key point is that a sequence of conservative measures should be attempted before hysterectomy to control uterine hemorrhage, as indecisiveness can lead to fatal excessive bleeding. The "Triple-P procedure" is also summarized as a three-step conservative approach involving obstetric, anesthesia and interventional radiology teams to prevent hemorrhage and need for hysterectomy in high-risk cases.
1. Shirodkar's sling surgery is a conservative surgical procedure for uterine prolapse that involves attaching a tape to the cervix and passing it through the broad ligaments and behind the sigmoid colon to attach to the sacral promontory, creating a hammock of support.
2. It was developed by Dr. V.N. Shirodkar in the 1960s as one of several sling procedures established in India to address high rates of uterine prolapse among young, anemic women after childbirth.
3. The procedure involves making an abdominal incision, attaching a tape to the cervix, passing it through the broad ligaments and retroperitoneum on each side
Endometrial cancer is the most common gynecologic cancer. It has a lifetime risk of 2.4% in white women. Risk factors include obesity, late menopause, diabetes, and unopposed estrogen exposure. Diagnosis is usually made with endometrial biopsy. Treatment involves hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection. Adjuvant radiation and/or chemotherapy may be used in high risk cases. With early stage diagnosis, endometrial cancer has a good prognosis.
Management of Early Stage Carcinoma CervixSubhash Thakur
This presentation covers the management of early stage carcinoma cervix (FIGO stage I to IIA). A brief introuduction to different surgical procedures and the radiation treatment techninques have been described.
This document provides information on operative hysteroscopy, including prerequisites, contraindications, instrumentation, anaesthesia, distension media, indications, and techniques for various procedures like endometrial ablation, uterine septum resection, myomectomy, and adhesiolysis. It discusses the advantages and disadvantages of hysteroscopic morcellators. Complications of hysteroscopic myomectomy and post-operative care are also outlined. Various classifications for submucous fibroids and intrauterine adhesions are presented.
The document discusses the pelvic ureter and prevention of ureteric injuries during pelvic surgery. It provides details on the anatomy of the pelvic ureter and sites where it is vulnerable to injury. Ureteric injuries can occur during abdominal or vaginal hysterectomy or other pelvic operations, with an incidence ranging from 0.4-2.5% for benign conditions and up to 30% for malignancies. Preventive measures include adequate exposure of the ureter during surgery, identification of its location using surrounding structures as guides, and avoidance of blind clamping or coagulation near the ureter. Early diagnosis and management of any ureteric injuries is important to reduce morbidity.
Hypertrophic elongated cervix (elongation of cervix)Yapa
This document discusses the anatomy and causes of cervical elongation. The normal cervix is approximately 2.5cm in length. Elongation can occur in the supravaginal or vaginal portions. Supravaginal elongation is commonly associated with uterine prolapse and puts strain on the cervix. Vaginal elongation is usually congenital and can cause symptoms like feeling of something coming down and dyspareunia. Physical exam can distinguish the two by determining if the elongation is in the uterine canal or vaginal portion. Treatment depends on the cause, with supravaginal elongation addressed like prolapse and congenital elongation requiring cervical amputation or cervicopexy.
The document discusses various gynecological procedures including:
1. Dilatation and curettage which is used to dilate the cervix for procedures like hysteroscopy or IUD insertion and to curette the uterine cavity to diagnose or treat conditions.
2. Anterior and posterior colporrhaphy which are used to repair cystocele and rectocele by incising and suturing the anterior and posterior vaginal walls.
3. Fothergill's operation which is used to treat combined vaginal and uterine prolapse and involves cervical amputation and shortening of ligaments.
4. Various myomectomy and hysterectomy techniques for removing fibroids and
Local infiltrative anesthesia can be safely used for cesarean section in certain situations. It is commonly used in resource-limited settings when regional or general anesthesia is unavailable. The procedure involves infiltrating the surgical site with local anesthetic like lidocaine. It allows the woman to remain awake but without pain sensation in the operated area. Local anesthesia avoids risks of other techniques like hypotension from spinal or loss of airway control from general anesthesia. It is indicated for high-risk patients or when other options are unavailable. The recovery is quicker with less side effects compared to other anesthetic techniques.
This document discusses mood disorders during pregnancy and the postpartum period. It covers depression during pregnancy, postpartum blues, postpartum depression, postpartum psychosis, and postpartum obsessive-compulsive disorder. Depression is common during pregnancy, with risks including preterm birth and poor health behaviors. Postpartum blues typically occur within the first 2 weeks after delivery and involve mood swings and crying. Postpartum depression has a later onset and can involve intrusive thoughts, while postpartum psychosis involves confusion and delusions. Risks, symptoms, and treatment options are discussed for each condition.
This document discusses the surgical management of carcinoma of the cervix. It describes the investigations used to establish diagnosis and stage the cancer, including biopsy techniques. It outlines the different types of hysterectomy based on the extent of resection (e.g. simple, radical, extended radical). Radical hysterectomy with lymph node dissection is recommended for stage I disease depending on tumor size and invasion depth. Complications of radical hysterectomy include blood loss, fistula formation, and damage to adjacent organs. Palliative care and radiotherapy/chemotherapy are discussed for advanced disease.
A hysterectomy is a surgical procedure to remove a woman's uterus. It is the most common non-obstetrical surgery for women in the United States, with approximately 300 out of every 100,000 women undergoing the procedure. There are several types of hysterectomies, including total abdominal hysterectomy, vaginal hysterectomy, supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy, and laparoscopic supracervical hysterectomy. A total abdominal hysterectomy involves removing the uterus through an abdominal incision, while a vaginal hysterectomy removes the uterus through the vagina. A laparoscopy-assisted vaginal hysterectomy adds the use of a laparoscope to the vaginal
The uterus is a pear-shaped organ divided into the fundus, body, and cervix. Lymph drainage from the fundus goes to para-aortic nodes at L1, while the body and cervix drain to internal and external iliac nodes. Endometrial cancer is the most common gynecologic malignancy in the US, with risk factors including age, estrogen exposure, genetics, and medical history. Treatment depends on staging and includes surgery, radiation, chemotherapy, and hormonal therapy.
The document describes the development and use of a new 20mm straight needle for suturing during non-descent vaginal hysterectomies. The author details the challenges of using a standard 40mm half-circle needle in the narrow space of the vagina. He developed a shorter straight needle that allows for easier insertion and handling compared to the half-circle needle. Over 9 years and 3000 surgeries, the author found the straight needle to be more convenient, time-saving, and less strenuous on the wrist joints during suturing for non-descent vaginal hysterectomies.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, has a shorter recovery time, and allows the uterus to be preserved. The document provides details on the various techniques for endometrial ablation as well as preoperative preparation and counseling. It emphasizes the importance of completely ablating the entire endometrial thickness for treatment to be effective.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, allows the uterus to be preserved, and has a shorter recovery time. The document provides details on the various techniques for endometrial ablation and notes it is most effective when performed hysteroscopically to allow direct visualization. Preparation of the endometrium and cervix is recommended to improve outcomes.
This document discusses permanent contraception options for men and women, including vasectomies and tubal ligations. It provides details on the procedures, such as vasectomies involving transecting and occluding the vas deferens through non-scalpel or scalpel methods. Tubal ligations can be performed through abdominal, laparoscopic, or vaginal approaches. Both procedures are generally safe and effective but require extensive counseling as they provide permanent sterilization.
Cervical cancer is the third most common cancer in females that typically spreads to the lymph nodes, liver, lungs and bones. For early or locally advanced stages, treatment involves external radiotherapy combined with chemotherapy, sometimes followed by internal radiotherapy. Diagnosis involves tests like Pap smear, HPV DNA testing, colposcopy and biopsy. Treatment depends on cancer stage but may include surgery, radiation therapy, chemotherapy or a combination. Internal radiotherapy (brachytherapy) often uses devices placed in the vagina and cervix to deliver a radioactive source directly to the cancer.
Complications of C section & Gynaecological procedures1 .pdfYyhVghh
This document discusses complications that can arise from various gynecological procedures such as Caesarean sections, dilation and curettage (D&C), endometrial ablation, hysteroscopies, hysterectomies, and biopsies of the endometrium and cervix. Common complications include hemorrhage, infections, organ injuries, adhesions, and failure to resolve the presenting symptoms. Risk factors, prevention methods, and treatment options are provided for several major complications.
1. Hysterectomy is a surgical procedure to remove the uterus and sometimes other reproductive organs. It can be performed abdominally through an incision in the abdomen, vaginally through the vagina, or laparoscopically through small incisions using specialized instruments.
2. Over 600,000 hysterectomies are performed annually in the US, most commonly to treat benign conditions like fibroids, endometriosis, or uterine prolapse. The preferred method is vaginal hysterectomy when possible due to faster recovery.
3. Risks of hysterectomy include earlier menopause, increased risks of cardiovascular disease and osteoporosis, as well as potential short-term risks like infection,
medical and surgical treatment of uterine fibroidsHabibaIsah
This document discusses the medical and surgical treatment options for uterine fibroids. It begins with an introduction to fibroids and their prevalence. Expectant management is recommended for small, asymptomatic fibroids. Medical treatment includes GnRH analogues, antiprogestins, androgens, and LNG-IUS to reduce fibroid size and symptoms. Surgical options are hysterectomy, which eliminates symptoms but removes the uterus, and myomectomy, which removes only the fibroids to preserve fertility. Other minimally invasive treatments discussed are myolysis, uterine artery embolization (UAE), and high-intensity focused ultrasound (HIFU).
This document discusses various laparoscopic gynecological procedures including hysterectomy, myomectomy, oophorectomy, and treatment of endometriosis. It provides details on how laparoscopic surgeries are performed, noting they involve several small incisions through which a camera and instruments are inserted. This allows visualization and treatment while avoiding a large incision. Benefits discussed include less pain, shorter recovery time, and smaller scars compared to open surgeries. Specific procedures covered in detail include laparoscopic hysterectomy, adnexal surgery, presacral neurectomy, and hysteroscopy.
The document discusses acute scrotum, which refers to acute scrotal pain with or without swelling and redness. It can be caused by conditions ranging from minor issues requiring reassurance to emergencies needing immediate surgery. Common causes include testicular torsion, epididymitis, trauma, and torsion of the appendix testis. Diagnosis involves history, exam, and sometimes ultrasound or MRI. Treatment depends on the underlying cause, with epididymitis often resolving on its own but testicular torsion requiring urgent surgery to detorse the testis within 24 hours to prevent loss of the testis. Even with timely treatment, testicular atrophy can still sometimes occur from testicular torsion.
This document summarizes various fertility treatments and procedures offered by a fertility specialist, including hysterectomy, IVF, IUI, and fertility assessments. It provides details on hysterectomy procedures like abdominal, vaginal, and laparoscopic assisted vaginal hysterectomy. It explains the various reasons a hysterectomy may be performed and tests that are typically done before proceeding with one.
Hysterectomy is the surgical removal of the uterus. There are several types including total, partial, and radical hysterectomy. The type depends on what structures are removed and the surgical approach which can be vaginal, abdominal, or laparoscopic. Complications can include infection, injury to nearby organs, bleeding, and changes to hormonal balance.
SAVE UTERUS COMPAIGN, Dr.Sharda Jain, Dr. Ila Gupta Lifecare Centre
This document discusses the overuse and misuse of hysterectomies in India. It summarizes the following key points:
1. Hysterectomy rates in India are much higher than in Western countries, often performed unnecessarily for benign conditions or without adequate diagnostic evaluation and consideration of alternative treatments.
2. Removal of the uterus at a young age can have negative long-term impacts on a woman's health like early menopause, increased risks of heart disease and osteoporosis.
3. More conservative treatments for conditions like heavy menstrual bleeding exist, like medical therapies and uterine balloon therapy, that can avoid unnecessary hysterectomies in many cases.
4. Guidelines in Western countries
This document provides information about breast cancer, including:
- Breast cancer develops from breast tissue and is the second leading cause of cancer deaths in women. Early diagnosis and treatment has improved survival rates.
- Risk factors include age, family history, obesity, lack of physical activity, hormone exposure. Genetic factors contribute to some cases.
- Symptoms may include lumps, nipple discharge, skin changes. Advanced cases may spread to bones or organs. Diagnosis involves mammograms, biopsies and scans.
- Treatment includes surgery to remove cancer (mastectomy or lumpectomy), radiation therapy, chemotherapy, hormone therapy, targeted therapies and bone-directed therapies depending on cancer type and stage
This document discusses permanent family planning methods, focusing on vasectomy for men and tubal ligation for women. It defines these methods, describes the surgical techniques, benefits, risks, and complications. Counseling is emphasized as critical due to the irreversible nature of these procedures. Minilaparotomy is presented as the preferred method for female sterilization. The summary highlights that permanent methods are less common in Ethiopia and counseling is essential to discuss potential risks, benefits, and possibility of later regret.
Hysterectomy is a surgical procedure to remove the uterus, and sometimes other female reproductive organs. It is commonly performed to treat conditions like fibroids, adenomyosis, endometriosis, dysfunctional uterine bleeding, and various cancers affecting the uterus or ovaries. There are three main types of hysterectomy - total, partial, and radical. Hysterectomy is a major surgery that impacts a woman's health and hormones permanently. It is usually only recommended after other treatment options have been considered.
The document provides an overview of bladder cancer, including types, risk factors, signs and symptoms, diagnostic tests, treatment options such as surgery, chemotherapy, and radiation therapy. It discusses various surgical procedures for bladder cancer like cystectomy, urinary diversions, and postoperative care including management of stomas, catheters, and instructions for patients.
Hysteroscopy Explained - Procedure, Benefits, and Recovery.pdfMeghaSingh194
If you’re researching ‘hysteroscopy,’ you’re likely seeking information on this medical procedure used to examine the inside of the uterus. Hysteroscopy can identify and sometimes treat causes of abnormal bleeding, assist with infertility evaluations, or detect and remove growths like polyps and fibroids. Let's explore more: https://www.southlakegeneralsurgery.com/hysteroscopy-explained-procedure-benefits-and-recovery/
Unnecessary Medicine in ObGyn
Many unnecessary medical procedures are performed in Egyptian hospitals, including screening, examinations, investigations, treatments, hospitalizations, and surgeries. This wastes resources and can harm patients. Some contributing factors include defensive medicine due to malpractice fears, a desire for profits, and incorrect diagnoses. Examples given include unnecessary pelvic exams, too frequent ultrasounds during pregnancy, cervical cancer screenings for low-risk groups, osteoporosis screening in young women, and medical treatments like antibiotics for minor issues. Reducing unnecessary care could benefit both patients and health systems in Egypt.
An intrauterine device (IUD) can be inserted during a cesarean section to provide postpartum contraception. This offers several advantages: it adds little time or cost to the cesarean procedure, the patient does not need to return for follow-up insertion, and there is no risk of primary perforation as it is inserted under direct vision. While IUD insertion during cesarean section can decrease the chances of expulsion compared to postpartum vaginal insertion, expulsion rates are still higher than with interval insertion. Proper training and techniques like suturing the IUD in place can further reduce expulsion risks. Complications are still possible and include bleeding, pain, embedment, perfor
1) Genital trauma during first intercourse, known as wedding trauma, most commonly causes minor injuries in women such as lacerations or abrasions that typically heal with little or no treatment.
2) Factors that can contribute to genital injuries during intercourse include lack of lubrication, disproportionate genital sizes, forceful or rough thrusting, and certain sexual positions. Younger women and those with infections or other genital abnormalities are also at higher risk.
3) Treatment depends on the severity of the injury. While shallow tears may heal on their own, deep lacerations require sutures. Seeking medical care is advised for bleeding, pain, discharge or fever. Proper diagnosis and repair
The document discusses the concept of "VIP syndrome", where physicians may provide riskier or less standardized care to influential patients due to pressures from the patient, their families, or status. It provides definitions of VIP syndrome and lists examples of VIPs. Nine principles are proposed for handling VIP patients, such as not bending clinical rules, careful communication, and treating VIPs in the most appropriate care setting. The risks of VIP syndrome include unnecessary tests, rejection of medical advice, and worse health outcomes.
Platelet-rich plasma (PRP) involves concentrating the platelets from a patient's own blood, which contain growth factors that promote healing. It is used in gynecology to accelerate wound healing after surgery, treat conditions like lichen sclerosus and vulvodynia, and help with vaginal prolapse and abnormal uterine bleeding resistant to drugs. The PRP procedure concentrates platelets from blood through centrifugation and activates them to release growth factors through injection into injured tissues. It provides benefits with few side effects and contraindications since it uses the patient's own blood. Multiple treatments spaced one month apart may be needed depending on the condition.
Platelet-rich plasma (PRP) is an autologous concentration of platelets that contains high levels of growth factors. It is used as a non-surgical treatment for various gynecological disorders by injecting PRP into the affected areas. PRP therapy involves drawing the patient's blood, centrifuging it to extract PRP, and injecting PRP to stimulate healing. It has shown benefits for sexual dysfunction, vaginal rejuvenation, reconstructive surgery, and breast reconstruction. PRP therapy is a simple, affordable, and low-risk procedure with few side effects and promising results for various gynecological applications.
Platelet-rich plasma (PRP) is an autologous concentration of platelets that contains high levels of growth factors. It is used in regenerative medicine to treat various medical conditions. PRP preparation involves drawing a patient's blood, centrifuging it to separate platelets from other blood components, and injecting the concentrated platelets into injured tissues. The growth factors in PRP promote natural healing processes like tissue regeneration and reduced inflammation. The document discusses the use of PRP injections to treat urogynecological conditions like stress urinary incontinence, genital fistulae, and interstitial cystitis. The entire PRP treatment process from blood draw to injection typically takes less than an hour.
Platelet-rich plasma (PRP) involves concentrating the platelets from a patient's own blood, which contain growth factors that promote healing. PRP is being used increasingly in various medical fields as a non-operative treatment. In obstetrics, studies have found PRP may help seal tears in the amniotic membrane in cases of premature rupture of membranes. It may also accelerate wound healing after cesarean sections and episiotomies. The PRP preparation process involves drawing and centrifuging blood to separate out platelets, which are then injected into the target site to stimulate healing. More research is still needed but PRP represents a promising regenerative approach with few risks.
Platelet-rich plasma (PRP) is an autologous concentration of platelets in plasma. PRP contains high concentrations of growth factors that promote healing. It is prepared by drawing a patient's blood, centrifuging it to separate platelets from other blood components, and collecting the platelet-rich plasma. PRP is being used increasingly in regenerative medicine due to its ability to promote natural healing responses. In reproductive medicine, PRP is being used for endometrial rejuvenation, ovarian rejuvenation, treatment of ovarian torsion, and treatment of azoospermia. PRP injections are generally well-tolerated with minimal side effects.
Platelet-rich plasma (PRP) is an autologous concentration of platelets that contains high levels of growth factors. It is used in regenerative medicine to promote healing. PRP is prepared by drawing a patient's blood, centrifuging it to separate platelets from other blood components, and collecting the platelet-rich plasma. The growth factors in PRP stimulate healing in conditions like tendonitis and joint injuries. In gynecology, PRP is being used for procedures like vaginal rejuvenation and reconstructive surgery after cancer to reduce complications and speed healing. The PRP injection process takes less than 5 minutes after blood is drawn and centrifuged to obtain the plasma.
Cervical insufficiency, also known as cervical incompetence, is a condition where the cervix is unable to retain a pregnancy at term due to a functional or structural defect. It is characterized by painless dilatation of the cervix resulting in premature rupture of membranes and delivery, usually occurring in the second or third trimester. Cervical cerclage procedures aim to surgically suture the cervix closed to prevent premature opening. There are several techniques for cervical cerclage placement depending on the location and indication, including McDonald, Shirodkar, emergency/rescue cerclages, and pessary or balloon alternatives. Cerclage procedures can be done through the vagina or abdomen depending
Labia minora adhesions (LMA) are the partial or complete fusion of the labia minora. They occur in 0.6-3.3% of prepubertal girls and are usually asymptomatic, resolving spontaneously during adolescence. Potential causes include microtraumas from overcleaning or chronic irritation/inflammation. Treatment is usually not needed unless causing symptoms like urinary issues. Options include topical estrogen or steroid creams, or manual separation under local anesthesia. Surgery is rarely required and recurrence can be prevented with gentle separation and avoiding irritants.
Prophylactic bilateral salpingectomy may reduce the risk of ovarian, fallopian tube, and peritoneal cancers by removing the fallopian tubes. Opportunistic salpingectomy involves removing the fallopian tubes during another pelvic surgery in women who no longer desire fertility or have damaged tubes. Risk-reducing salpingectomy removes the fallopian tubes to lower cancer risk and is recommended for women with BRCA mutations after childbearing. Leaving the fallopian tubes in place after hysterectomy still carries cancer risks, so complete salpingectomy is preferred.
This document describes the Hennawy glove balloon catheter, which is used to control postpartum hemorrhage. It consists of a glove with the fingers tied off except one, into which a Foley catheter is inserted. It is inserted into the uterus and inflated to exert pressure and stop bleeding. The document discusses how to prepare it, its advantages over other methods, its mechanisms of action, indications, contraindications and technical considerations for use. It is presented as an inexpensive option for controlling PPH where resources are limited.
Thromboprophylaxis Of Venous ThromboEmbolism (VTE )In Obstetrics And Gy...muhammad al hennawy
This document discusses thromboprophylaxis for venous thromboembolism (VTE) in obstetrics and gynecology. It covers the risks of VTE associated with pregnancy, hormonal contraceptives, and various gynecological surgeries. It recommends low molecular weight heparin as the anticoagulant of choice for prophylaxis and treatment, and discusses dosing and monitoring considerations during pregnancy due to increased clearance. Monitoring tests discussed include anti-Xa levels, APTT, INR, and delivery planning when on anticoagulation.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Travel Clinic Cardiff: Health Advice for International Travelers
Hysterectomy decision el-hennawy
1. To Do
Or
Not To Do
(about the hysterectomy)
Dr Muhammad El Hennawy
Ob/gyn Consultant
Rass el barr - Dumyat – Egypt
Mobile 01222503011
www. Mmhennawy.co.nr
2. There Are Many Controversies About
Hystrectomy
All medical conditions have more than one option for treatment.
Medicine is an evolving art as well as a science.
Recently, with more open attitudes towards women's opinions
and feelings, and with the advent of new technology,
Doctors have been looking for new medical treatments for
gynecologic symptoms in order to avoid hysterectomy.
There are possible side effects of hysterectomy, none of which are
entirely predictable for each individual.
But, for some women, hysterectomy will be the right treatment.
3. How Can we Answer These 4 Questions?
1 -To remove or not to remove the uterus
2 - To remove or not to remove the normal cervix
3 - To remove or not to remove the normal ovaries
4 - To do it laparoscopic , vaginal or abdominal
6. To Remove The Uterus
• Hysterectomy is the surgical removal
of all or part of the uterus
• Hysterectomy is one of the most
frequently performed of all surgical
operations
• Reasons why hysterectomies may be
recommended fall into three categories:
1- to save lives;
2 - to correct serious problems that
interfere with normal functions;
3- to improve the quality of life.
7. One Of The Most Commonly Performed
Operations In The World
Hysterectomy has long been regarded as an operation performed by
“hyster-happy," mostly male, surgeons
• In the United States,
• Hysterectomy is the second most common major operation performed in the
United States today, second only to cesarean section
600 000 hysterectomies are performed each year
or one hysterectomyevery minute.
By the age of 60, one out of every three women in the U.S. has had a
hysterectomy
• In the United Kingdom, women have a one in fivechance of having a
hysterectomy by the age of 55
• Nine of every 10 hysterectomies are performed for non-cancerous conditions.
• In many of these, no disease is present—and the term dysfunctional uterine
bleeding is used to describe these cases.
• When there is disease it is commonly limited to the uterus and, in most parts of
the world, is more likely than not to be a leiomyoma
8. DIFFERENT TYPES OF
HYSTERECTOMIES
• SUBTOTAL HYSTERECTOMY OR
SUPRACERVICAL Hysterectomy
• MODIFIED SUBTOTAL HYSTERECTOMY
• TOTAL HYSTERECTOMY
• EXTRAFACIAL HYSTERECTOMY
• SUBTOTAL OR MODIFIED SUBTOTAL OR
TOTAL OR EXTRAFACIAL
HYSTERECTOMY WITH BILATERAL OR
UNILATERAL SALPINGO-
OOPHORECTOMY
• RADICAL HYSTERECTOMY Or
WERTHEIM‘S HYSTERECTOMY
9. Indications For Hysterectomy In
American Women
• Treatment of fibroid tumors, accounting for 30% of
these surgeries
• Treatment of endometriosis is the reason for 20% of
hysterectomies
• 20% of hysterectomies are done because of heavy or
abnormal vaginal bleeding that cannot be linked to
any specific cause and cannot be controlled by other
means.
• 20% are performed to treat prolapsed uterus, pelvic
inflammatory disease , pelvic pain, or endometrial
hyperplasia, a potentially pre-cancerous condition.
• About 10% of hysterectomies are performed to treat
cancer of the cervix, ovaries, or uterus
10. • Subtotal hysterectomy was the most common type of
hysterectomy performed before 1940. Leaving the cervix in
place avoided some of the risk of injuring the nearby
ureters, bladder or intestines and reduced blood loss.
• However, the remaining cervix was susceptible to
developing cancer, a fairly common condition at that time.
• As surgical and anesthetic techniques became safer and
antibiotics became available, doctors began performing
more total hysterectomies in order to prevent the future
development of cervical cancer.
• These changes all preceded the discovery of the pap smear.
Once the pap smear became widely used as a means to find
pre-cancer, an easily curable condition, removing the cervix
was no longer essential for all women.
11. Do Not Remove The Uterus
remove the disease not remove the organ
ALTERNATIVES TO HYSTERECTOMY
uterus is not organ to discard after woman complete her family
uterus is not a a foreign body after woman complete her family
• ALTERNATIVES TO HYSTERECTOMY –
• less expensive --less psychologic instability ---- Eg :
• Laparoscopic uterine artery ligation
• Uterine artery embolisation
• Hormone levonorgesteil IUD
• medical treatment options, including progesterone antagonist mifepriston (RU 486)
and gonadotropin-releasing hormone (GnRH) antagonists
• Endometrial ablation utilizes laser, thermal (thermal balloon ablation – foley’s
catheter balloon ablation), cold, microwave or electricity to remove those areas of the
uterine lining which are causing the high rate of bleeding
• Transcervical resection of endometrium
• Myolysis is the destruction of fibroids (necrosis) by different methods, including
coagulation of the tumors with bipolar or unipolar electric electrodes or laser beams.
Another technique for destruction of fibroids utilizes a freezing probe (cryomyolysis)
• Thermal ablation of myoma with focused ultrasound surgery without probe ( totally
non-invasive )
• Hysteroscopic, laparoscopic or abdominal myomectomy
12. • Hysterectomy is a major operation and carries with
it risks of infection, injury to other organs,
anesthetic complications, and blood loss that can
sometimes result in the need for transfusion.
• While complications are uncommon, they should
not be taken lightly.
• Recovery from abdominal hysterectomy takes four
to six weeks, recovery from vaginal hysterectomy
takes about three to four weeks, and recovery from
laparoscopic hysterectomy takes about two weeks.
• The cost of surgery is expensive, including doctors'
fees, anesthesia fees, hospital charges, and operating
room charges. It's preferable to avoid major surgery
if possible
13. • Hysterectomy is never needed for fibroids unless a
woman has the wrong doctor
• Most fibroids do not cause more than annoying
symptoms, but in the event that they do cause a true
medical problem
• fibroids can be removed by myomectomy.
• Myomectomy is surgical removal of fibroids
leaving the uterus intact.
• The uterus is a hormone responsive reproductive
sex organ that supports the bladder and the bowel. It
has essential functions all of a woman’s life.
14. NEPRINOL??
. NEPRINOL contains Serrapeptase and
Nattokinase, two systemic enzymes that are
remarkably efficient at removing fibrous
tissue.
Clinical studies illustrate how the enzymes in
NEPRINOL work to emulsify fibrosis and
may significantly reduce the size of a
fibrous tumor in just a few months
15. Myolysis
• Myolysis is the destruction of fibroids (necrosis) by
different methods, including coagulation of the tumors
with bipolar or unipolar electric electrodes or laser
beams. Another technique for destruction of fibroids
utilizes a freezing probe (cryomyolysis).
• The probe is inserted into fibroids through the
laparoscope and the electrical, laser or freezing
apparatus is activated, resulting in necrosis of the
affected portions inside the fibroid.
• This is repeated several times, at different locations
inside the individual fibroid, until the extent of the
necrosis inflicted in a certain fibroid is considered
sufficient
16. Endometrial Ablation
• Endometrial ablation destroys the endometrial lining to various
extent (depending on technique and skill). There are numerous
different techniques to achieve endometrial ablation that lead
essentially to the same end result. These techniques include hot
water balloon, cryo- ablation (freezing the endometrium), laser
ablation, roller ball cautery and electric loop resection of the
endometrium.
• These procedures are quite effective for the treatment of true
functional uterine bleeding (bleeding due to hormonal imbalance
without the presence of any anatomical abnormality) but in the
presence of sub mucous fibroids endometrial ablation usually fails
(unless effective myomectomy is also performed at the same time).
Ablation also fails when the bleeding is caused by deep
adenomyosis. Unfortunately, failure to recognize the presence of
adenomyosis happens frequently.
17. MR-guided Focused Ultrasound Surgery
for Uterine Fibroids
• This is the first non-invasive therapy for uterine fibroids. The patient lies on
her back and ultrasound waves are focused with the guidance of Magnetic
Resonance Imaging into the center of a particular fibroid. The treatment is
limited only to those fibroids where the focused ultrasound energy does not
traverse bowel or bladder on its way to reach the fibroid. Otherwise, the
bladder or bowel may sustain damage. The focused ultrasound energy is
continued long enough to produce thermablation of the center of the sonicated
fibroid. This volume will become necrotic and eventually shrink.
• Presently, the procedure is allowed to continue for two or three hours and is
limited to fibroids smaller than 7 cm. The treatment leads to a modest
reduction in the fibroid volume of about 13%. However, improvement in the
quality of life, such as bleeding, pain, and pressure is apparently more
significant.
• Frequently, the procedure has to be discontinued because of the patient's
inability to lie still on her back for such a long time. She often has to tolerate
three or more 3-hour sessions inside a noisy, cramped MRI machine without
moving. The procedure may cause skin burns at the treatment site and
possibly some damage to adjacent tissues such as nerves. The procedure is still
in its early stages of evaluation and long term results and complications are
unknown.
18. Uterine Artery Embolization (UAE
• Uterine artery embolization (UAE) is a radiological procedure
recently introduced as an alternative treatment for symptomatic
uterine fibroids.
• The American College of Obstetrics and Gynecology officially
considers UAE at the present time an investigational procedure,
and cautions about its potential for infection and other serious
complications requiring emergency surgery.
• The radiologist introduces a catheter, usually through the right
femoral artery, into each of the two uterine arteries, which supply
blood to the uterus and, in turn, to the fibroids. A solution
containing small particles is injected into the uterine arteries. The
particles occlude the branches of the uterine arteries (blood
outflow) and thereby drastically reduce blood supply to the uterus
and the fibroids. The procedure is usually done under conscious
sedation and local anesthesia, without general anesthesia
19. To Remove or Not To Remove
The Normal ovary
Prophylactic oophorectomy remains a
controversial issue among gynecological surgeons
20. To Remove The Normal Ovary
(Female Castration)• The main reason to remove normal ovaries is the prevention of
ovarian cancer.
• The probability of developing ovarian cancer in a lifetime is
approximately 1 in 70.
• The disease is almost uniformly fatal except for early stage disease
which unfortunate is not common.
• It decreases residual ovary syndrome
• There are 4 opinions :
1-The predominant teaching is that [ovary removal] in the low-risk
patient should be avoided under the age of 40, should be routinely
performed over age 50, and should be considered and discussed in the
interval between
(40 - 45 year discus -- 45-50 year consider--- above 50 year – remove )
2- should be routinely performed all above 40 year
3 - should be routinely performed all above 65 year
4 - The American College of Obstetricians and Gynecologists (ACOG)
officially recommends that the decision about ovary removal be made
on a case-by-case basis
21. • Ovarian cancer is the fifth leading cause of cancer death in women and the leading
cause of death from gynecologic cancer
• the remaining ovaries cease to function after two or three years, although this is
more contentious
• the flushes/sweats: if these are hormone-related, which is likely, HRT (hormone
replacement therapy) is now pretty effective
• Why??
• (1). One simple and effective method of prevention is prophylactic oophorectomy in
women undergoing hysterectomy for gynecologic indications
• (2).Prophylactic oophorectomy has advantages and disadvantages.
The actual incidence of cancer in retained ovaries is difficult to estimate.
The risk of woman developing ovarian cancer is 1.4% and previous studies have
reported an incidence of up to 1.2% in retained ovaries (3). Consideration should be
given to prophylactic oophorectomy in younger women undergoing pelvic surgery
if they have high-risk factors
• (3). Although prophylactic oopherectomy may not completely eliminate the
potential for intra-abdominal carcinomatosis
• (4), it remains an effective strategy for the prevention of ovarian cancer. This approach is
not limited by age
22. Do Not Remove The Normal Ovary
• Ovary not die till woman died
• Create harm that oppose benefit of cancer ovary
• The main reasons not to remove normal ovaries are that it
will cause acute menopause in the pre-menopausal woman
and that the ovary, at all stages of a woman life, produces
many poorly understood hormones which may help
someone feel better and which cannot always be replaced.
• Most gynecologists would not recommend the routine
removal of ovaries in women under the age 40-45 and
would recommend their removal after menopause. Removal
of healthy ovaries at any age requires an adequate informed
consent
23. Ovarian Hormones
• the ovaries continue to produce hormones for many years after menopause and these
hormones have many health benefits, as well as benefits for improved mood,
prevention of vaginal dryness, preservation of skin tone and elasticity
• Significantly, the ovaries produce hormones long after menopause. Estrogen
continues to be produced in small amounts,
• about 25 percent of normal pre-menopausal levels.
• Testosterone is another hormone normally produced by the ovary and the ovary
continues to make testosterone for about 30 years after menopause.
• Muscle, skin and fat cells change testosterone into estrogen, so the ovary continues
to make estrogen this way for many, many years. This source of estrogen appears to
be responsible for the lower risks of heart disease and osteoporosis that have been
found in the studies of women who still have their ovaries
• In addition, ovaries produce several hormones which are beneficial to
women. They protect against serious common diseases such as heart
disease and osteoporosis and contribute to sexual pleasure.
24. Ovarian Canaer
• Ovarian cancer is rare and because removing the
ovaries does not always guarantee women will not
develop ovarian cancer.
• (Rarely, the cells that cause ovarian cancer can be
present in the body even after the ovaries are
removed.)
26. To Remove The Cervix
• It is done by senior well experience well
knowledge doctors done by academic
doctors
• In well equipped public hospital
• It decreases CIN or cancer cervix stump
27. Intrafascial Or Intrastromal Or
Modified Hysterectomy
(Classical Intrafascial Supracervical Hysterectomy = CISH (
• technique, similar to standard supracervical hysterectomy,
leaves the cardinal ligament, uterosacral ligament, vascular
supply, and innervation to the upper vagina and cervix
intact,
• but unlike supracervical hysterectomy removes the
transition zone and endocervical canal
• whereas the bed and the pericervical stroma remain. In the
outer stroma of the cervix is a pericervical bed, and the
cervix is removed from this bed
• It can be done by laparotomy . Laparoscopy or vaginal
28. The advantage of this technique
• The advantage of this technique is that the pelvic floor
integrity remains intact (nerval and vascular side); , and
because uterine arteries and ureters were not touched, the
so called "complication zone" is thus avoided.
continuation of the normal sexual life for both partners;
and protection
• This technique pretends to combine the
advantages of the traditional
supracervical hysterectomy, including a
shorter operative time and the
preservation of the cardinal ligaments
and pericervical tissue, with the
prevention against cervical carcinoma
• Intrastromal Abdominal Hysterectomy is a bloodless,
nerve-sparing technique that does not disturb the pelvic
support system. It also proves to be an effective alternative
to the traditional hysterectomy, with advantages such as
reduced blood loss, shorter hospital stay, and less frequent
post-operation complications. Throughout this process, it
is imperative that the patient’s fear cervical cancer should
29. • In traditional hysterectomies,
• most surgeons remove the uterus by cutting the uterosacral
ligaments, the cardinal ligament of Mackenrodt, and the
uterine vessels prior to entering the vaginal fornix
• In this procedure, significant damage occurs to nerves in
Franken Hauser’s nerve plexus, the vesical plexus, and other
downstream nerves.
• Additionally, the fibrous condensation in the endopelvic
fascia are severed and no longer support the vaginal
Hysterectomy to alleviate the traditional concern about
possible interference with sexual or bladder function
postoperatively as well as blood loss and length of hospital
stay.
30. Total Hysterectomy
• In a hysterectomy,
• the reproductive organs are accessed
through a lower abdominal incision or
laparoscopically or vaginally
• (A). Ligaments and supporting
structures connecting the
uterus( including cervix) to
surrounding organs are severed
• (B). Arteries to the uterus are severed
• (C). The uterus, fallopian tubes, and
ovaries are removed (D and E).
31. Extrafascial Hysterectomy
the extrafascial hysterectomy are the following:
(1) the uterine vessels are skeletonized (to lessen the need to slide the tip of the clamp
off the cervix) and are clamped and cut to allow the ligated vessels to fall away
from the cervix;
(2) the pubovesicocervical fascia is not separated from the cervix and is excised with
the specimen;
(3) the plane for bladder separation from the cervix is created with sharp dissection
because blunt dissection is more often associated with accidental entry into the
bladder; and
(4) the uterosacral ligaments are transected separately near their insertion into the
cervix. This frees the uterus and cervix posteriorly and gains mobility for the
specimen. This facilitates amputation of the vagina in front of the cervix, securing
at least a 1-cm vaginal cuff.
The extrafascial technique permits removal of the intact uterine fundus and cervix,
leaving the parametrial soft tissues or a portion of the upper vagina. Extrafascial
hysterectomy can be accomplished through an abdominal incision, transvaginally,
or by using a combination of laparoscopic and transvaginal techniques.
32. Do Not Remove Normal The Cervix
Supracervical hysterectomy
• It Is done by jenior less experience less knowledge doctor
done by non - academic doctors
• In less equipped private hospital
• It is followed by better sexual life , bladder function , rectal function
• It is easier
• Reduced operating time
• shorter recovery period
• less operative complications - injury to bladder , ureter, colon
• less post-operative complications
• gynecologist prefer subtotal hysterectomy
• It is good in presence of adhesions
• It is good in postpartum emergency
• It is not followed by vault ganuloma
• a cost-effective
• No loss of some sexual sensation due to loss of cervix
• Cancer of the cervical stump is an uncommon and largely preventable
occurrence due to Cervical cytologic screening and effective outpatient
treatment of preinvasive cervical disease
33. • It is easier to leave in the cervix if the uterus is removed
through the abdomen, but the reverse is true for a vaginal
hysterectomy.
• Although we have good screening methods for cervical
cancer, adenocarcinoma (cancer of the glands inside of the
cervix) is increasing in frequency, and can be fatal.
• In addition, there are now reports of having to go back and
remove the cervix after a supracervical hysterectomy
because of bleeding or other problems.
• There is a small but definite risk of cancer in a remaining
cervix, and of needing to have surgery to remove the cervix
at a later time if it causes problems. The arguments about
pelvic support and sexual functions have not been tested, so
their validity is unknown. Hopefully there will be good
prospective studies to better determine whether or not it is
best to remove the cervix.
35. Three factors should be considered in the selection of surgical
route regardless of the scope of the patient's condition:
• 1 - Uterine size
Weight >280 g or 12 weeks' gestational size versus <280 g
• 2 - Uterine attachments
Patients with a history or clinical findings suggestive of
- Endometriosis - Adnexal disease - Chronic pelvic pain - Adhesions -
Previous pelvic surgery
- Chronic pelvic inflammatory disease
may be candidates for a laparoscopy-assisted vaginal hysterectomy
If the laparoscopic score is less than 10, a vaginal hysterectomy is performed without
further laparoscopic assistance.
Scores between 11 and 19 indicate use of laparoscopic surgical techniques, such as
adhesiolysis or fulguration of endometriosis, to convert the score to 10 or less
before proceeding with a vaginal hysterectomy.
Patients with a score of 20 or higher are best managed with abdominal or
laparoscopic procedures
• 3 - Anatomic accessibility
a - Bituberous diameter <9 cm
b - Pubic arch <90°
c - Narrow vagina (less than two fingerbreadths, especially at the apex)
d - an undescended uterus
36. Do It Laparoscopic
• Laparoscopic hysterectomy is a safe procedure for
selected patients scheduled for abdominal
hysterectomy, and offers benefits to the patients in the
form of less operative bleeding, less post-operative pain,
shorter time in hospital and shorter convalescence time
, leave smaller scarc on the abdomen than abdominal
• But it takes more operative time, uses more operating
room equipment (some of which is “single-use”
equipment, which can be expensive), and requires
specialized surgical skills
• most doctors don’t practice modern endoscopy
techniques due to lack of training facility for the same
• A LAVH or LH is often less invasive than an abdominal
hysterectomy, but more invasive than a vaginal
hysterectomy
37. • Laparoscopically Assisted Vaginal Hysterectomy Just like in a
TAH or TVH, the uterus (including the cervix) is detached from
the ligaments that attach it to other structures in the pelvis, and
removed through a cut at the top of the vagina which is repaired
with stitches
• Laparascopic Supracervical Hysterectomy This procedure is done
completely laparoscopically and does not remove the cervix
• Laparascopic Total Hysterectomy This procedure is done
completely laparoscopically and remove the cervix also
38. Do It Vaginal
• Vaginal subtotal hysterectomy
(conservation of the cervix ) and
sacrospinous colpopexy in the
management of patients with
marked uterine prolapse who desire
retention of the cervix
• Total Vaginal Hysterectomy
This procedure is the same as in the
TAH, performed vaginally
• less morbidity less mortality
• Only gynecologist can do vaginal
hysterectomy
39. Three factors should be considered in the selection of
Vaginal route
• 1 - Uterine size
Weight>280 g or > 12 weeks' gestational size
• 2 - Uterine attachments
Patients with no history or clinical findings suggestive of
- Endometriosis - Adnexal disease - Chronic pelvic pain
- Adhesions - Previous pelvic surgery
- Chronic pelvic inflammatory disease
3 - Anatomic accessibility
a - Bituberous diameter <9 cm
b - Pubic arch< {90°
c -wide vagina (more than two fingerbreadths, especially at
the apex)
d - descended uterus
40. • The advantages of this procedure are that it leaves no
visible scar and is less painful, a shorter hospital stay,
Fastest return to normal activities Highest quality of life
scores , Lowest hospitalization and postoperative costs
• The disadvantage is that it is more difficult for the surgeon
to see the uterus and surrounding tissue. This makes
complications more common.
• Large fibroids cannot be removed using this technique.
• unable to remove a very large uterus or areas of
endometriosis, adenomyosis, or scar tissue (adhesions)
• Doesn't allow free access to the pelvic organs , It is very
difficult to remove the ovaries during a vaginal
hysterectomy, so this approach may not be possible if the
ovaries are involved.
41. VH for large uterus
• 1 - cervix prolapsing through vaginal introitus grasped by tenaculi
• 2 - cervix being bivalved with scalpel
• 3 - uterine corpus being bivalved after separation of cervix has been completed
• 4 - uterus halved after bivalving procedure to facilitate its removal
• 5 - after half of uterus is removed. cervix is grasped with uterine corpus below
• 6 - vaginal cuff closed with suture after removal of uterus
• 7 - following procedure bladder is drained with foley catheter revealing non-bloody
urine
• 8 - removed uterus sent for pathology examination
42. Do It Abdominal
• Physicians use the procedure they are
most comfortable with, and residents
lack sufficient hands-on experience with
laparoscopic and vaginal surgery.
• Medicolegal risk and reimbursement also
have an impact
43. The advantages of an abdominal hysterectomy are that the large uterus
can be removed even if a woman has internal scarring (adhesions) from
previous surgery or her fibroids are large. The surgeon has a good view
of the abdominal cavity and more room to work. Also, surgeons tend to
have the most experience with this type of hysterectomy.
Requires less time under anesthesia and in surgery than a laparoscopic
hysterectomy but more than vaginal hysterectomy
But The abdominal incision is more painful than with vaginal
hysterectomy, and hospital stay and recovery period is longer
Costs more than a vaginal hysterectomy but less than laparoscopic
Twice the risk of postoperative fever
Significantly increased blood loss
44. • Abdominal hysterectomy remains the predominant method
of uterine removal in the United States, despite evidence
that vaginal hysterectomy offers advantages in regard to
operative time, complication rates, return to normal
activities, and overall cost of treatment.
• We must improve training in vaginal surgery for the
younger generation of gynaecologists, and our colleges
should now establish clinical guidelines for selecting the
appropriate route of hysterectomy, based on the best
available evidence. Such guidelines have been shown to
enhance the uptake of vaginal hysterectomy
45. Is it necessary to get a Second Or
Third opinion before Hysterectomy?
• The second opinion will confirm any concerns about
whether Her was correctly diagnosed
• Getting a second opinion from another doctor is a good way
to make sure that hysterectomy is the right option for her
• Don't be uncomfortable about telling Her doctor She want a
second opinion.
• Doctors expect their patients to ask for another opinion. .
46. Many factors are embodied in these differences
• cultural attitudes, physician training, the availability of
elective surgery in a particular country, the ability to pay for
care, etc.
• Women tend to make very different decisions based on their
particular circumstances, their feelings about estrogen
replacement therapy, and their risk and fear of ovarian
cancer. However, it is always best to make these decisions
based on accurate and current medical information. This
decision is yours to make and should be discussed in detail
with her doctor. As always, if there are unanswered
questions or concern, get a second opinion.
• the final decision about the appropriateness of a
hysterectomy, or any type of surgery or medical care,
should be made by each woman herself
47. Conclusion
• Each case is differrent and decision is difficult
• Doctor must share decision with Her patient and her
family
• Every Step should be offered as an option to
selected patients
• Decision is based on guidelines rather than
physicians' preferences or experience
• Final decision should be made by the woman herself
based on her age, her options, and the severity of
her symptoms
48. My Opinion
the decision should be made on a case-by-case basis
• If medical or hormonal ttt or hystrectomy alternatives are failed –
I do hysterectomy --- specially classical intrafascial subtotal
hysterectomy
• I remove the the cervix
if cervix is unhealthy
when vault well not supported
or patient can not recur regularly for follow up ( Pap smear)
• I try to leave at least one normal ovary to patient who is still
menstrating
and I remove both
after menopause
or patient have relative with cancer ovary or breast
• Attention : I may change my opinion later