Preoperative hot conization of the cervix: a possible method to reduce postoperative febrile morbidity following vaginal hysterectomy

[Antibiotic prophylaxis in gynecologic surgery]

Hysterectomies are contaminated procedures; surgical wound related sepsis ranges from 10 to 25%. Several randomised controlled studies demonstrated a significant benefit with prophylactic antibiotics. The study results were more controversial for abdominal hysterectomies. Ureidopenicillins, cephamycins and other antibacterial agents active on Gram negative rods and anaerobes can be recommended as a preoperative flash at anaesthesia induction, followed by a second injection whenever the procedure duration exceeds 3 hours. In case of extended hysterectomy for cancer, broad spectrum antibiotic prophylaxis is usual; some recent studies demonstrated the efficacy of a short duration antibacterial agent use. Mastectomies are at low risk for postoperative infection. Antibacterial prophylaxis is common, especially in plastic surgery.

Vaginal hysterectomy: past, present, and future

Progress has been made in the following aspects of vaginal hysterectomy: improvement of technique and reduction of the incidence of febrile morbidity, the length of hospitalization, and the postoperative retention of urine with associated repair. Vaginal hysterectomy should continue to have its widest application in women whose childbearing is complete and who have incapacitating hypermenorrhea and dysmenorrhea with or without small uterine leiomyomas or adenomyosis.

Genital bacteriology: a comparative study of premenopausal women with postmenopausal women

Premenopausal women are reportedly at a higher risk than postmenopausal women of postoperative infection following vaginal hysterectomy. A study was designed to determine whether a relationship exists between bacterial flora and patient age that may explain the difference in the risk of postoperative infection. No statistically significant difference was found in the number or type of bacterial species isolated from the cervix or vagina of premenopausal and postmenopausal women. Postmenopausal women on a regimen of conjugated estrogens had genital flora similar to that of the other women studied.