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Moradi B, Hejazian SS, Tahamtan M, Ghorani H, Karami S. Imaging the post-treatment pelvis with gynecologic cancers. Abdom Radiol (NY) 2024; 49:1248-1263. [PMID: 38340181 DOI: 10.1007/s00261-023-04163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
Gynecological malignancies, such as ovarian cancers, cervical cancers, and endometrial cancers, have a significant global impact. Women with gynecologic malignancies may receive a single or a combination of treatments, including surgery, chemotherapy, and radiation-based therapies. Radiologists utilize various diagnostic imaging modalities to provide the surgeon with relevant information about the diagnosis, prognosis, optimal surgical strategy, and prospective post-treatment imaging. Computerized Tomography (CT) and magnetic resonance imaging (MRI) may be used initially to evaluate and detect post-treatment complications. Although CT is primarily used for staging, MRI is commonly used for a more accurate evaluation of a tumor's size and detection of local invasion. Complications such as hematoma, abscess, inclusion cyst, seroma, tumor thrombosis, anorectovaginal fistula, and gossypiboma may occur after the three primary treatments, and systems such as the genitourinary, gastrointestinal, neurological, and musculoskeletal may be affected. In order to distinguish between early-onset and late-onset complications following gynecological treatment, radiological findings of the most common post-treatment complications will be presented in this review.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Women's Yas Hospital, Tehran, Iran
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Sina Hejazian
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Tahamtan
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Karami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
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Vaginal vault drainage as an effective and feasible alternative in laparoscopic hysterectomy. Obstet Gynecol Sci 2022; 65:477-482. [PMID: 35903944 PMCID: PMC9483674 DOI: 10.5468/ogs.22083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022] Open
Abstract
Objective Infected pelvic hematoma is a serious complication of hysterectomies. Pelvic drainage can help reduce complications. In this study, we evaluated the efficacy and safety of vaginal vault drainage in patients who underwent laparoscopic hysterectomy for benign gynecological diseases. Methods Patients who underwent laparoscopic hysterectomy and pelvic drain insertion for benign gynecological diseases between January 2008 and December 2015 were enrolled retrospectively in the study. They were grouped according to drain insertion sites, that is, through the abdomen (group 1) and vaginal vault (group 2). The postoperative outcomes were compared between the two groups. Results A total of 504 women were included. No significant differences were observed in the prevalence of postoperative fever, readmission, and reoperation between the two groups. Conclusion Given the discomfort associated with holding and removing the abdominal drain, inserting a closed pelvic gravity drain through the vaginal vault appears to be a feasible alternative to an abdominal drain.
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Perioperative hemorrhagic complications in pelvic floor reconstructive surgery. Int Urogynecol J 2018; 30:1141-1146. [PMID: 29785542 DOI: 10.1007/s00192-018-3667-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/25/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to assess the incidence, symptoms, and risk factors of perioperative hemorrhagic complications in patients undergoing pelvic floor reconstructive surgery. METHODS This is a retrospective study on 694 consecutive patients who underwent pelvic floor reconstructive surgery with or without using mesh in our hospital over a 3-year period. RESULTS We identified 694 pelvic floor reconstructive procedures from 2014 to 2016, including complete/incomplete colpocleisis (176, 25.4%), sacral colpopexy/hysteropexy with mesh (140, 20.1%), colporrhaphy (77, 11.1%) or vaginal mesh repair (99, 43.1%). Two patients who received only sacrospinous ligament suspension were excluded. There were 68 (9.8%) and 3 (0.1%) patients whose blood loss reached 200 and 500 ml respectively. Procedures involving mesh and vaginal hysterectomy (VH) caused more intraoperative blood loss. Postoperative hemoglobin drop was least in colpocleisis (p < 0.05). All 6 of the patients (0.9%) who developed postoperative pelvic hematoma underwent concomitant VH, and 5 of them received mesh. CONCLUSIONS Hemorrhagic complications during or after pelvic floor reconstructive surgery are rare. Mesh use and concomitant VH are two major surgical risk factors for hemorrhagic complications in pelvic floor reconstructive surgery.
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Obermair H, Janda M, Obermair A. Real-world surgical outcomes of a gelatin-hemostatic matrix in women requiring a hysterectomy: a matched case-control study. Acta Obstet Gynecol Scand 2016; 95:1008-14. [PMID: 27199208 DOI: 10.1111/aogs.12924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to compare adverse events and surgical outcomes of hysterectomy with or without use of a gelatin-hemostatic matrix (SURGIFLO(®) ). MATERIALS AND METHODS Prospective case-control study (Canadian Task Force classification II2) of total hysterectomy (Piver Type 1) provided by surgeons in Australia between November 2005 and May 2015. Data were collected via SurgicalPerformance, a web-based data project which aims to provide confidential feedback to surgeons about their surgical outcomes. Of 2440 records of women who received a hysterectomy, 1351 were eligible for these analyses; 107 received SURGIFLO(®) hemostatic matrix to prevent postoperative blood loss and 1244 did not. RESULTS Patients with or without SURGIFLO(®) differed in age, Charlson comorbidity index, and American Society of Anesthesiologists physical status classification system score (ASA), and also differed in clinical outcomes. After matching for patient's age and ASA at surgery, patients with and without SURGIFLO(®) had comparable baseline characteristics. Matched patients with and without SURGIFLO(®) had comparable clinical outcomes including risk of developing vault hematoma, return to the operating room, transfusion of red cells, surgical site infection (pelvis), readmission within 30 days and unplanned ICU admission. CONCLUSIONS In a sample matched by age and ASA, SURGIFLO(®) neither prevented nor caused additional adverse events in women undergoing hysterectomy. Surgeons used SURGIFLO(®) more commonly among women who were older, had more comorbidities and a higher ASA score. This indicates that it may be most useful in complicated surgery or cases.
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Affiliation(s)
- Helena Obermair
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Monika Janda
- Institute for Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,SurgicalPerformance Pty Ltd, Greenslopes Private Hospital, Brisbane, QLD, Australia
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Uysal A, Taner CE, Mun S, Aydemir S. Prevention of infectious morbidity after elective abdominal hysterectomy. Arch Gynecol Obstet 2012; 286:959-63. [DOI: 10.1007/s00404-012-2382-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/08/2012] [Indexed: 11/29/2022]
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Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG 2011; 119:348-53. [DOI: 10.1111/j.1471-0528.2011.03170.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Segev Y, Auslender R, Lissak A, Lavie O, Abramov Y. Symptomatic pelvic hematoma following transvaginal reconstructive pelvic surgery: incidence, clinical presentation, risk factors, and outcome. Eur J Obstet Gynecol Reprod Biol 2010; 153:211-4. [PMID: 20674137 DOI: 10.1016/j.ejogrb.2010.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 06/10/2010] [Accepted: 07/06/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the incidence, clinical presentation, risk factors and outcome of symptomatic pelvic hematomas following transvaginal pelvic reconstructive surgery. MATERIALS AND METHODS We reviewed the medical records of all women undergoing transvaginal reconstructive pelvic surgery in our institution between January 2006 and July 2009. RESULTS 462 patients underwent pelvic reconstructive surgery, of whom 28 (6%) presented with symptomatic pelvic hematomas. All cases occurred after transvaginal hysterectomy, 25 (90%) presented with fever, 20 (71%) with pelvic pain and 5 (20%) with urinary retention. All hematomas were diagnosed by ultrasound. They were located at the vaginal cuff in 18 (64%), anterior vaginal wall in six (21%) and posterior vaginal wall in four patients (14%), and had a mean volume of 590 ± 140 cm(3). Laboratory data included leukocytosis (71%), thrombocytosis (57%) and elevated liver enzymes (18%). Nine patients (33%) required ultrasound-guided drainage of the hematoma, which resulted in marked clinical improvement. Surgical outcome was not affected by the presence of pelvic hematoma. CONCLUSIONS A postoperative symptomatic pelvic hematoma is not rare and is closely related to transvaginal hysterectomy. Its clinical presentation includes fever, pelvic pain, leukocytosis, thrombocytosis and occasionally liver dysfunction. Surgical outcome is generally unaffected.
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Affiliation(s)
- Yakir Segev
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, 7 Michal St., Haifa 34362, Israel.
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Paspulati RM, Dalal TA. Imaging of Complications Following Gynecologic Surgery. Radiographics 2010; 30:625-42. [DOI: 10.1148/rg.303095129] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Moustafa M, Elgonaid WEM, Massouh H, Beynon WG. Evaluation of closure versus non-closure of vaginal vault after vaginal hysterectomy. J OBSTET GYNAECOL 2009; 28:791-4. [PMID: 19085546 DOI: 10.1080/01443610802552058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This randomised prospective study in 53 women having vaginal hysterectomy for benign conditions compared a closed vault technique with an open technique. Twenty-seven had the vault closed (group A) whereas 26 patients had an open vault (group B). The primary outcomes include, vault haematoma (as detected by ultrasound on day 3) and fever. Secondary outcomes are haemorrhage, urinary tract infection, urinary retention and vault granulation tissue. The study did not show any statistical difference between either group. Prolapse of the fallopian tube was recorded in one case in the open vault group. A randomised controlled study on a larger scale is recommended.
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Affiliation(s)
- M Moustafa
- Department of Obstetrics and Gynaecology, Frimley Park Hospital, Frimley, UK.
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Lima AG, Taha MO, Rivoire HC, Fagundes ATN, Fagundes DJ. Fibrin adhesive and the vaginal vault synthesis on female rabbits abdominal hysterectomies. Acta Cir Bras 2009; 24:30-5. [PMID: 19169539 DOI: 10.1590/s0102-86502009000100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 11/18/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the effectiveness of fibrin glue in comparison with polyglycolic acid suture to promote the closure of rabbit's vaginal vault, after abdominal hysterectomy. METHODS Twenty female, adults, New Zealand rabbits, were submitted to abdominal hysterectomy and randomly distributed to polyglycolic acid suture (G-PA / n=10) or fibrin glue closure of vaginal vault (G-FG / n=10). Radiograph study allowed identifying vault vaginal suture disrupter or fistulas to urinary bladder or rectum. Videovaginoscopy study allowed identifying the presence of cellulites, abscess formation, tissue granulation or granuloma. Vaginal cuff burst test allowed to identify by the escape of air bubbles and rupture pression record. Histological sections stained with Picrosirius red allowed the measure of fibrous tissue healing. RESULTS The videovaginoscopy identified a significant difference (Fisher Test p<0.3142) of granulation tissue in the animals of G-PA (40%) in comparison with the G-FG (20%). The gross inspection showed the same relation in the granulation tissue occurrence (Fisher test p< 0.1749) with G-PA (50%) and G-FB (20%). The visceral adhesion to the vaginal vault wound was statistical significant (Fisher test p< 0.1749) with G-PA (50%) and G-FG (20%). The pressure of rupture (mm Hg) of the burst test was similar (p<0.0421) in the animals of G-PA (61.5+/-19.3) and G-FG (72.5+/-21.9). The collagen matrix of vault wound healing was similar (p< 0.0231) between the G-PA (31.63+/-15) and the G-FG (23.2+/-13.2). CONCLUSION The vaginal vault closure using the fibrin glue is a safe and reliable procedure after abdominal hysterectomy in female rabbit model.
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Affiliation(s)
- Ari Gonçalves Lima
- Surgical Technique Division, Department of Surgery, Rio Grande Federal University, Rio Grande, RS, Brazil
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Dane C, Dane B, Cetin A, Yayla M. Sonographically diagnosed vault hematomas following vaginal hysterectomy and its correlation with postoperative morbidity. Infect Dis Obstet Gynecol 2007; 2009:91708. [PMID: 17485823 PMCID: PMC1847506 DOI: 10.1155/2007/91708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 01/04/2007] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity. METHODS We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity. RESULTS The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20) had fever while only 2.4% (2/83) of cases without vault hematoma suffered from fever. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma. Fifty percent of patients (3/6) with large-sized hematoma, as compared to only 35% (5/14) with small-sized hematoma, suffered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The significant difference was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group. CONCLUSION Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be significant. Vaginal ultrasound examination should not be performed routinely after hysterectomy.
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Affiliation(s)
- Cem Dane
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, 34019 Istanbul, Turkey
- *Cem Dane:
| | - Banu Dane
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, 34019 Istanbul, Turkey
| | - Ahmet Cetin
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, 34019 Istanbul, Turkey
| | - Murat Yayla
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, 34019 Istanbul, Turkey
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Antonelli E, Morales MA, Dumps P, Boulvain M, Weil A. Sonographic detection of fluid collections and postoperative morbidity following Cesarean section and hysterectomy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:388-392. [PMID: 15065191 DOI: 10.1002/uog.1023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the clinical significance of sonographically detected fluid collections following Cesarean section and hysterectomy, and to identify risk factors associated with their formation. METHODS This was a prospective study including 280 women, 145 of whom had undergone a Cesarean section and 135 of whom had undergone abdominal or vaginal hysterectomy. Ultrasound examinations were carried out on all women on day 4 after surgery to assess the presence of abdominal wall or pelvic fluid collections. The sonographers were unaware of the clinical course before the examination and were not involved in any clinical decision-making. Ultrasound findings were correlated with clinical data and postoperative morbidity. RESULTS A fluid collection was found in 69 (48%) women after Cesarean section, and in 59 (44%) women who had undergone hysterectomy. No risk factors for the development of fluid collections after Cesarean section or hysterectomy were identified. The risk of developing febrile morbidity was not related to the presence, location or size of fluid collections. CONCLUSIONS Postoperative fluid collections are common after Cesarean section and hysterectomy. As fluid collections detected by sonography were not associated with postoperative morbidity, this finding is unlikely to be useful in the workup for postoperative fever.
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Affiliation(s)
- E Antonelli
- Unité de Développement en Obstétrique, Department of Obstetrics and Gynaecology, Geneva University Hospitals, Geneva, Switzerland.
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Shen CC, Huang FJ, Hsu TY, Weng HH, Chang HW, Chang SY. A prospective, randomized study of closed-suction drainage after laparoscopic-assisted vaginal hysterectomy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:346-52. [PMID: 12101333 DOI: 10.1016/s1074-3804(05)60415-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To estimate whether closed-suction drainage of the pelvis after laparoscopic-assisted vaginal hysterectomy reduces the risk of postoperative morbidity. DESIGN Prospective, randomized study (Canadian Task Force classification 1). SETTING Teaching medical center. PATIENTS Three hundred twenty-four women. INTERVENTION Laparoscopic-assisted vaginal hysterectomy. MEASUREMENTS AND MAIN RESULTS The 160 women in group 1 had closed-suction (Jackson-Pratt) drains inserted into the peritoneal cavity and cul-de-sac, whereas the 164 in group 2 had no drains. Postoperative time to flatulence, hemoglobin, analgesic requirements, duration of hospital stay, rehospitalization, complications, febrile morbidity, and infection were studied. No statistically significant differences were seen between groups in demographics, outcome measures, postoperative infectious morbidity, or complications. The small power value may mean that no true differences existed for most tests. A statistically significant difference in analgesic requirement was found, with more oral analgesics taken by women in group 2. CONCLUSION Prophylactic surgical drainage may not be necessary to prevent postoperative morbidity after laparoscopic-assisted vaginal hysterectomy when prophylactic and postoperative antibiotics are given. A drain still has its role in gynecologic laparoscopy in selected women, such as in those with persistent ooze from raw surfaces, bowel injury, or frank pus in the abdomen.
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Affiliation(s)
- Chung-Chang Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 4F-4, 123-6, Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan
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Miskry T, Chatzipapas I, MB, BS, MRCOG RH, Gabrielle A, Magos A. Sonographic Comparison of Pelvic Collections After Abdominal, Vaginal, and Laparoscopic Hysterectomy. J Gynecol Surg 2001. [DOI: 10.1089/104240601753196227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cross JJ, Fynes M, Berman L, Perera D. Prevalence of cystic paraurethral structures in asymptomatic women at endovaginal and perineal sonography. Clin Radiol 2001; 56:575-8. [PMID: 11446756 DOI: 10.1053/crad.2000.0709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To prospectively assess the prevalence of paraurethral cystic structures in asymptomatic adult women. PATIENTS AND METHODS One hundred and forty consecutive women undergoing endovaginal sonography with no history of lower urinary tract symptoms. RESULTS Paraurethral cystic structures were identified in 4/140 subjects (2.9%). Ultrasound assessment allowed rapid definition of the site, size and vascularity of these lesions and was well tolerated by the patient. CONCLUSION This is the first prospective ultrasound study to determine the prevalence of paraurethral cystic structures in a large consecutive cohort of asymptomatic women. Our findings are in accordance with previously published post-mortem data and surgical series which have estimated the prevalence of paraurethral cystic structures to be between 1 and 6%.
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Affiliation(s)
- J J Cross
- University Department of Radiology, Cambridge University and Addenbrooke's Hospital, Cambridge, UK
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Thomson AJ, Farquharson RG. Vault haematoma and febrile morbidity after vaginal hysterectomy. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2000; 61:535-8. [PMID: 11045221 DOI: 10.12968/hosp.2000.61.8.1395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vaginal hysterectomy is associated with significant risk of vaginal vault haematoma (40%) and febrile morbidity (30%). Numerous interventions have been used to try and avoid these complications but very few have been shown to be effective.
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Affiliation(s)
- A J Thomson
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital
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Predictive Value for Infection of Febrile Morbidity After Vaginal Surgery. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199906000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aharoni A, Kaner E, Levitan Z, Condrea A, Degani S, Ohel G. Prospective randomized comparison between an open and closed vaginal cuff in abdominal hysterectomy. Int J Gynaecol Obstet 1998; 63:29-32. [PMID: 9849708 DOI: 10.1016/s0020-7292(98)00116-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare an operative and postoperative course of open vaginal cuff hysterectomy and closed vaginal cuff hysterectomy, and to correlate the length of stay, febrile morbidity and the incidence of pelvic fluid collections to the type of surgery. PARTICIPANTS One-hundred women scheduled for hysterectomy were prospectively randomized into two groups that underwent either a closed or an open vaginal cuff technique. RESULTS The open vaginal cuff technique took on average 19% more time than the closed vaginal cuff operation (P < 0.05, t-test). The incidence and size of pelvic fluid collections was significantly higher after the closed vaginal cuff hysterectomy than after the open technique (P < 0.01, t-test). However, the postoperative length of stay, febrile morbidity and the rate of complications were similar. CONCLUSIONS Both techniques of hysterectomy produced a similar postoperative course despite the fact that the closed vaginal cuff technique resulted in a higher incidence of pelvic fluid collections. Therefore considering a shorter operation time for the closed vaginal cuff hysterectomy, this technique seems slightly preferable.
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Affiliation(s)
- A Aharoni
- Gynecology and Obstetrics Department, Bnai-Zion Medical Center, Haifa, Israel.
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Thomson AJ, Sproston AR, Farquharson RG. Ultrasound detection of vault haematoma following vaginal hysterectomy. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1998; 105:211-5. [PMID: 9501789 DOI: 10.1111/j.1471-0528.1998.tb10055.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess whether ultrasound detection of vault haematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy. DESIGN Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994. SAMPLE Two hundred and twenty-three women having undergone vaginal hysterectomy. METHODS All women had transvaginal ultrasound examination by an independent observer on the third post-operative day. Routine observations and clinical assessments were made by established management protocol, by staff blinded to the ultrasound findings. MAIN OUTCOME MEASURES Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re-admission rate and length of stay. RESULTS Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31% vs 7%), post-operative haemoglobin drop (2.5 g/dL vs 1.6 g/dL), need for blood transfusion (14.5% vs 1.2%), representation to hospital (25.5% vs 5.4%) and length of hospital stay (8.87 days vs 6.25 days) were seen in the haematoma group. CONCLUSION Ultrasound detection of vault haematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, need for blood transfusion, longer hospital stay and higher re-admission rate. In view of increasing demand for early discharge, driven by purchasers and patients, post-operative ultrasound identifies a high risk population and is both convenient and noninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trial of prophylactic antibiotics in this identified subset.
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Affiliation(s)
- A J Thomson
- Liverpool Women's Hospital NHS Trust, Mersey Regional Health Authority, UK
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Abstract
Thirty consecutive patients underwent transabdominal ultrasound scanning on day 2 postoperatively in order to provide data on the incidence of vaginal vault haematoma following laparoscopic hysterectomy. Details of postoperative morbidity, both inpatient and after discharge, were recorded. Results support the view that there is no significant association between the presence of vaginal vault haematoma (73%) and the incidence of posthysterectomy febrile morbidity (16.7%). Furthermore the incidence of vault haematoma after laparoscopic hysterectomy is comparable to literature figures for both abdominal and vaginal hysterectomy, whilst that of febrile morbidity is at least equivalent if not reduced for the laparoscopic approach. We believe this provides further evidence confirming the safety of the laparoscopic approach to hysterectomy.
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Affiliation(s)
- D M Rosen
- Sydney Women's Endosurgery Centre, St George Hospital, University of New South Wales, Australia
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Eason EL, Sampalis JS, Hemmings R, Joseph L. Povidone-iodine gel vaginal antisepsis for abdominal hysterectomy. Am J Obstet Gynecol 1997; 176:1011-6. [PMID: 9166161 DOI: 10.1016/s0002-9378(97)70395-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our goal was to assess the safety and effectiveness of vaginal povidone-iodine gel in reducing febrile morbidity after abdominal hysterectomy. STUDY DESIGN This cohort study included 158 women treated with gel immediately before hysterectomy, after the usual surgical preparation, and 317 historic control subjects with the usual surgical preparation only, at two teaching hospitals. Febrile morbidity was assessed by a blinded review of temperature records and was analyzed by Fisher's exact test and multiple logistic regression. RESULTS Febrile morbidity occurred in 17% of gel-treated patients and 26% of controls (adjusted odds ratio 0.52, 95% confidence interval 0.31 to 0.89). In patients receiving prophylactic antibiotics the adjusted odds ratio for febrile morbidity in gel-treated patients was 0.47 (95% confidence interval 0.27 to 0.83). Prolonged fever occurred in 17% of controls and 10% of gel-treated patients (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.97). CONCLUSION Preoperative vaginal povidone-iodine gel is a safe and promising technique for reducing febrile morbidity after hysterectomy.
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Affiliation(s)
- E L Eason
- Department of Obstetrics and Gynecology, Montreal General Hospital, Canada
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Langer JE, Jacobs JE. High-resolution computed tomography of the female pelvis: spectrum of normal appearances. Semin Roentgenol 1996; 31:267-78. [PMID: 8896103 DOI: 10.1016/s0037-198x(96)80017-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J E Langer
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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Bearcroft PW, Miles KA. Leucocyte scintigraphy or computed tomography for the febrile post-operative patient? Eur J Radiol 1996; 23:126-9. [PMID: 8886724 DOI: 10.1016/0720-048x(96)01039-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The optimal initial investigation for the post-operative patient with suspected occult intra-abdominal sepsis is controversial, although the diagnostic accuracy of a variety of techniques is known. Our objective is to determine which investigation has the greatest positive effect on patient management. METHODS AND PATIENTS We reviewed 67 consecutive post-operative patients investigated for suspected occult sepsis retrospectively and analysed the sequence of investigations required to achieve the diagnosis depending on the choice of initial investigation, and the interval between between initiating investigations and performing definitive percutaneous drainage. RESULTS Forty patients had scintigraphy as the initial investigation and 21 of these went on to require CT. None of the 27 patients who had CT as the initial investigation required any other imaging (chi 2 = 20.6, P < 0.0001) and appropriate percutaneous drainage was offered immediately. Conversely, the average interval to drainage in those who had scintigraphy first was 3.1 days. Fourteen out of 20 patients (70%) who had scintigraphy as the initial investigation following recent surgery, and 7 of 20 (35%) following old surgery, needed subsequent CT. None of the 20 and 7 patients in the recent and old surgery groups respectively who had CT initially required further imaging. CONCLUSION Our results suggest recommending CT as the initial investigation in the early post-operative period as this will reduce the total number of investigations required to achieve the diagnosis and the time to definitive drainage. In the late post-operative period, scintigraphy will resolve the majority of problems.
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Affiliation(s)
- P W Bearcroft
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
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