[Convalescence recommendations after hysterectomy. A study of opinions among Danish physicians]

INTRODUCTION

The aim of this study was to describe advice and restrictions given by Danish general practitioners (GPs) and gynaecologists to patients after uncomplicated hysterectomy.

MATERIALS AND METHODS

Four hundred and ninety-one randomly selected GPs and 433 gynaecologists received a postal questionnaire in 1998/1999. The questions concerned the length of recommended sick leave, lifting restrictions, and time to resumption of seven defined common activities after hysterectomy. In addition, the gynaecologists were asked about the use of vaginal packaging, bladder catheters, and expected length of hospital stay.

RESULTS

The total response rate was 72%. GPs and gynaecologists recommended a median of 4 weeks (1-8 weeks) of convalescence after hysterectomy to patients, whose work did not involve heavy lifting, and a median of six weeks (2-12 weeks) to women, whose work did. Responses concerning the resumption of common activities showed considerable variation, for instance patients were advised to postpone sexual intercourse for a median of four weeks postoperatively (0-12 weeks). Lifting restrictions varied from lifting a maximum of 15 kg for two weeks to a maximum of 2 kg for 12 weeks.

CONCLUSION

A considerable variation was found in recommendations and regimens for hysterectomised patients. Evidence-based guidelines do not exist, and until these are available, the national and local boards of physicians need to agree on what restrictions should be given to patients.

[Laparoscopic surgery--an update of current status]

Recent developments have allowed most intra-abdominal procedures to be performed by the laparoscopic technique. Potential clinical advantages are supported by the reduced pathophysiological changes demonstrated in the surgical stress response, as compared with open surgery. However, a critical assessment of randomised, controlled studies and meta-analyses comparing laparoscopic and open surgery has not convincingly shown that laparoscopic surgery improves the outcome, except in a few operations. Because the concept of minimal invasive surgery is based on well-documented pathophysiological advantages, future randomised studies comparing laparoscopic and open surgery should include a revision of perioperative care regimens with early rehabilitation, in order to demonstrate more significant benefits of laparoscopic surgery.

[Hospitalization and convalescence after hysterectomy. Open or laparoscopic surgery?]

Approximately 6,000 hysterectomies are performed per year in Denmark. The major part of these are performed by laparotomy, although the use of laparoscopically assisted techniques is increasing. Laparoscopic surgery seems to lead to a reduction in the need for postoperative hospitalization and convalescence, which is confirmed in the few available randomised and to our knowledge all retrospective studies. The length of stay seems to be reduced from four to two days if the patient is hysterectomised by the laparoscopically assisted or vaginal techniques. The introduction of endoscopic techniques has caused a change in routines and recommendations, but not for women operated by the classical open procedures. In this article we question the relevance of comparing different types of operations given the fact that the routines and recommendations are different.

Thermal balloon endometrial ablation: safety aspects evaluated by serosal temperature, light microscopy and electron microscopy

OBJECTIVES

Thermal balloon endometrial ablation is a new method for treating menorrhagia. The technique appears to be less difficult compared to standard hysteroscopic ablation techniques and to be significantly safer. The influence into the uterine wall of the thermal balloon ablation procedure was investigated with special reference to the ability of total destruction of the endometrium and the thermal action on the myometrium and the serosa.

STUDY DESIGN

Temperatures were measured at the uterine serosal surface during thermal balloon endometrial ablation for 8-16 min in eight patients. After subsequent hysterectomy the extent of thermal damage into the myometrium was assessed by light and electron microscopy.

RESULTS

The highest temperature measured on the uterine serosa was 39.1 degrees C. Coagulation of the myometrium adjacent to the endometrium could be demonstrated by light microscopy in all patients, with a maximum depth of 11.5 mm. By electron microscopy no influence of heat could be demonstrated beyond 15 mm from the endometrial surface.

CONCLUSION

Up to 16 min of thermal balloon endometrial ablation therapy can destroy the endometrium and the submucosal layers. The myometrium is only coagulated to a depth where full thickness necrosis or injury is unlikely.