No abstract

This study shows that preoperative low fibre diet and mechanical bowel preparation provide similar quality of surgical field exposure. However, when compared with mechanical bowel preparation, preoperative low fibre diet may be better tolerated by the patients, thus increasing compliance. Moreover, a 7 days preoperative low fibre diet allow the patient to continue working and social activities until the day of surgery without requiring admission to the hospital or home bowel preparation on the day before surgery.

More than 600,000 hysterectomies are done each year, making this the most common major nonobstetric operation performed on women in the United States. This study was an attempt to determine annual rates, types, and indications for hysterectomy done on benign indications. The study population consisted of 32,321 hysterectomies done for benign conditions in women at least 20 years of age in the years 1994 to 2003. All women had been enrolled for a year or longer in Kaiser Permanente Northern California.Rates of hysterectomy decreased significantly by 15%, from 4.01 per 1000 women in 1994 to 3.41 per 1000 in 2003. This trend held for abdominal and vaginal hysterectomies as well as laparoscopy-assisted vaginal hysterectomy (LAVH). The relative proportions of both vaginal hysterectomy and LAVH, especially the latter, declined during the years under review. The relative proportion of total abdominal hysterectomy also declined, but that of subtotal abdominal hysterectomy increased 3-fold. Hysterectomy was done for uterine leiomyoma more often than for all other indications combined in each of the years under review. Rates of hysterectomy decreased 11.2% for uterine leiomyoma, 33.1% for endometriosis, and 18.6% for uterine prolapse. Hysterectomies done for "other" indications declined 5.7%. Rates of hysterectomy were consistently highest for women 40 to 44 and 45 to 49 years of age. The increase in rates for these age groups was not statistically significant, however. Rates for all other age groups decreased significantly over time. Uterine leiomyoma was the most common indication for hysterectomy in women aged 35 to 54 years and uterine prolapse in those aged 55 and older.Rates of hysterectomy for benign disease declined significantly in this large population, but the reasons are not clear. Studies focusing on the potential effects of alternative surgical procedures and medical treatments on rates of hysterectomy would be of interest. GYNECOLOGYVolume 61, Number 9 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTAn indwelling catheter has routinely been used after major gynecologic operations, but little evidence is available that this practice is beneficial during the first 24 hours after hysterectomy. The presence of a catheter has been associated 578Obstetrical and Gynecological Survey Operative Gynecology 579 ABSTRACTMinimally invasive forms of the tension-free vaginal tape (TVT) procedure have shown considerable promise in women with stress urinary incontinence (SUI). Operating times have decreased, as have complications, in part because TVT may be done under local anesthesia. This study analyzed the results of midurethral sling procedures in 266 women who were followed up for at least 6 months and for a mean of 10.4 months. Outcomes were compared in an elderly group of 60 women aged 65 years and older and 206 middle-aged women 45 to 64 years of age. Both TVT and suprapubic arch (SPARC) procedures were carried out. Uroflowmetry was performed with the patient sitting to monitor voided volume and maximal flow rate during...