A Prospective Observational Study of the Safety and Acceptability of Vaginal Hysterectomy Performed in a 24-Hour Day Case Surgery Setting

Abstract

Endometrial ablation is a less invasive treatment for menorrhagia than is hysterectomy, and it preserves the uterus. This randomized controlled trial was undertaken to assess 10-year outcomes for 2 established methods of endometrial ablation in 120 women with heavy dysfunctional ablation who were enrolled in the years 1993 to 1995. Sixty-one of them were treated by endometrial coagulation and 59 by endometrial resection. All of these women would have undergone hysterectomy had ablation not been an option. Excluded from the study were women younger than 35 years, those whose uterus was more than twice the normal size or had a cavity depth exceeding 12 cm, and those for whom pelvic pain was a major problem.Only one death, from infection, was related to the initial treatment. Two-thirds of patients had had a single ablation when followed up 2 years after treatment, and the figure after 10 years was 63%. Twenty-six women had had a hysterectomy within 10 years of endometrial ablation. The likelihood of this happening was substantially greater in women less than 40 years of age than in older women (43% vs. 18%). In all, 78% of women had avoided major surgery. The major indications for hysterectomy were bleeding and lower abdominal pain. Only 7% of women still had episodic bleeding 10 years after initial treatment. None of them was more than 45 years of age. On a scale of 0 ("not satisfied") to 100 ("very satisfied"), the overall degree of satisfaction with the outcome of treatment was 84. Nearly 95% of women would recommend the same treatment.The investigators believe that endometrial ablation is an excellent way of treating heavy dysfunctional bleeding. In the present series, if a woman required no further intervention within 2 years of ablation, the chance of having a hysterectomy within 10 years after initial treatment was only 6%. GYNECOLOGY Volume 62, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe first established treatment for anovulatory women having polycystic ovarian syndrome (PCOS) who failed to respond to medical treatment was laparoscopic ovarian wedge resection. Since then, the risk of adhesion formation has prompted the development of less invasive surgical procedures such as ovarian wedge resection by minilaparotomy. This study compared the risk of adhesion formation in 37 anovulatory infertile women with PCOS who had failed to respond to clomiphene citrate and who had ovarian wedge resection by minilaparotomy (group I), and 39 others who underwent laparoscopic ovarian electrodrilling (group II). All participants had a second-look laparoscopy 1 week after the initial procedure. Adhesion formation was assessed using the American Fertility Society classification. The 2 treatment groups were similar demographically and with respect to serum gonadotropin levels.Three women in group II (7.7%) had periovarian adhesions. In contrast, 81% of group I women had periovarian adhesions, and 54% and 46%, respectively, had intra-abdominal and uterine adhesions. Adhesions at all 3 sites were Operative Gyneco...

A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24‐hour day case surgery setting

“…The prospective observational study by Penketh et al 1 has serious methodological deficiencies and should be read with caution.…”

A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24‐hour day case surgery setting

“…I read with interest the article by Penketh et al 1 regarding the safety and acceptability of vaginal hysterectomy performed in a 24‐hour day case setting. It is a great step forward in curtailing the rising cost to the NHS and solving the problem of bed shortage.…”

A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24‐hours day case surgery setting

“…We read with interest the article by Penketh et al 1 Ten of 71 (14%) women, who were supposed to have 24‐hour day case hysterectomy, were either admitted or readmitted, which is a very high percentage given the fact that this is a well‐selected population. The overall incidence of unanticipated admission after ambulatory surgery ranged in various reports between 1.4 and 7.8% 2,3 .…”