Ten‐year review of hysterectomy morbidity and mortality: can we change direction?

Abstract

The medical records of all women who underwent hysterectomy for benign disease performed between 1986 and 1995 were reviewed to ascertain the incidence of morbidity and mortality of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy at a university teaching hospital. A total of 1940 hysterectomies were performed during this period; 74% of hysterectomies were performed abdominally, 24% vaginally and 2% were laparoscopically assisted. In 80% of the patients uterine leiomyomas, adenomyosis, dysfunctional uterine bleeding or uterine prolapse were the indications for hysterectomy The overall complication rate was 44% for abdominal hysterectomy (AH) and 27.3% for vaginal hysterectomy (VH). An unintended major surgical procedure was required in 3% and 1% of women undergoing AH and VH respectively The rate of return to the operating room for haemostasis was 0.6% for AH and 0.2% for VH. The AH group was four times more likely than the VH group to require surgical intervention (36% versus 9%) at readmission. Vaginal hysterectomy was associated with a lower febrile morbidity and minor complication rate. Prophylactic antibiotics reduced the febrile morbidity for VH and AH by 50% (Student's t-test, p = 0.02) and 40% (Student's t-test, p < 0.001) respectively The overall mortality rate was 1.5 per 1000.

Antiproliferative Effects by Let-7 Repression of High-Mobility Group A2 in Uterine Leiomyoma

“…Uterine leiomyomas are a major public health problem, represented by a high incidence (1), a high rate of hysterectomies for symptomatic disease (2), and a high medical cost (3,4). About 20% of patients with leiomyomas experience clinical symptoms and seek medical treatment.…”

The use of prophylactic antibiotics in the tension-free vaginal tape procedure: is it indicated?

“…Spread of the infective process to the surrounding pelvic tissues might lead to serious conditions such as pelvic fasciitis. The use of prophylactic antibiotics in operations that carry similar infective hazards, such as the TVT procedure, is well established [7][8][9][10][11][12][13][14][15][16]. Hence, based on empirical grounds only, prophylactic antibiotics are widely used in TVT even though the efficacy of their administration has not been demonstrated.…”

“…Postoperative infection in the ''clean-contaminated'' [6] TVT surgical field carries the ominous hazard of spreading to the neighbouring tissues and forming pelvic abscesses. Hence, as widely recommended for operations similar to the TVT that involve potential exposure to bacteriologic pathogens [7][8][9][10][11][12][13][14][15][16], prophylactic antibiotics are used routinely to minimise the possibility of TVT-related infections. Reported here are three patients diagnosed with post-TVT surgical field infections [17].…”

Thermal Balloon Endometrial Ablation: A Safe and Effective Modality for Treatment of Dysfunctional Menorrhagia

“…Although dilatation and curettage is the quickest way to stop acute bleeding specially in hypovolemic patients, yet it is a temporary treatment with a limited efficacy (3). Hysterectomy, on the other hand, is the definitive surgical treatment, but it is a major operative procedure that could be associated with significant morbidity and mortality (4).…”