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Results for “Gynecologic Surgery”

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PubMed1991

Ureteric injuries associated with gynecologic surgery.

We conducted a review of eight ureteric injuries associated with major gynecologic surgery in seven patients over an 11-year period. Our low incidence of 0.36% is comparable with other reports. Diagnosis was made either intra-operatively or postoperatively. Immediate ureteric repair is advocated for all injuries discovered intra-operatively. Attention to preventive measures both before and during gynecological operations will reduce the incidence of ureteric injuries.

Adult↗

PubMed1986

Intestinal injury in gynecologic surgery: a ten-year experience.

From 1973 to 1982, a total of 128 incidents of intestinal injury were recorded in patients undergoing gynecologic operations. Of all lacerations, 37% occurred during entrance into the peritoneal cavity, 35% during lysis of adhesions or performance of pelvic or abdominal dissections, 10% during laparoscopy, 9% during vaginal operations, and 9% during dilatation and curettage and dilatation and evacuation. Injury involved the small intestines in 75% and the large intestines in 25% of the cases. Sixty-nine percent of all lacerations were minor, and 31% were major. Seventy-two percent of the lacerations occurred during uncomplicated gynecologic operations. All lacerations were repaired with one or more of four basic procedures: one- or two-layer closure of intestinal lacerations, partial bowel resection, intestinal reanastomosis, and colostomy. It is suggested that gynecologists acquire basic knowledge in the prevention of intestinal injury and the principles of repair of intestinal lacerations. The role of animal surgical laboratories for the training of residents practicing gynecologic surgery is emphasized.

Adnexal Diseases↗

PubMed1990

Temporary gastrostomy tubes in major gynecologic surgery.

Prophylactic, temporary tube gastrostomy was done in 39 patients having major gynecologic surgery. Patients who were thought to be at high risk for postoperative ileus had a Foley catheter inserted intraoperatively through the greater curvature of the stomach. The procedure was found to be technically easy, well tolerated by the patients, and clinically useful, since postsurgical ileus was prevented or treated without the local and respiratory ill effects of the commonly used nasogastric tube.

Adolescent↗

PubMed1989

Infections after gynecologic surgery.

Infections observed after gynecologic surgical procedures are polymicrobial and require parenteral broad-spectrum antimicrobial therapy until the patient has been afebrile 24 to 72 hours. Therapy should be tailored to the specific infection and patient response thereto. When the infections are complicated by abscess or infected hematoma, combination therapy appears to be effective in a shorter period of time, and surgical drainage is infrequently necessary other than drainage of those in the supravaginal, extraperitoneal space. Administration of antibiotics immediately before surgery to women at high risk for postoperative infection has essentially eliminated pelvic infections. These infections range from cuff cellulitis through pelvic abscess and include pelvic thrombophlebitis. Pelvic infections and those in an abdominal, perineal, or vaginal incision can occur during the immediate postoperative period or after discharge from the hospital. As many as 50 per cent of these infections may occur after the patient is discharged from the hospital. Without question, the most appropriate means of objectively identifying infection rates, appropriate and inappropriate use of antimicrobials, and trends in morbidity is with an infection control program, usually consisting of an epidemiologist or specially trained nurses. Their contribution to appropriate patient care is significant. Information uncovered may put some clinicians on the defensive. This need not happen if gynecologic surgeons participate in and define criteria to be used for various infection diagnoses and similar situations. These diagnoses must be based on physical examination evidence, not "presumptive evidence." Antimicrobial administration and selection has an emotional component; objective evaluation avoids this bias. Optimal and efficient patient care is the goal and these programs should be established with that as their only goal. Several synergistic polymicrobial infections involve skin, subcutaneous tissue, and perhaps fascia; these are infrequently observed but require prompt recognition and antimicrobial therapy as well as wide surgical excision to healthy tissue to effect a cure. Clinical presentation extends to both ends of the spectrum with respect to degree of illness. These infections also occur spontaneously in gynecologic sites, and do so only in patients at high risk, such as those with diabetes, delibitating disease, advanced age, or evidence of arteriosclerotic disease. Another infection that was diagnosed and managed only surgically (that is, septic pelvic thrombophlebitis) can now be accurately diagnosed without surgery and can be adequately treated medically.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Bacterial Agents↗

PubMed2026

Esketamine vs. sufentanil for quality of recovery after outpatient gynecological surgery: a randomized clinical trial.

BACKGROUND: Perioperative administration of esketamine has been reported to improve early quality of recovery (QoR). However, data on its effects in outpatient surgery are limited. This study aimed to assess the impact of esketamine on QoR in patients undergoing outpatient gynecological procedures. METHODS: In this investigator-initiated, double-blind, randomized clinical trial, patients aged 18-65 years scheduled for outpatient gynecological surgery under sedation were allocated to receive esketamine (0.2 mg/kg) or sufentanil (0.1 μg/kg) combined with propofol (1.5-3 mg/kg). The primary outcome was quality of recovery on postoperative day (POD) 1. Secondary outcomes included quality of recovery on POD2, sedation success rate, length of post-anesthesia care unit (PACU) stay, injection pain, postoperative pain, nausea and vomiting, fatigue, patient and clinician satisfaction, sleep quality, and anxiety and depression. RESULTS: A total of 126 patients were randomized, with 63 assigned to the esketamine group and 63 to the sufentanil group. Of these, 125 patients were included in the final analysis (62 in the esketamine group and 63 in the sufentanil group), as one patient lacked follow-up data. The mean (SD) QoR-15 score on POD1 was 137.9 (14.5) in the esketamine group and 137.8 (10.7) in the sufentanil group, with no significant difference between groups (absolute difference, 0.2; 95% CI, -4.2 to 4.6; p = 0.93). For secondary outcomes, the esketamine group had a longer PACU stay (median, 28.0 vs. 23.0 min; p < 0.001), a lower incidence of severe injection pain (22.6% vs. 50.8%; p = 0.002), a higher proportion of patients with pain scores ≥ 4 at 30 min postoperatively (30.6% vs. 6.3%; p = 0.001), and higher fatigue scores (median, 3.0 vs. 2.0; p = 0.01). Other secondary outcomes did not differ significantly between groups. CONCLUSION: Among patients undergoing sedation for outpatient gynecological procedures, esketamine did not significantly improve quality of recovery on POD1 compared to sufentanil. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2500098466.

Humans↗

PubMed1978

Wound infections and systemic antibiotic prophylaxis in gynecologic surgery. A review.

The gynecologic literature was reviewed and yielded 11 well-designed and well-conducted studies since 1960 involving the use of systemic prophylactic antibiotics. Five had significant results that support using prophylactic antibiotics in vaginal hysterectomy while three supported prophylaxis in cesarean sections. A cephalosporin agent is effective as a prophylactic agent and should be administered 2 hours before surgery by the intravenous route and discontinued 24-72 hours after surgery. A change in the bacteriologic flora of the cervical cuff occurs after surgery with an increase in E. coli and enterococci and a decrease in coagulose negative staphylococci and steptococci. Future studies should be randomized, prospective, and performed in a double-blind manner with antibiotics begun preoperatively. Special attention should be given to bacteriologic techniques, especially the search for anaerobic pathogens.

Anti-Bacterial Agents↗

PubMed1979

Coagulation studies of patients taking low-dose heparin during and after major gynecologic surgery.

In February, 1975, a prospective, randomized study of 75 patients undergoing major gynecologic surgery was undertaken. Patients were randomly assigned to three groups regardless of diagnosis and surgery contemplated. Coagulation studies were performed preoperatively and postoperatively in a control group, a receiving 2,000 U heparin/12 hr subcutaneously, and a third group receiving 5,000 U/12 hr via the same route. There was a statistically significant increase noted in fibrin degradation products in the group treated with 5,000 U heparin/12 hr as compared to the control group. Excessive bleeding intraoperatively or postoperatively was not encountered.

Antifibrinolytic Agents↗

PubMed1980

Necrotizing vasculitis in gynecological surgery.

Extensive clinical investigation of asymptomatic vasculitis found in routine histopathological studies following gynecological surgery may often be unnecessary. In 11 patients necrotizing angiitis was an incidental finding in surgically removed uterine and uterine adnexal tissues. Following irradiation for urinary bladder carcinoma, one patient died during radical surgery: vasculitis was found in surgically resected pelvic organs, colon and kidneys. In other patients, vasculitis may have been attributable to drugs, e.g. penicillin, or to local arthus-like reaction following cone biopsy of cervix. Available from 6 of these cases, follow-up data presented no evidence of progressive systemic vascular disease, supporting the view that incidentally encountered necrotizing angiitis of uterus and uterine adnexa, like that of the appendix, may be innocuous.

Adult↗

PubMed1983

[Knowledge and well-being of patients before and after preoperative findings disclosed by gynecologic surgery (hysterectomy and plastic breast surgery)].

Ten patients with gynecological problems were examined in the context of a preoperative discussion for informed consent. The Patients were tested before and following the discussion with questionnaires and partly standardized interviews regarding their condition and knowledge and the evaluation of the information style of the physician. The informative discussions were taped and evaluated for duration and informative content. The patients usually were able to quote important informations regarding the planned hysterectomies or cosmetic breasts operations. The patients were best informed about risks and least about the post-operative treatment and healing. The informative discussion showed a function of conveying information. The patients retained many of the informations given to them by the physicians. The operation and the risks were best covered. In addition, the informative discussion reduced anxiety. The anxiety and tenseness of the patients was obviously less following the discussion. The positive condition of the patient showed a correlation to the style of information displayed by the physician. It became obvious that less anxious patients absorbed information easier than anxious patients who profited less from the informative discussion. Redundant informations appear to be of significance. New informations were considered to be stressful by the patients although the transmission of information was important for the patients and all patients desired complete information. In our opinion, the results allow the conclusion that the pre-operative informative discussion has important functions to relieve anxiety by cognitive orientation about the planned procedure as long as the pre-operative discussion is part of continual transmission of information.

Adult↗

PubMed1985

[Focalization and development of the utilization of antibacterial drugs problem in obstetric-gynecologic surgery in the Department of Obstetrics and Gynecology of the Castellamonte Hospital].

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Anti-Bacterial Agents↗

PubMedDate not supplied

[Experience in the use of regional methods of anesthesia in oncological and gynecological surgeries].

The block loco-regional methods of anesthesia as applied to onco-gynecology surgery were used in 1310 patients with the predominant 2nd stage ASA risk. The best results (efficiency, safety, convenience) were ensured with spinal anesthesia by intraoperative sedative analgesia (micro-units of midazolam, propofol and ketamine) and by a 0.3 mg single-unit intramuscular injection of buprenorphine (made at the final surgery stage) that prevented a severe postoperative pain syndrome, which was later arrested by an "on-demand" intramuscular injection of peri pheral-action analgetics (ketoprofen or methamezol--therapeutic dose).

Adolescent↗

PubMed1991

Anti Xa activity and prothrombinase inhibition in patients treated with two different doses of enoxaparin in gynecologic surgery.

A prospective open study was performed in a series of 547 patients undergoing gynecologic surgery. A dose of 20 mg of enoxaparin was administered to all patients 2 hours before surgery. Then patients at high risk of thrombosis (mostly oncologic surgery) received 40 mg of enoxaparin daily whereas those at moderate risk received 20 mg of enoxaparin daily. The principal aim of this prospective open study was to monitor amidolytic anti Xa activity and to study the inhibition of intrinsic prothrombinase using prothrombin consumption measurement as a simple and global test. A second aim was to investigate efficacy and tolerance of these regimens. Treatment tolerance was satisfactory with both regimens since the total incidence of bleeding was 1.8%. A single patient developed a clinically significant thrombosis during hospital stay. The results confirm and extend previous reports regarding a dose effect relationship between the dose of Enoxaparin and plasma Anti Xa activity 3 hours after s.c. injection. A significant relationship was found between Anti Xa activity and patients body weight. Interestingly a dose dependent inhibition of intrinsic prothrombinase was observed when using a one stage prothrombin consumption assay in whole blood. This test in whole blood can be considered as closer to physiological conditions than assays performed in citrated platelet rich or platelet poor plasma samples. The mechanism of intrinsic prothrombinase inhibition during prophylactic treatment with enoxaparin requires further investigation.

Adult↗

PubMed1994

[150 cases of vedio-laparoscopic gynecologic surgery].

From September 1992 to September 1993, 150 patients aged 15-68 years underwent laparoscopic gynecologic surgery. These patients included 63 patients with acute abdominal diseases (46 had ectopic pregnancy, 9 rupture of ovary, and 8 torsion of ovarian cyst), which consisted of 90% of total patients with acute abdomen in corresponding period, 63 patients with mass of adnexa, which made up 72% of total patients with ovarian tumors, and 24 patients with uterine diseases. We successfully performed laparoscopic salpingostomy, fallotomy, removal of ovarian cyst, oophorosalpingectomy, myomectomy and laparoscopy assisted vaginal hysterectomy (LAVH) with 2-4 puncture technic after general anesthesia. The largest ovarian tumor and the enlarged uterus were 14 and 16 cm in diameter respectively. Four patients had laparotomy because of severe pelvic adhesions and the laparotomy rate was about 2.6%. The procedure lasted 20-240 minutes and bleeding was less than 200ml. No major surgical complication was encountered.

Adolescent↗

PubMed2000

Neutropenia accompanying parvovirus B19 infection after gynecologic surgery.

The hematologic data and symptoms of 7 patients seropositive for parvovirus B19 IgM antibody after gynecologic surgery were analysed. Parvovirus may have been transmitted by fibrin glue prepared from heat-treated human plasma and used for hemostasis during surgery. The peripheral blood neutrophil count decreased to below 1 x 10(9)/l between postoperative day (POD) 10 and 18, but recovered spontaneously to within the normal range. G-CSF injection was effective in preventing neutropenia or obtaining a prompt recovery. The reticulocyte count fell below 10 x 10(9)/l between POD 13 and 19, and also recovered spontaneously. A slapped-cheek rash was not observed in any of the 7 patients.

Adolescent↗

PubMed1980

Antimicrobial prophylaxis in obstetric and gynecologic surgery: a critical review.

Thirty-three human studies concerned with antimicrobial prophylaxis in obstetric-gynecologic surgery were analyzed, with particular attention to experimental design. Eighty-two percent of the studies were prospective, 70% randomized and 39% double-blind. Patients were stratified according to underlying disease in 15%, complications of prophylaxis were mentioned in 61% of the studies, and statistical analysis was done in 55% of the studies. There was considerable variation in antibiotics employed and in the types of infection encountered. Twenty-seven of the 28 papers published after 1966 advocated prophylaxis. In contrast, less than two thirds of the papers concerned with general surgery support the use of perioperative prophylactic antibiotics. Despite some variability in methodology and antibiotic agents used, there is little controversy among the studies analyzed.

Anti-Bacterial Agents↗

PubMed2002

C-reactive protein should accelerate the diagnosis of bowel injury after gynecologic surgery.

STUDY OBJECTIVE: To search for a marker that could aid in earlier diagnosis of bowel injury after gynecologic surgery. DESIGN: Retrospective case study with prospective controls (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Fourteen women with bowel injuries and 50 controls with no postoperative complications. MEASUREMENTS AND MAIN RESULTS: Bowel injury occurred in 14 (2.4/1000) of 5901 gynecologic procedures. Of these, eight were recognized intraoperatively and treated immediately. In six women C-reactive protein levels were markedly increased (>100 mg/L) relative to control patients (p <0.0001). CONCLUSION: Systematic postoperative assessment of C-reactive protein in patients at high risk for bowel injury may help identify this complication earlier in the postoperative period.

Adult↗

PubMed1993

A comparison of epidural 1% ropivacaine and 0.75% bupivacaine for lower abdominal gynecologic surgery.

A randomized double-blind study was performed to compare ropivacaine and bupivacaine in epidural anesthesia for intraperitoneal surgery. Forty-four patients undergoing epidural anesthesia for intraperitoneal lower abdominal gynecologic surgery received 20 mL of either 1% ropivacaine or 0.75% bupivacaine via an epidural catheter. There was no difference between the two drugs in the onset, extent, and duration of sensory and motor block. Satisfactory conditions for surgery were produced in the same number of patients in each group. The cardiovascular changes and the overall incidence of adverse reactions were similar for both drugs. It is concluded that ropivacaine is an effective and safe alternative to bupivacaine when used in epidural anesthesia for lower abdominal, intraperitoneal surgery.

Adult↗

PubMed2005

Intermittent pneumatic compression for prevention of pulmonary thromboembolism after gynecologic surgery.

BACKGROUND: To investigate the incidence of pulmonary embolism and risk factors for this condition after obstetric and gynecologic surgery, as well as the efficacy of intermittent pneumatic compression. METHODS: A total of 6,218 patients operated at Keio University Hospital excluding obstetric or infertility-related surgery and uterine cervical conization were evaluated retrospectively to determine the preventive effect of intermittent pneumatic compression on postoperative pulmonary embolism. RESULTS: Pulmonary embolism occurred in 42 patients (0.68%). Multivariate analysis showed that malignancy, blood transfusion, and a body mass index > or =25 kg/m2 or > or =28 kg/m2 were independent risk factors for postoperative pulmonary embolism. A significantly lower incidence of pulmonary embolism occurred in patients receiving pneumatic compression postoperatively versus those without it. Among gynecologic malignancies, endometrial cancer was a significant risk factor for pulmonary embolism. CONCLUSION: Preventive measures, including intermittent pneumatic compression, should be taken to avoid postoperative pulmonary thromboembolism in the gynecology field.

Journal Article↗