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PubMedDate not supplied

Post-hysterectomy morbidity after previous punch cervical biopsy plus diagnostic curettage.

The post-operative morbidity of 70 patients who underwent total abdominal hysterectomy five to thirteen days after punch-biopsy of the cervix uteri and diagnostic curettage was compared of that of a control group of patients, with hysterectomy alone. It was observed that the sequence punch-biopsy hysterectomy presented a significantly higher post-operative morbidity. This increase was mainly due to higher parametritis, excessive vaginal discharge and wound infections rates. The interval between the two operations was also found to influence the post-hysterectomy morbidity, which seems to decrease with longer intervals.

Biopsy, Needle↗

PubMed1979

A study of hysterectomy in a family practice.

This paper reports on a study of women in a family practice who have undergone hysterectomy as compared with a group of matched controls. Significant differences were found in the greater number of major surgical procedures (other than hysterectomy) and the reporting of chronic and recurrent symptoms for the study group. Study group women were also found to have a greater number of identified intrapersonal and family problems. There was no significant difference, however, in the number of identified chronic organic problems. Differences which did not reach statistical significance suggest that women in the study group may be more likely to be living without a male partner, to be using long-term medication, and to be smokers. A most important finding was that the group of women who had undergone hysterectomy had also had 2.6 times the number of major surgical operations than the controls, excluding the hysterectomy. There were no differences between the two groups with respect to a number of other factors studied, eg, education, religion, history of psychiatric admission, obesity.

Adult↗

PubMed1977

[Indications for hysterectomy in placental tumors].

Indications for hysterectomy in placental tumours are now most often to carry out hysterectomy as a second attack designed to deal with residual lesions of choriocarcinoma that prove resistant to chemotherapy. Of 80 patients treated, 24 were first seen for chemotherapy after hysterectomy and this is too great a number. On the remaining 56 patients we carried out hysterectomy in 8 cases of whom 7 were secondary to chemotherapy. Seven times we found a residual lesion. These patients are now apparently cured.

Adult↗

PubMed1977

The 'problem' radical hysterectomy.

This is a study of 243 radical hysterectomy and pelvic lymphadenectomy procedures performed for gynecologic malignancy. The term 'problem' radical hysterectomy was applied to those patients with one of the following conditions: (1) recent cervical conization (within 21 days). (2) previous total or supravaginal hysterectomy, (3) pregnancy, or (4) previous pelvic radiation. There were 88 patients in theses categories. One hundred and fifty-five patients had none of these predisposing problems which might influence operative or postoperative complications. There were two deaths (0.82 per cent). There was no statistically significant difference in operative injuries to the bladder, ureters, or rectum or in the mean operative time and mean blood loss across the categories. However, there was a statistically significant difference across the categories in postoperative complicatons, both major and minor. The greatest incidence of such complications occurred in patients who had previous radiation therapy and the second greatest incidence was in patients who had recent cervical conization. Pregnant patients had the least number of complications.

Adolescent↗

PubMed1979

Ten-year review of hysterectomies: trends, indications, and risks.

This report concerns the indications, morbidity, and death associated with 6,435 consecutive abdominal and vaginal hysterectomies at Hutzel Hospital during a 10 year period. There was an extraordinary number of high-risk patients included in this group. Morbidity and postoperative bleeding were more common following vaginal rather than abdominal hysterectomy. These complications were also more common when the operation was performed during the proliferative phase of the menstrual cycle. There were 17 deaths. Thromboembolic complications were the major cause of death. Selective use of prophylactic antibiotics and low-dose heparin and reduction in the number of blood transfusions by preoperative endocrine and hematinic therapy may reduce the postoperative morbidity and mortality rates. Probably few operations will ever contribute as much to improving the quality of life of women as do indicated hysterectomies. However, the added risk do not seem to justify utilizing this operation for the sole purpose of sterilization in preference to simpler and safer procedures.

Adult↗

PubMed1975

Iliac artery aneurysm presenting as a complication of hysterectomy.

Aneurysms rarely presenta as a complication of hysterectomy. A case is reported of a left common iliac artery aneurysm causing readmission 2 weeks after total abdominal hysterectomy. The aneurysm remained undiagnosed prior to percutaneous rupture and subsequent laparotomy. The aneurysm was ligated and resected. No graft or arterial repair was attempted because of the infection that was present. Twenty-three days after hysterectomy, the patient underwent above-the-knee amputation. A review of the literatureis undertaken and possible etiolgic mechanisms discussed.

Aneurysm↗

PubMed1977

Vaginal hysterectomy in obese women.

The influenced of obesity in vaginal hysterectomy was examined by comparing the characteristics and outcome in 108 patients who weighed 200 pounds or more with matched controls weighing less than 200 pounds. Obese and nonobese subjects were similar in age and surgical indications, though overweight patients, who averaged nearly 60% above standard weight for height and age, were more likely to have hypertension and diabetes mellitus. Both operating time and operative blood loss were greater in obese patients, presumably because of more frequent employment of vaginal repair in this group. However, obese and nonobese patients did not differ significantly with respect to mortality (none in either group), postoperative febrile morbidity (62 and 56%, respectively), or postoperative hospitalization in excess of 12 days (19 and 16%, respectively). Thus, obesity does not seem to impose additional risks in vaginal hysterectomy, in contrast to abdominal hysterectomy in which the increased morbidity relates to wound infection.

Female↗

PubMed1976

T-tube suction drainage and/or prophylactic antibiotics. A randomized study of 451 hysterectomies.

The technics of T-tube suction drainage of the retroperitoneal space and of prophylactic antibiotics were evaluated each alone and then in combination in a randomized study of 451 private patients undergoing abdominal or vaginal hysterectomy. As compared with results in a control group, suction drainage alone and prophylactic antibiotics alone were equally effective in reducing the incidence of postoperative pelvic infection and febrile morbidity. When the two technics were used in combination, there was further reduction in the incidence of pelvic infection and febrile morbidity. However, these results were not statistically different from those of either technic alone. Date are presented to indicate that hysterectomy is performed in a bacteriologically contaminated operative field and that a contaminated fluid collection routinely accumulates in the retroperitoneal space. It is therefore suggested that hysterectomy be managed as a potentially infected surgical wound.

Adult↗

PubMedDate not supplied

Hysterectomy following sterilization.

In a review of 108 cases of consecutively selected women undergoing hysterectomy for nonmalignant disease, it was found that one third of the patients or their husbands had previously been sterilized. In many instances, the gynecologic problem necessitating hysterectomy antedated the sterilizing procedure. It is postulated that, when couples request sterilization, two operations might be avoided if routine consideration were given to any condition that might lead to hysterectomy.

Adult↗

PubMed1977

Elective hysterectomy.

Hysterectomy is the most frequently performed major operation. Its frequency is increasing due to greater use of elective indications such as uterine cancer prophylaxis, contraception, and menopausal problems. The effects of elective simple hysterectomy are evaluated in terms of morbidity and mortality rates and costs. Among 35-year-old women operated upon, the average over-all gain in life expectancy is only 0.2 years. This is due to the saving of 1.3 per cent of women who would have died from cancer of the cervix or endometrium; they gained 14.3 years of life. In addition, 3 per cent of women are spared the development of and treatment for these two conditions. All women operated upon would be relieved of some undesirable aspects of the menopausal years such as irregular uterine bleeding. There are also economic gains. However, the operation has adverse health effects which could offset any gains from cancer prevention. In addition, each year of life saved would cost about $12,800 and most of the added years would be lived in old age. Delaying the operation to age 45 and including oophorectomy would result in a lower cost per year of life saved-about $9,800-but the risk of adverse health effects probably would be increased very much. Cancer prophylaxis cannot justify elective hysterectomy; we cannot assess whether quality-of-life considerations do.

Adult↗

PubMed1979

Surgical treatment of stages IB and IIA invasive carcinoma of the cervix by radical abdominal hysterectomy.

From 1963 to 1977, 349 radical abdominal hysterectomies with bilateral pelvic lymphadenectomy were performed for Stage IB (331 patients) and Stage IIA (18 patients) cervical cancer at the New York Medical College, with no operative deaths. Definitive diagnosis was obtained from the biopsy specimen in 281 patients. Twenty-nine patients were pregnant when the diagnosis was established. The average operating time was 4 hours and 48 minutes with an average blood loss of 900 ml. Eleven fistulas were noted: ureterovaginal, 7; vesicovaginal, 3; rectovaginal, 1. Since 1972, there have been no fistulas in 130 radical hysterectomies. Metastatic carcinoma of the regional lymph nodes was discovered in 27 patients for an incidence of 7.7%. Postoperative total pelvic external irradiation was utilized in 40 patients (27 with positive nodes, 10 with microscopic carcinoma in vascular channels, and an additional three patients with an inadequate vaginal extirpation margin). A total of 62% of those patients with poor prognostic criteria receiving postoperative irradiation are alive and well. Two hundred nineteen patients have been followed up for at least 5 years and the survival rate was 90%. Our data support the view that radical abdominal hysterectomy with bilateral pelvic lymphadenectomy is the treatment of choice for patients with Stages IB and IIA cervical cancer in the nonpregnant state, unless there are major medical contraindications.

Adenocarcinoma↗

PubMed1979

The value of intravenous urography prior to abdominal hysterectomy for gynecologic disease.

Negligence and failure to "test timely" are the two most common charges in obstetric and gynecologic malpractice suits. Both charges are often made in cases involving urinary tract injury during gynecologic surgery. These injuries occur most commonly during abdominal hysterectomy. This report is a 6 year study of 170 consecutive abdominal hysterectomies to ascertain the value of routine preoperative urography in preventing urinary tract injuries. As a control, 260 consecutive abdominal hysterectomies were performed without preoperative urography. There was one ureteral transection in the control group, but unrecognized urinary tract injuries did not occur in either the study or control group. The risks, costs, and benefits of urography are analyzed.

Adult↗

PubMed1977

The radiology of urinary tract abnormalities associated with hysterectomy.

A review of urinary tract complications following hysterectomy shows that these are more likely to occur after radical hysterectomy than after hysterectomy for benign conditions. The role of associated radiotherapy has also been considered and the use of preoperative and postoperative radiological investigations of the urinary tract discussed. Ureteric complications include transient hydroureter and hydronephrosis, ureteric stricture, ureteric fistulae and ureteric severance. The bladder complications which may occur are vesicovaginal fistula, impingement from postoperative haematoma and abscess, the development of bladder calculi, urinary retention and prolaspe of the bladder base. Ureteric complications are often serious especially when there has been fistula or stricture formation, but other abnormalities may be transient. Serious bladder complications such as fistula formation are rare, but urinary retention and prolapse of the bladder base are not uncommon. The purpose and means of radiological investigation have been discussed, as well as some diagnostic pitfalls.

Female↗

PubMed1977

An investigation into the psychological effects of hysterectomy.

The major aim of the present study was to determine whether women exposed to a hysterectomy procedure showed any greater evidence of postsurgery mood disorder than a cholecystectomy control group. In addition, the investigation also considered whether sterilization by hysterectomy resulted in more frequent mood disturbance than in tubal ligation where the uterus remains undisturbed. Fifty-five hysterectomy patients were compared with 38 cholecystectomy and 60 tubal ligation patients by means of the Profile of Mood States. Presurgery, 6-weeks postsurgery, and 3-months postsurgery measures were obtained. No evidence was found to support the view that the special psychological significance of the uterus results in greater postsurgery mood disturbance than occurs with a control procedure such a cholecystectomy. Neither did the results suggest that sterilization involving organ removal was psychologically more traumatic than where the sterilization procedure left the uterus undisturbed. The two significant group X occasion interactions implied that the groups differed in their pattern of responding to surgery with respect to the Tension-Anxiety and the Fatigue-Inertia variables.

Adult↗

PubMedDate not supplied

Characteristics of posthospitalization recovery following hysterectomy.

A study to determine the characteristics of posthospitalization recovery after hysterectomy was designed and implemented. Explicit consideration was given to women's feelings of sexuality and the fears and myths which precede and follow the surgery. Retrospective and current self-report data on four major areas were obtained: a) physical changes, b) emotional changes, c) changes in sexuality, and d) fears or beliefs. The results identify some common posthysterectomy physical and emotional experiences. The data challenge the belief that hysterectomy is usually a blow to a woman's concept of self and indicate that most women do not harbor unrealistic fears of physical, emotional, and sexual sequelae. The study findings have implications for nursing care of hysterectomy patients.

Adaptation, Physiological↗

PubMed1978

Hysterectomy rates and their influence upon mortality from carcinoma of the cervix.

Cumulative hysterectomy rates for women in England and Wales have been estimated from data in the Hospital In-Patient Enquiry, and the effect of hysterectomy operations on mortality from cancer of the cervix has been calculated. About six to seven per cent of women born at about the turn of the century have had an hysterectomy by the age of 70, and this proportion could rise to about 19% for women born in the 1940s if present operation rates continue. The time trends in mortality from cancer of the cervix between generations of women are not at present distorted by correction for women without a cervix. Operation rates and their effect on cervical cancer mortality rates are much smaller in England and Wales than in the United States of America.

Adult↗

PubMed1979

The pathology of hysterectomy specimens.

Six hundred and twenty-one hysterectomies were performed at National Women's Hospital, Auckland, during 1975. Abnormal vaginal bleeding was the clinical indication in 50.72% of the cases. Fibroids, pelvic mass, prolapse, stress incontinence and cervical neoplasia were the indication for 45.88% of the cases. Total hysterectomy was performed in 618 (99.5%) patients whilst sub-total hysterectomy was done in only three cases. Histopathological studies revealed that 567 (91.30%) specimens were pathological and there was multiple pathology in 55.87% of the specimens. Leiomyomas were present in 278 cases (44.76%); microleiomyomatosis in 178 specimens (22.66%); endometrial hyperplasia in 139 specimens (22.33%) adenomyosis in 87 cases (14.00%); malignant diseases in 76 cases (12.23%); and endometriosis in 40 specimens (6.44%). There were no histological abnormalities in 54 specimens, 8.69% of this series.

Adult↗

PubMed1979

Cesarean hysterectomy: a twenty-five-year review.

This article analyzes cesarean hysterectomies performed at Louisville General Hospital on clinic patients for the 25 year period 1953 through 1977. During this time there were 63,259 deliveries, of which 2417 were cesarean sections and 149 were cesarean hysterectomies. Twenty-six of the latter were classified as emergency operations done for urgent medical indications; in the remaining 123 patients the indications were elective to some degree. Operative and postoperative complications and morbidity are discussed, and changing trends regarding the place of cesarean hysterectomy in obstetrics over the years are evaluated.

Adolescent↗