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At least 19 recordsLinked to original sources

PubMed1977

Surgical complications of gynecologic surgery.

Complications of gynecological surgery are considerable and when reviewed in detail are almost frightening. There is no substitute for experience and intimate knowledge of the intricate pelvic structures in health and disease.Anyone who is active in the field is sooner or later going to experience some difficulty whether it be due to his miscalculation or to innate conditions in the patient which are beyond his/her control.It is the responsibility of the pelvic surgeon to recognize the complication and apply proper corrective measures. The patient should not be given false hopes of sure success nor should she be deprived of whatever hope for success does exist.

Abortion, Spontaneous↗

PubMed1976

Ureteral injuries associated with gynecologic surgery: prevention and management.

Gynecologic surgery is responsible for most of the ureteral injuries that occur. The "easy" operation--the "simple" abdominal hysterectomy--and not the technically difficult pelvic one, is responsible for most ureteral injuries. Total abdominal hysterectomy accounts for almost 50% of the genitourinary fistulas and perhaps 80-99% of all surgical ureteral injuries. This problem will persist until a most important surgical axiom is applied routinely during the accomplishment of all pelvic operations: With all dissections, the contiguous structures subject to injury must be exposed. This step not only will avoid injuries to the ureter but also will facilitate an equally important aspect, that is, urinary tract injuries must be recognized at the time of operation. With recognition and adequate repair, problems such as fistula formation and serious morbidity (and litigation) can be avoided almost entirely. Because the gnecologic surgeon frequently will find that urologic consultation is not available at the time of urinary tract injury, he or she must be aware of and familiar with the various ureteral reconstructive procedures that may be required. The gynecologic surgeon must devote time and study to the management of urinary tract injuries before their occurrence. All pelvic surgeons eventually will encounter ureteral problems. The methods of bladder mobilization and ureteroneocystostomy should be within the ability of all who operate within the pelvis. When extensive damage has occurred and a urologist is not available, the gynecologist who is unfamiliar with the more demanding techniques (that is, ureteroureterostomy, bladder flaps, ileal conduits) should avoid additonal damage to the urinary tract and accomplish a simple catheter ureterostomy, deffering the definitive repair for a urologist.

Female↗

PubMed1976

Perineovulvovaginal preoperative preparation in minor gynecological surgery.

Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued.

Adult↗

PubMedDate not supplied

[Prophylactic use of cefotetan in gynecologic surgery].

The efficacy of prophylactic treatment with systemic antibiotics in laparotomic gynecologic surgery is well established. Lately, short-term schemes have been preferred in surgical prophylaxis for different reasons. First of all, experimental data demonstrated that the efficacy of an antibiotic is maximal when it reaches active tissue concentrations at the time of bacterial contamination. In addition with the availability of new, long-acting antibiotics, a long period of time around the operations was possibly covered. The effectiveness of a single preoperative 2 gm dose of Cefotetan was compared with a traditional treatment of 3 gm daily of Cefazolin for one week following surgery in 86 women undergoing laparotomic gynecologic surgery for benign pathology. Our results confirm that preoperative treatment with Cefotetan is able to prevent infectious disease such as 3 gm of Cefazolin per day for one week. Thus, Cefotetan can be used for this type of prophylaxis considering its broad spectrum of action and pharmacokinetic properties.

Anti-Infective Agents↗

PubMed1990

[Plasma cortisol levels during abdominal surgery under sevoflurane anesthesia: comparison between gastrointestinal and gynecological surgery].

Plasma cortisol levels during abdominal surgery under sevoflurane anesthesia were evaluated in 22 patients who ranged in ages from 37 to 65. They underwent either gastrointestinal or gynecological abdominal surgery. Anesthesia was induced and maintained with sevoflurane (1-5%) in nitrous oxide (4 l.min-1) and oxygen (2 l.min-1). Succinylcholine was administered intravenously to facilitate tracheal intubation and pancuronium was given intravenously during surgery. Lactated Ringer's solution at a speed of 10-15 ml.kg-1.hr-1 was also administered intravenously throughout the surgical procedures. Plasma cortisol levels were unchanged with the induction of sevoflurane anesthesia alone, but they increased significantly 2-3 times of the preanesthetic levels during and after surgery in both groups. However, the concentrations of plasma cortisol after recovery from anesthesia were significantly higher in the gastrointestinal group than in the gynecological group. The findings suggest that plasma cortisol levels after surgery reflect the difference in magnitude of stress response between gastrointestinal and gynecological surgery.

Abdomen↗

PubMed1992

Unscheduled hospital admission following ambulatory gynecologic surgery.

OBJECTIVE: To identify causes of unscheduled admission following ambulatory gynecologic surgery. METHODS: We compared each patient admitted on an unscheduled basis with two patients who did not require admission. Thirty demographic and clinical factors were evaluated by univariate analysis. Significant factors (P less than .05) were then analyzed using multivariate stepwise logistic regression. RESULTS: During a 4-year period, 90 patients required unscheduled admission. This represented 3.64% of 2470 patients who underwent ambulatory gynecologic surgery. Factors associated with admission by multivariate analysis included: 1) previous abdominal surgery, 2) significant medical illnesses, 3) preoperative hemoglobin concentration, 4) general anesthesia, 5) procedure length, and 6) blood loss. Sensitivity was 60.0%, specificity was 90.6%, and the overall correct rate of prediction was 80.4%. Postoperative emesis, the most common reason for unscheduled admissions, occurred in 23.4% of patients. CONCLUSIONS: Previous abdominal surgery and significant medical illnesses are factors that cannot be altered preoperatively. The need for general anesthesia, procedure length, and blood loss are functions of the procedure and cannot be easily modified. Postoperative emesis may warrant further investigation. Successful antiemetic therapy may reduce unscheduled admissions.

Ambulatory Surgical Procedures↗

PubMed1990

The mons pubis: an excellent graft donor site in gynecologic surgery.

Split-thickness skin grafting has many applications in gynecologic surgery. Selection of the donor site is an aspect of the procedure that is very important for preventing highly visible lifelong scars. In this regard the mons pubis is an excellent choice as a donor site. Scar visibility is minimized by regrowth of the pubic hair. Another advantage is the anterior location of the mons, which allows for healing without constant pressure in patients who must remain supine in the postoperative period. Graft harvesting requires shaving the mons pubis and injecting saline solution into the subcutaneous tissue to elevate the skin and thus provide a firm flat base for dermatome application. Hair growth does not occur in the recipient site because the hair follicles are not harvested. Healing of both donor and recipient sites has been excellent with minimal discomfort during pubic hair regrowth. Thus it is recommended that the mons pubis be given serious consideration as a graft donor site in gynecologic surgery.

Carcinoma in Situ↗

PubMed1989

An assessment of the value of frozen sections in gynecological surgery.

In 203 consecutive gynecological operations where frozen sections were performed, 35.6% were from conditions of the ovary, 22.7% from the cervix, 18.2% from the endometrium, and 11.4% from the vulva. There were 0.5% false-positive, 1.0% false-negative and 2.0% deferred diagnosis. Incorrect interpretation was the cause of the single false-positive diagnosis, while the false-negative diagnoses were due to errors in block selection. The deferred diagnoses mainly occurred in gynecological conditions where diagnosis was difficult, required extensive sampling or a formal mitotic count. As in other surgical fields, gynecological frozen sections were used principally to guide the extent of surgery. The most valuable frozen sections were in those instances where the operation was affected most. These were on lymph nodes in cases of carcinoma of the vulva and cervix, myometrial lesions in young women where myomectomy was being considered, and ovarian tumours to distinguish primary from secondary tumours. Occasionally, frozen sections were also found useful to establish margins of vulval and cervical tumours, in hysterectomy specimens of endometrial carcinomas to determine prognostic factors, and in suspected recurrences and metastases of tumours to determine the adequacy of the biopsy material. Frozen sections in obviously benign conditions, e.g., ovarian cysts without papillary or solid areas, were found to be unnecessary. Frozen sections are contraindicated when only a small amount of crucial material is available, as the paraffin diagnosis may be compromised. Pathologists should have a clear idea of the role of frozen sections in gynecological surgery and work closely with the surgeon in the management of gynecological oncology patients.

Fallopian Tube Diseases↗

PubMed1990

[Defibrotide in the prevention of deep venous thrombosis in gynecologic surgery. A controlled study versus calcium heparin in 120 patients].

The efficacy of defibrotide and calcium heparin in the prevention of Deep Vein Thrombosis (DVT) in gynecological surgery were compared in a randomized study. Seventy patients candidate to gynecological surgery (for benign conditions) and 50 candidate to surgery for malignancies were randomly allocated either to defibrotide (400 mg b.i.d. IM from the day before operation to the 7th postoperative day, n = 60) or to calcium heparin (5000 IU t.i.d. SC from the operation to the 7th postoperative day, n = 70). The diagnosis of DVT was made with impedance plethysmography and if necessary confirmed with phlebography. No patient developed established DVT in either groups and no adverse reactions were observed. These results indicate that defibrotide may be considered as an alternative to heparin in the DVT prophylaxis in gynecological surgery.

Female↗

PubMed2026

HSK21542 for Postoperative Analgesia in Gynecological Surgery: A Pooled Post-Hoc Analysis of Two Phase III Randomized Controlled Trials.

BACKGROUND: Effective postoperative pain management in gynecological surgery is challenging because of complex visceral-somatic pain interactions and the adverse effects of conventional analgesics. HSK21542, a novel peripherally restricted kappa-opioid receptor (KOR) agonist that selectively targets visceral pain pathways enriched with KORs, may provide adequate analgesia without systemic adverse events. METHODS: We conducted a pooled post-hoc analysis of data from two phase III, multicenter, triple-blinded, randomized controlled trials (Study 301, HSK21542 vs placebo; Study 303, HSK21542 vs tramadol vs placebo). Eligible patients undergoing elective gynecological surgery were included. The primary outcome was the summed pain-intensity difference over 12 and 24 hours (SPID 12h and SPID 24h ). Secondary outcomes were pain-relief quality (proportion of patients relieved from severe pain with a pain numerical rating score ≤ 3 between 0 and 24 hours) and rescue-analgesic requirements (number of doses and time to first rescue analgesic). Adverse events were also assessed. RESULTS: A total of 370 patients were analyzed: 150 received HSK21542, 139 received a placebo, and 81 received tramadol. After inverse probability of treatment weighting (IPTW) adjustment, baseline characteristics were well-balanced across treatment groups (all standardized mean differences [SMD] <0.1; see Table 1 for 95% CIs). HSK21542 produced greater reductions in pain intensity over 12 and 24 hours than placebo (least-squares mean differences -8.1 and -16.3 for SPID 12h and SPID 24h , respectively. Both P < .001) and no statistically significant difference was observed between HSK21542 and tramadol ( P > .05). Significantly more patients in the HSK21542 group were relieved from severe pain at 0 to 12 hours (92.7% vs 82.7%, P < .001) and required fewer rescue doses at 0 to 12 hours (0.00 [IQR 0.00-1.00] vs 1.00 [IQR 0.00-2.00], P < .001) and 0 to 24 hours (0.00 [IQR 0.00-1.00] vs 1.00 [IQR 0.00-2.00], P < .001) than those in the placebo group, whereas no significant differences with tramadol both in 0 to 12 and 0 to 24 hours. HSK21542 was also associated with significantly lower incidences of nausea (24.7% vs 66.7%) and vomiting (21.3% vs 60.5%) than tramadol. Only one case of dizziness occurred in the tramadol group. CONCLUSIONS: HSK21542 could provide adequate postoperative analgesia with few adverse events in patients undergoing gynecological surgery.

Humans↗

PubMed1975

Major gynecologic surgery in the elderly female 65 years of age and older.

A total of 185 cases were reviewed of major gynecologic surgery performed upon women 65 years of age and older from 1970 to 1973 at a 350 bed community hospital. Each private staff physician operated upon his private patient. There were 112 vaginal operations performed, mostly for pelvic relaxation problems, and 73 abdominal operations. Forty-two patients had surgery for cancer. There were nine postoperative complications and only two deaths. It can be concluded from this study that the elderly female can tolerate major gynecologic surgery very well in a modern-day hospital setting.

Age Factors↗

PubMed1976

[Influence of gynecologic surgery on the blood concentration of adenosine phosphate].

Blood concentrations of ATP, ADP and AMP studied before and immediately after incomplicated gynecologic surgery due to not malignant indications showed the following changes: 1. The initial blood concentration values ranged within the physiological limits and were not therefore essentially influenced by gynecologic diseases. 2. There was a short-term non significant increase of ATP blood concentrations after the operation. 3. After more extensive surgical operations there was a significant short-term decrease of ADP and AMP concentrations that however, approached pre-operation values within 24 hours. 4. The values of ATP/ADP and ATP/AMP coefficients increased significantly after the operation but decreased again within 24 hours. It may be concluded that gynecologic surgery itself as well as attendant circumstances do not induce metabolic changes unfavorably influencing the adenosinephophate system in the blood.

Adenosine Diphosphate↗

PubMed1992

Subarachnoid and intramedullary cysts secondary to epidural anesthesia for gynecological surgery.

Three women who received epidural anesthesia for gynecological surgery developed spinal arachnoiditis leading to subarachnoid cysts and cord cavitation. MRI was useful to show the subarachnoid and intramedullary cysts, as well as to monitor lesion extent and progress. Associated MRI findings were a Chiari anomaly in 1 case and a tethered cord in another. Two cases underwent surgery: 1 improved, but the other suffered progressive neurological deterioration. Although the 3rd patient had no treatment, there was spontaneous reduction in cavity size and clinical improvement. Careful handling of this procedure is urged to avoid such severe complications in young mothers.

Adult↗

PubMed1976

[Progress and change in geriatric gynecological surgery (author's transl)].

Two periods of geriatric gynecological surgery (1947-1959 and 1960-1972) at the University Women's Hospital in Hamburg-Eppendorf were compared in regard to the age of the patient, surgical indications, surgical procedure, anesthetic technique, preoperative and postoperative morbidity, length of hospitalization and mortality rate. During a period of 26 years, 1514 women over the age of 60 were treated surgically. During the first period, 489 women were treated, and in the second period, 1,025. This 109.6% increase has been confirmed statistically. The increase in geriatric surgical cases stems basically from the increase in the number of surgical patients over the age of 70. The increase in breast carcinoma during the second period (from 43 to 348 operations) is most conspicuous. This is an increase of 809.3%. On the basis of this disproportionately large increase in breast surgery, more women were treated surgically in the University Women's Hospital in Hamburg-Eppendorf for breast carcinoma during the second period, than for carcinoma of the reproductive organs. Vulva carcinoma and craurosis vulvae were also more frequently considered to be an indication for surgical treatment. The total number of women who were surgically treated for prolapsed uterus and vagina remained more or less constant. In the analyzing the surgical records, it should be emphasized that, in the second observation period, two-thirds of these cases were treated by performing a vaginal hysterectomy with anterior and posterior vaginoplasty. For older patients, palliative surgical measures for prolapsed uterus and vagina were abandoned in favor of more definitive methods. The postoperative morbidity and mortality rate remained more or less constant for both periods. The postoperative period of hospitalization was slightly longer while the preoperative period was slightly shorter. The statistically confirmed increase in geriatric surgery during the last 13 years at the University Women's Hospital in Hamburg-Eppendorf clearly shows how important geriatric surgery has become. The immediate consequences are an increased workload for physicians, nursing staff and physical therapists.

Age Factors↗

PubMedDate not supplied

Preventing postoperative deep venous thrombosis in gynecological surgery with defibrotide.

This was an open, fully randomized clinical study designed to compare the effectiveness and tolerability of defibrotide and calcium heparin as prophylactic agents for preventing postoperative DVT of the lower limbs in patients scheduled for gynecological surgery for nonmalignant disease (100 cases) or for tumoral pathology (60 cases). Defibrotide was administered by intramuscular injection in doses of 400 mg b.i.d., starting one day before surgery and continuing for seven postoperative days (n = 80); calcium heparin was given by subcutaneous injection in doses of 5000 IU t.i.d., starting two hours before surgery and continuing likewise for seven days (n = 80). DVT was to be diagnosed by computerized impedance plethysmography. Not a single case of DVT occurred in either treatment group; nor were there any significant differences in the magnitude of surgical or postoperative bleeding or in pertinent laboratory test returns. The Authors conclude that defibrotide can be used to advantage instead of calcium heparin as a measure for preventing DVT of the lower limbs in patients undergoing major surgery for gynecologic disorders including malignancy.

Female↗

PubMed1977

Pulmonary thromboembolism associated with gynecologic surgery and pregnancy.

Pulmonary thromboembolism continues to be an infrequent but serious complication of gynecologic surgery and pregnancy. The record of each patient with such a complication treated in two community hospitals during the 10 year period to 1976 was examined in detail. An attempt was made to identify weaknesses in past management and suggest changes to improve future care. Embolism will continue to occur unexpectedly and be of such magnitude as to cause death before effective treatment. can be instituted. Patients at risk can often be identified and prophylactic anticoagulants and antibiotics are appropriate in selected cases. An understanding of the pathology of embolism of and principles of genital sepsis combined with vigorous treatment will save some patients who now would die. If the risks are appreciated, anticoagulants may be used in pregnant patients who are closely monitored. These patients must be alerted to the dangers of both embolism and the treatment.

Anticoagulants↗

PubMed1992

Comparative study of single-dose cefotaxime and multiple doses of cefoxitin and cefazolin as prophylaxis in gynecologic surgery.

In this comparative, randomized, multicenter trial, 273 patients scheduled for gynecologic surgery were studied: 87 received a single 1-g dose of cefotaxime 30 minutes before surgery; 81 were given a 1-g dose of cefoxitin 30 minutes before surgery and 1 g every 6 hours for 24 hours after surgery (total dose 4 g); and 105 received a 1-g dose of cefazolin 30 minutes before surgery, followed by 1 g every 8 hours for 48 hours (total dose 6 g). Patients who received cefotaxime had a significantly lower incidence of postoperative fever compared with those treated with cefoxitin or cefazolin (p < 0.01). The incidence of positive urinary cultures was lower in the cefotaxime and cefazolin groups when compared with the cefoxitin group (p < 0.01 and p < 0.05, respectively). The results of this study confirm the efficacy of cefotaxime as prophylaxis in surgical infections and demonstrate that single-dose cefotaxime is more effective than a four-dose regimen of cefoxitin.

Adolescent↗

PubMed1990

Antibiotic prophylaxis in gynecological surgery.

A randomized prospective study was undertaken at the Obstetrics and Gynecology Clinic of the Catholic University of Rome in order to evaluate the effectiveness of two wide spectrum antibiotics: mezlocillin and cefotetan. Both drugs were administered 2 g i.v. 15 to 20 minutes preoperatively to allow optimal serum and tissue levels of antibiotic at the moment of bacterial innoculation. 184 patients undergoing elective gynecological surgery for nonmalignant disease were considered eligible for the study (124 pts abdominal hysterectomy, 58 pts vaginal hysterectomy). We found no statistically significant differences between the results obtained with the two drugs.

Adult↗