Intra- and post-operative outcomes of the Enhanced Recovery after Surgery (ERAS) Program in laparoscopic hysterectomy.

PURPOSE: To investigate the effect of the Enhanced Recovery After Surgery (ERAS) protocol on perioperative and post-operative outcomes in laparoscopic hysterectomies (LHs) performed for benign gynecological diseases. METHODS: This prospective study was conducted with randomized 100 participants who underwent LH between 1 January and 31 December, 2022. A standard care protocol was applied to 50 participants (Group 1, control) and the ERAS protocol to the other 50 (Group 2, study). Length of hospitalization was compared between the groups as the primary outcome, and the duration of the operation, the amount of bleeding, post-operative nausea-vomiting, gas discharge time, visual analog scale (VAS) pain scores, and complications as the secondary outcomes. RESULTS: No statistically significant difference was seen between the groups in terms of sociodemographic characteristics, medical history, operation indications, surgical procedures applied in addition to hysterectomy, operative time, pre-operative and post-operative hemoglobin levels, amount of bleeding, or drain use (p > 0.05). However, a statistically significant difference was observed in terms of nausea (60% vs. 26%, p = 0.001), vomiting (28% vs. 10%, p = 0.040), duration of gassing (17.74 ± 6.77 vs. 14.20 ± 7.05 h, p = 0.012), length of hospitalization (41.78 ± 12.17 vs. 34.12 ± 10.90 h, p = 0.001), analgesic requirements (4.62 ± 1.36 vs. 3.34 ± 1.27 h, p < 0.001), or VAS scores at the 1st (5.86 ± 1.21 vs. 4.58 ± 1.31, p < 0.001), 6th (5.16 ± 1.12 vs. 4.04 ± 1.08, p < 0.001), 12th (4.72 ± 1.12 vs. 3.48 ± 1.12, p < 0.001), 18th (4.48 ± 1.21 vs. 3.24 ± 1.34, p < 0.001), and 24th (4.08 ± 1.29 vs. 3.01 ± 1.30, p < 0.001) hours. CONCLUSION: The findings of this study show that the ERAS protocol has a positive effect on peri- and post-operative outcomes in LH. Further prospective studies are now needed to confirm the validity of the results.

Emergency hysterectomy after 2nd trimester abortion in a patient with placenta accreta spectrum disorder who had four cesarean deliveries.

OBJECTIVE: To perform an emergency hysterectomy by ligation of the uterine arteries before bladder dissection in a patient with placenta accreta spectrum disorder who developed excessive hemorrhage after abortion. CASE REPORT: A patient with four previous cesarean deliveries presented with pelvic pain and excessive vaginal bleeding following a fetal abortion. The patient's hemodynamic status worsened. The patient underwent surgery, and the bladder was densely adherent to the previous incision scar. A classic hysterectomy was performed up to the level of the uterine artery bilaterally. The uterine arteries were then skeletonized and ligated before bladder dissection. The anterior visceral peritoneum was dissected at the isthmic level. The bladder below the adhesion was dissected in the lower uterine segment using a lateral approach. The adhesions were dissected, the bladder was removed from the uterus, and a hysterectomy was performed. CONCLUSION: Obstetricians should be familiar with the dia-gnosis and management of placenta accreta spectrum disorders. In an emergency, the uterine artery could be ligated before bladder dissection. After cessation of bleeding, the bladder could be dissected from the lower uterine segment and a safe hysterectomy could be performed.