RESUMO
OBJECTIVE: Evaluate initial results of a ambulatory major surgery program in Gynecology. MATERIAL AND METHODS: Retrospective, descriptive study of the period March 2018 to June 2019. The interventions included were: surgical sterilizations via vaginal, minilap and laparoscopic, diagnostic laparoscopy, laparoscopic cyst or anexectomy, hysteroscopy, TOT, vaginal plasty, biopsy curettage, polypectomy, extraction of IUD under anesthesia, labiaplasty, and removal of transobsturatrix tape. Quality indicators such as suspension, readmissions and systemic and surgical complications have been analyzed. RESULTS: 136 patients were operated by CMA of which 43 were laparoscopic (31.6%), 55 patients vaginally (40.4%), 34 histeroscopy (25%) and 4 patients by minilap (3%)There were 4 minor and late complications (2.9%) that corresponded to operative wound infection in vaginal plasty and nymphoplasty, a dysfunctional TOT tape that had to be removed in a mediated manner and a PIP post surgical sterilization via vaginal route. CONCLUSIONS: Gynecological ambulatory major surgery is feasible to perform in a hospital of medium complexity with a low percentage of minor complications in this study.
Assuntos
Humanos , Feminino , Laparoscopia/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Histerectomia Vaginal/métodos , Pacientes Ambulatoriais , Readmissão do Paciente , Complicações Pós-Operatórias/etiologia , Ficha Clínica , Epidemiologia Descritiva , Resultado do Tratamento , Histerectomia/métodosRESUMO
As normas brasileiras condicionam o acesso às modificações corporais para alteração da identidade sexual à confirmação do diagnóstico psiquiátrico de transexualismo - transtorno de identidade de gênero ou sexual -, e o acompanhamento psiquiátrico por dois anos para sua realização. O desconforto com o sexo anatômico e o desejo de a pessoa modificar a genitália para a do sexo oposto é o principal critério definidor do diagnóstico de transexualismo. A cirurgia de transgenitalização é considerada etapa final do tratamento, e vem sendo admitida pela instância judicial como condição necessária para a alteração da identidade sexual legal. O artigo discute o conflito moral entre o sujeito transexual e as normas vigentes em relação ao exercício da autonomia individual nas práticas terapêuticas, aplicando as ferramentas da bioética, a partir da análise dos argumentos utilizados pelas instâncias de saúde e judicial sobre o tema, nos artigos, documentos e decisões judiciais nacionais. Observa-se que houve avanços no acesso aos recursos terapêuticos e legais, mas as limitações e restrições ainda impostas ao exercício da autonomia do/a transexual podem ter efeitos negativos para a saúde e os direitos daqueles não considerados pela norma vigente como "verdadeiros transexuais". Os direitos da pessoa transexual à assistência integral à saúde, inclusive sexual, e ao livre desenvolvimento de sua personalidade são infringidos no momento em que a autonomia do paciente não é adequadamente preservada pelas normas vigentes, convertendo-se os direitos humanos num tipo de dever de a pessoa adequar-se à moralidade sexual dominante.
According to current Brazilian health authority policies, one's access to physical modifications to have his/her sexual identity altered is dependent upon an established psychiatric diagnosis of transsexualism - gender or sexual identity disorder - in addition to two years of psychiatric evaluations, in order to have it come to fruition. The discomfort with his/her sexual anatomy and the desire to have his/her genitalia modified is the defining criteria to the diagnosis of transsexualism. Sex reassignment surgery is considered to be the last step of such a treatment, and it is viewed by the Judiciary as a necessary condition to effect change in the legal sexual identity status of the transsexual person. This paper argues the moral conflict between transsexual issues and current health policies related to one's exercise on autonomy with regard to therapeutic practices. Hence, Bioethics tools are applied to the discussion, due to the result obtained from an analysis of the arguments made by the health authorities and judicial systems, on the subject, through articles, documents, and Brazilian court decisions. Regarding therapeutic and legal access, some advances have been made. However, notwithstanding, limitations and restrictions still being imposed regarding the exercise of the autonomy of the transsexual individual, might have a negative impact on the health and legal rights of those not acknowledged by the current norms as "true transsexuals". The rights of the transsexual individual to a comprehensive healthcare assistance system, including sexually related health issues, as well as the right to the free development of his/her personality are infringed, at the very moment when the patient's autonomy is not duly safeguarded by current health policies, thus making human rights look more like a duty, to which the person must adapt to as the dominant sexual morality.