The relationship between body image and sexual satisfaction in women who have undergone hysterectomy.

OBJECTIVE: This study aims to examine the relationship between body image and the level of sexual satisfaction in women who have undergone a hysterectomy. METHODS: This descriptive study utilized a relational screening model. Conducted between June 2023 and March 2024, the study included a total of 300 sexually active women who had undergone a hysterectomy 6 months prior. Data were collected using a personal information form, the Golombok-Rust Sexual Satisfaction Scale, and the Body Image Scale through face-to-face interviews lasting approximately 20-30 min. RESULTS: The average age of the participating women was 44.4±10.55 years. Of the participants, 96.7% were married and 42.4% had entered menopause. The average score on the Body Image Scale was 81.2±3.8, and the average score on the Golombok-Rust Sexual Satisfaction Scale was 33.0±15.1. A positive significant relationship was found between body image and sexual satisfaction (p<0.05). There was also a statistically significant positive relationship between the total scores on the Body Image Scale and the Golombok-Rust Sexual Satisfaction Scale with age and frequency of sexual intercourse (p=0.049, p<0.001, p<0.001, p=0.047, and p=0.014). It was determined that as the age and frequency of sexual intercourse increased, the levels of body image and sexual satisfaction also increased. CONCLUSION: Our study found that women's self-image is negatively affected, and their level of sexual satisfaction decreases following a hysterectomy.

Effect of Shoulder Movement Routine on Postoperative Shoulder Pain in Total Laparoscopic Hysterectomy: A Randomized Clinical Trial.

Background and Objectives: Postoperative shoulder pain is a common issue after total laparoscopic hysterectomy (TLH). This study evaluated the impact of a shoulder movement routine on postoperative shoulder pain in women undergoing uncomplicated TLH. Materials and Methods: An open-label randomized clinical trial included women without prior shoulder pain undergoing TLH between 20 January and 20 March 2024. Participants were randomized into two groups: Group 1 (n = 36) received a shoulder movement routine, while Group 2 (control, n = 39) performed a hand movement routine. Shoulder pain was assessed using the visual analog scale (VAS) at 6 h, 24 h, and 7 days postoperatively. Results: Seventy-five women participated. No significant differences were found between the groups regarding demographic variables, surgery duration, or hospital stay. Shoulder pain scores (VAS) at three time points (6 h, 24 h, and 7 days) showed no significant differences between groups (p = 0.57, p = 0.69, and p = 0.91, respectively). Similarly, there were no significant differences in incisional or abdominal pain. Conclusions: The shoulder movement routine did not significantly reduce postoperative shoulder pain in women undergoing uncomplicated TLH.

[Single-center cohort study of perioperative outcomes on total laparoscopic hysterectomy (TLH): a 10-year experience]. / Histerectomía total laparoscópica: resultados perioperatorios en 10 años de experiencia.

INTRODUCTION: The removal of the uterus, (hysterectomy), is the most frequent surgery in gynecology. In Argentina there are few publications on the perioperative results of this type of procedure, and even less on minimally invasive hysterectomy. The objective of this study was to determine the rate of perioperative complications in patients with total laparoscopic hysterectomy performed at Hospital Italiano de Buenos Aires, from January 7, 2010 to December 22, 2020. METHODS: retrospective cohort study where electronic medical records were reviewed. Intrasurgical and postoperative complications were evaluated using the validated Clavien-Dindo's classification. RESULTS: 1014 patients were included. The rate of intra-surgical complications was 4.5%. In respect to postoperative complications, there was found a rate of 16.6% (n=168), being 12.3% (n=125) Clavien-Dindo = 2, and 4.2% (n=43) Clavien-Dindo = 3. In a multivariable analysis that adjusted for uterine weight > 170g, age, body mass index, and more than two previous abdominal surgeries, an association was found between uterine weight >170g and postoperative complications OR 1.49, 95% CI 1.04- 2.14, p=0.03. DISCUSSION: When evaluating the percentage of minor and major complications, our findings are within the acceptable parameters for performing this type of surgery, even though the evaluation was carried out in an educational setting.

Introducción: La extirpación del útero, (histerectomía) es la cirugía más frecuente en ginecología. En Argentina existen pocas publicaciones sobre los resultados perioperatorios de este tipo de procedimiento, y menos aún sobre histerectomía mínimamente invasiva. El objetivo de este estudio fue determinar la tasa de complicaciones perioperatorias en pacientes con histerectomía total laparoscópica realizada en el Hospital Italiano de Buenos Aires, desde el 7 de enero de 2010 al 22 de diciembre de 2020. Métodos: estudio de cohorte retrospectivo donde se revisaron las historias clínicas electrónicas de pacientes sometidas a una histerectomía laparoscópica en el período mencionado. Se evaluaron las complicaciones intraquirúrgicas y postoperatorias utilizando la clasificación validada de Clavien-Dindo. Resultados: Se incluyeron 1014 pacientes. La tasa de complicaciones intraquirúrgicas fue de 4.5%. Se halló una tasa de complicaciones postoperatorias de 16.6% (n=168), siendo 12.3% (n=125) Clavien-Dindo = 2, y 4.2% (n=43) Clavien-Dindo = 3. En el análisis multivariable que se ajustó por peso uterino >170g, edad, índice de masa corporal y más de dos cirugías abdominales previas, se encontró asociación entre peso uterino > 170 g y complicaciones postoperatorias, OR 1.49, IC 95% 1.04-2.14, p = 0.03. Discusión: Al evaluar el porcentaje de complicaciones menores y mayores, nuestros números se encuentran dentro de los parámetros aceptables para realizar este tipo de cirugía, más aún, considerando que la evaluación se realizó en un ámbito educativo.

Intraoperative and early postoperative pain in cats that underwent ovariohysterectomy using a spay hook: a randomised, masked, experimental study.

BACKGROUND: This study aimed to compare the feasibility and practicality of the ovariohysterectomy (OHE) technique in cats with or without a spay hook with respect to the incision size, surgical time, surgical variables, and intra- and postoperative pain. Twenty-nine female cats underwent OHE using a spay hook (spay hook group [SHG], n = 15) or without using a spay hook (control group [CG], n = 14) to achieve the ovaries and cervix. Physiological parameters were monitored during the intraoperative period, and postoperative pain was assessed using a multidimensional composite and visual analogue pain scales. RESULTS: The SHG had a significantly shorter operative time than the CG. The variables in the intraoperative period showed no statistically significant difference between both groups, as well as the early postoperative pain. CONCLUSIONS: Less invasive OHE using a spay hook could potentially be a viable and feasible technique when performed by an inexperienced surgeon with appropriate training, especially in sterilisation campaigns, reducing the time to perform the procedure and increasing the number of animals spayed per time.

The impact of laparoscopic gynecological surgery training on the technicity index of a developing country center.

PURPOSE: To compare laparoscopic gynecological surgery training between a developed country's reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center's TI. METHODS: The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. RESULTS: The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. CONCLUSIONS: High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient's center with comparable surgical outcomes.

Metronidazole for Prevention of Pelvic Cellulitis and Abscess after Laparoscopic Hysterectomy: A Triple-blinded, Randomized, Placebo-controlled Clinical Trial.

STUDY OBJECTIVE: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN: A randomized, controlled, triple-blind, multicenter clinical trial. SETTING: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS: A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.

Função sexual pós-histerectomia: quais os impactos e aspectos técnicos envolvidos? / Sexual function after hysterectomy: what are the impacts and technical aspects involved?

Objetivo: Identificar o impacto da histerectomia para patologias benignas sobre a sexualidade feminina. Métodos: Revisão de literatura com busca na plataforma PubMed, sendo selecionados 23 artigos em português e inglês publicados entre 2016 e 2021. Resultados: Foi descrita, majoritariamente, melhora na função sexual após histerectomia, semelhante às abordagens totais ou supracervicais e independentemente da via de acesso cirúrgico, apesar de impacto ligeiramente menor com a via laparoscópica. Na laparoscopia, houve melhor desfecho sexual no fechamento da cúpula vaginal, quando comparado ao fechamento via vaginal. Ademais, a ooforectomia concomitante apresentou resultados conflitantes e inconclusivos. Conclusão: A histerectomia afeta positivamente a saúde sexual feminina e aspectos técnicos podem interferir na função sexual, porém os dados são limitados. Devido à importância do tema, necessitam-se de mais estudos com metodologias padronizadas para possibilitar análises mais detalhadas.

Objective: To identify the impact of hysterectomy for benign pathologies on female sexuality. Methods: Literature review with search on PubMed platform, being selected 23 articles in Portuguese and English published between 2016 and 2021. Results: Improvement in sexual function after hysterectomy was mostly described, being similar in total or supracervical approaches and independent of the surgical access route, although it had slightly lower impact when laparoscopic. In the laparoscopic approach, there was better sexual outcome in the vaginal dome closure when compared to vaginal closure. In addition, concomitant oophorectomy showed conflicting and inconclusive results. Conclusion: Hysterectomy positively affects female sexual health and technical aspects may interfere with sexual function, but data are limited. Due to the importance of the theme, more studies with standardized methodologies are needed to enable more detailed analyses.

The use of the double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum.

OBJECTIVES: To evaluate surgical outcomes of using a double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum. METHODS: Retrospective case-control study conducted at the Central Hospital of San Luis Potosi, Mexico. Patients with the diagnosis of placenta accreta spectrum who underwent obstetric hysterectomy were included. Two groups were formed: in the first, a double uterine segment tourniquet was used; and in the second, the hysterectomy was performed without a tourniquet. Primary surgical outcomes were compared. RESULTS: Forty patients in each group were included. The use of a double uterine segment tourniquet had lower total blood loss compared with the non-tourniquet group (1054.00 ± 467.02 vs. 1528.75 ± 347.12 mL, P = 0.0171) and a lower drop in hemoglobin (1.74 ± 1.10 vs. 2.60 ± 1.25 mg/dL, P = 0.0486). Ten patients (23.80%) in the double tourniquet group required blood transfusion, compared with 26 (65.00%) in the non-tourniquet group (P = 0.0003). Surgical time did not show a statistical difference between groups. CONCLUSION: The use of a uterine segment tourniquet in obstetric hysterectomy may improve surgical outcomes in patients with placenta accreta spectrum with no difference in surgical time and urinary tract lesions.

Oral pregabalin is effective as preemptive analgesia in abdominal hysterectomy-A randomized controlled trial.

Postoperative pain is one of the main negative symptoms resulting from surgery and the use of new methods to control this symptom is of ever-increasing relevance. Opioid-sparing strategies, such as multimodal analgesia, are trends in this scenario. Pregabalin is a well-established treatment for neuropathic pain; however, it is still controversial in the surgical context for postoperative analgesia. This study investigated the effect of pregabalin on postoperative analgesia in patients undergoing abdominal hysterectomy. It is a prospective, randomised, double-blind, placebo-controlled clinical trial. Female patients undergoing abdominal hysterectomy were randomised to use pregabalin (group P1), 300 mg orally 2 h before surgery, or identical placebo pills (group P0). The main outcome includes the postoperative pain index by visual analogue scale (VAS) and McGill's pain questionnaire. Secondary outcomes include opioid consumption and the presence of adverse effects. A value of p < 0.05 was used to reject type I error. Fifty-five patients were randomised amongst the groups. Patients in group P1 had lower pain rates by VAS scale, both at rest and in active motion, than group P0. In McGill's questionnaire, patients from group P1 also had lower pain rates (12 × 28.5). There was approximately twice as much opioid consumption amongst patients in group P0. Regarding side effects, there was a difference between the two groups only for dizziness, being more incident in group P1. This study suggests that pregabalin is an important adjuvant drug in treating postoperative pain in patients with abdominal hysterectomy.

Effect of intraoperative alveolar recruitment maneuver on intraoperative oxygenation and postoperative pulmonary function tests in patients undergoing robotic-assisted hysterectomy: a single-blind randomized study.

BACKGROUND: Robotic-Assisted Hysterectomies (RAH) require Trendelenburg positioning and pneumoperitoneum, which further accentuate alteration in respiratory mechanics induced by general anesthesia. The role of Recruitment Maneuver (RM) as a lung-protective strategy during intraoperative surgical settings has not been much studied. We planned this study to evaluate the effect of RM on perioperative oxygenation and postoperative spirometry using PaO2/FiO2 and FEV1/FVC, respectively in patients undergoing RAH. METHODS: Sixty-six ASA I‒II female patients scheduled for elective RAH were randomized into group R (recruitment maneuver, n = 33) or group C (control, n = 33). Portable spirometry was done one day before surgery. Patients were induced with general anesthesia, and mechanical ventilation started with volume control mode, with Tidal Volume (TV) of 6-8 mL.kg-1, Respiratory Rate (RR) of 12 min, inspiratory-expiratory ratio (I: E ratio) of 1:2, FiO2 of 0.4, and Positive End-Expiratory Pressure (PEEP) of 5 cmH2O. Patients in group R received recruitment maneuvers of 30 cmH2O every 30 minutes following tracheal intubation. The primary objectives were comparison of oxygenation and ventilation between two groups intraoperatively and portable spirometry postoperatively. Postoperative pulmonary complications, like desaturation, pulmonary edema, pneumonia, were monitored. RESULTS: Patients who received RM had significantly higher PaO2 (mmHg) (203.2+-24.3 vs. 167.8+-27.3, p < 0.001) at T2 (30 min after the pneumoperitoneum). However, there was no significant difference in portable spirometry between the groups in the postoperative period (FVC, 1.40 ± 0.5 L vs. 1.32 ± 0.46 L, p = 0.55). CONCLUSION: This study concluded that intraoperative recruitment did not prevent deterioration of postoperative spirometry values; however, it led to improved oxygenation intraoperatively.

Effect of intraoperative alveolar recruitment maneuver on intraoperative oxygenation and postoperative pulmonary function tests in patients undergoing robotic-assisted hysterectomy: a single-blind randomized study

Abstract Background Robotic-Assisted Hysterectomies (RAH) require Trendelenburg positioning and pneumoperitoneum, which further accentuate alteration in respiratory mechanics induced by general anesthesia. The role of Recruitment Maneuver (RM) as a lung-protective strategy during intraoperative surgical settings has not been much studied. We planned this study to evaluate the effect of RM on perioperative oxygenation and postoperative spirometry using PaO2/FiO2 and FEV1/FVC, respectively in patients undergoing RAH. Methods Sixty-six ASA I‒II female patients scheduled for elective RAH were randomized into group R (recruitment maneuver, n = 33) or group C (control, n = 33). Portable spirometry was done one day before surgery. Patients were induced with general anesthesia, and mechanical ventilation started with volume control mode, with Tidal Volume (TV) of 6-8 mL.kg−1, Respiratory Rate (RR) of 12 min, inspiratory-expiratory ratio (I: E ratio) of 1:2, FiO2 of 0.4, and Positive End-Expiratory Pressure (PEEP) of 5 cmH2O. Patients in group R received recruitment maneuvers of 30 cmH2O every 30 minutes following tracheal intubation. The primary objectives were comparison of oxygenation and ventilation between two groups intraoperatively and portable spirometry postoperatively. Postoperative pulmonary complications, like desaturation, pulmonary edema, pneumonia, were monitored. Results Patients who received RM had significantly higher PaO2 (mmHg) (203.2+-24.3 vs. 167.8+-27.3, p < 0.001) at T2 (30 min after the pneumoperitoneum). However, there was no significant difference in portable spirometry between the groups in the postoperative period (FVC, 1.40 ± 0.5 L vs. 1.32 ± 0.46 L, p= 0.55). Conclusion This study concluded that intraoperative recruitment did not prevent deterioration of postoperative spirometry values; however, it led to improved oxygenation intraoperatively.

Effects of Preoperative Acupuncture on Prevention of Nausea and Vomiting and Plasma Serotonin Values in the Hysterectomy Postoperative Period: a Randomized Clinical Trial.

Background: Nausea and vomiting are frequent complications of anesthesia in the postoperative period. Acupuncture at the pericardium point 6 (PC6) is known to be effective in preventing postoperative nausea and vomiting (PONV). Objectives: The objective of the present study is to investigate the effects of acupuncture performed at the PC6 point in the prevention of PONV in women undergoing elective open hysterectomy under general inhalational anesthesia and to assess its association with plasma serotonin levels. Methods: 97 patients undergoing elective open hysterectomy were randomly divided into two groups: acupuncture group (bilateral acupuncture at PC6, n = 49), and a control group (no acupuncture, n = 48). All patients prophylactically received ondansetron and dexamethasone and, as rescue medication, metoclopramide in case of occurrence of PONV. The primary outcome evaluated was occurrence of nausea and vomiting within 24 hours after surgery. Serotonin plasma levels were measured before and after acupuncture prior to anesthesia induction. For the control group, the repeat measurement was performed 30 minutes after admission to the preoperative unit. Results: Acupuncture at PC6 significantly reduced the incidence of nausea (29.2% vs. 6.1%; p > 0.003), and the need of rescue medication (metoclopramide) (33.3% vs. 10.2%; p > 0.006), but not vomiting (4.2 vs. 4.1; p > 0.98). The plasma serotonin levels between control and acupuncture groups did not differ. Conclusion: This study shows that acupuncture at PC6 resulted in a lower incidence of postoperative nausea in patients undergoing hysterectomy.

The Effects of Hysterectomy on Urinary and Sexual Functions of Women with Cervical Cancer: A Systematic Review.

OBJECTIVE: This systematic review aims at describing the prevalence of urinary and sexual symptoms among women who underwent a hysterectomy for cervical cancer. METHODS: A systematic search in six electronic databases was performed, in September 2019, by two researchers. The text search was limited to the investigation of prevalence or occurrence of lower urinary tract symptoms (LUTS) and sexual dysfunctions in women who underwent a hysterectomy for cervical cancer. For search strategies, specific combinations of terms were used. RESULTS: A total of 8 studies, published between 2010 and 2018, were included in the sample. The average age of the participants ranged from 40 to 56 years, and the dysfunctions predominantly investigated in the articles were urinary symptoms (n = 8). The rates of urinary incontinence due to radical abdominal hysterectomy ranged from 7 to 31%. The same dysfunction related to laparoscopic radical hysterectomy varied from 25 to 35% and to laparoscopic nerve sparing radical hysterectomy varied from 25 to 47%. Nocturia ranged from 13%, before treatment, to 30%, after radical hysterectomy. The prevalence rates of dyspareunia related to laparoscopic radical hysterectomy and laparoscopic nerve sparing radical hysterectomy ranged from 5 to 16% and 7 to 19% respectively. The difficulty in having orgasm was related to laparoscopic radical hysterectomy (10 to 14%) and laparoscopic nerve sparing radical hysterectomy (9 to 19%). CONCLUSION: Urinary and sexual dysfunctions after radical hysterectomy to treat cervical cancer are frequent events. The main reported disorders were urinary incontinence and dyspareunia.

OBJETIVO: Essa revisão sistemática visa descrever a prevalência de sintomas urinários e sexuais entre mulheres submetidas à histerectomia por câncer cervical. MéTODOS: Uma pesquisa sistemática foi realizada em seis bases de dados eletrônicas, em setembro de 2019, por dois pesquisadores. A busca foi limitada à investigação da prevalência e ocorrência de sintomas do trato urinário baixo e disfunções sexuais em mulheres após histerectomia por câncer cervical. Como estratégia de busca foi utilizada uma combinação específica de termos apenas em inglês. RESULTADOS: Um total de 8 estudos, publicados entre 2010 e 2018, foram incluídos na amostra. A idade média dos participantes foi de 40 a 56 anos, e as principais disfunções investigadas pelos artigos foram sintomas urinários (n = 8). Na literatura analisada, as taxas de incontinência urinária ligadas à histerectomia abdominal radical variaram de 7 a 31%. A mesma disfunção, para histerectomia radical laparoscópica, variou de 25 a 35%, e de 25 a 47% para histerectomia radical laparoscópica poupadora de nervo. A taxa de noctúria variou de 13%, antes do tratamento, a 30%, após histerectomia radical. A prevalência de dispareunia associada à histerectomia radical laparoscópica foi de 5 a 16%. Já a taxa de dispareunia relatada pós-histerectomia radical laparoscópica poupadora situou-se entre 7 e 19%. A dificuldade de alcançar o orgasmo foi relatada após histerectomia radical laparoscópica, variando de 10 a 14%, e também na histerectomia radical laparoscópica poupadora de nervo, variando de 9 a 19%. CONCLUSãO: Disfunções urinárias e sexuais após histerectomia para tratamento do câncer cervical são eventos frequentes. As principais desordens relatadas foram incontinência urinária e dispareunia.

Adjuvant therapy in early-stage cervical cancer after radical hysterectomy: are we overtreating our patients? A meta-analysis.

OBJECTIVE: There is a gap in knowledge regarding the ideal management of patients with early-stage cervical cancer and intermediate-risk features. Here, we present a meta-analysis of the published literature on oncological outcomes in these patients and determine trends in postoperative management. METHODS: MEDLINE and PubMed were used for literature searches. The inclusion criteria were: English language articles including ≥ 10 patients, patients who underwent radical hysterectomy, nodes negative, studies reporting oncological outcomes and complications treatment-related and compare a surgery-only cohort with a radiotherapy cohort. The PRISMA guidelines were followed. Combined relative risk was calculated using DerSimonian-Laird random-effects model and a forest plot was drawn. RESULTS: We collected 183 manuscripts on early-stage cervical cancer treated with radical hysterectomy alone or with adjuvant radiotherapy after surgery. A total of eight studies met the inclusion criteria. Regarding oncological outcomes, survival was reported in five studies. The relative risk of recurrence and the relative risk of mortality was similar in both groups independently whether receive or not adjuvant therapy. Most of the studies did not report significant differences regarding morbidity treatment related between the groups, except for a higher rate of lymphedema after radiotherapy. CONCLUSION: We found that the relative risk of recurrence and mortality was similar in both groups not depending on adjuvant therapy. Therefore, whether radiotherapy adjuvant treatment is indicated remains a topic of debate.

Allopurinol attenuates postoperative pain and modulates the purinergic system in patients undergoing abdominal hysterectomy: a randomized controlled trial.

PURPOSE: Allopurinol is a potent inhibitor of the enzyme xanthine oxidase used primarily in the treatment of hyperuricemia and gout. The aim of this study was to compare the analgesic efficacy of preanesthetic allopurinol versus placebo on postoperative pain and anxiety in patients undergoing abdominal hysterectomy. METHODS: This is a prospective, double-blinded, placebo-controlled, randomized clinical trial. We investigated 54 patients scheduled to undergo elective abdominal hysterectomy. Patients were randomly assigned to receive either oral allopurinol 300 mg (n = 27) or placebo (n = 27) the night before and 1 h before surgery. Patients were submitted to evaluation of pain and anxiety before the treatment, for 24 h postoperatively, 30 and 90 days after surgery. Cerebrospinal fluid was collected at the time of the spinal anesthesia to perform the measurement of the central levels of purines. RESULTS: Preoperative administration of allopurinol was effective in reducing postoperative pain 2 h after surgery. Allopurinol caused a reduction of approximately 40% in pain scores measured by the visual analogue pain scale after surgery (p < 0.05). No differences were found between groups in anxiety scores after surgery. There was a significant change in the cerebrospinal fluid concentrations of xanthine and uric acid before surgery (p < 0.01). CONCLUSION: This study showed a short-term benefit of the use of allopurinol as a preanesthetic medication since it was related to a reduction on pain scores 2 h after surgery. The purinergic system is a potential target for new analgesic drugs. New studies investigating more selective purine derivatives in the management of pain should be performed. TRIAL NUMBER REGISTRATION: Brazilian Registry of Clinical Trials-ReBEC #RBR-9pw58p.

Sexual, bladder and bowel function following different minimally invasive techniques of radical hysterectomy in patients with early-stage cervical cancer.

PURPOSE: Despite the establishment of radical surgery for therapy of cervical cancer, data on quality of life and patient-reported outcomes are scarce. The aim of this retrospective cohort study was to evaluate bladder, bowel and sexual function in women who underwent minimally invasive surgery for early-stage cervical cancer. METHODS: From 2007-2013, 261 women underwent laparoscopically assisted radical vaginal hysterectomy (LARVH = 45), vaginally assisted laparoscopic or robotic radical hysterectomy (VALRRH = 61) or laparoscopic total mesometrial resection (TMMR = 25) and 131 of them completed the validated German version of the Australian Pelvic Floor Questionnaire (PFQ). Results were compared with controls recruited from gynecological clinics (n = 24) and with urogynecological patients (n = 63). RESULTS: Groups were similar regarding age, BMI and parity. The TMMR group had significantly shorter median follow-up (16 months versus 70 and 36 months). Postoperatively, deterioration of bladder function was reported by 70%, 57% and 44% in the LARVH, VARRVH and TMMR groups, respectively (p = 0.734). Bowel function was significantly worse after TMMR with a higher deterioration rate in 72 versus 43% (LARVH) and 47% (VARRVH) with a correspondingly higher bowel dysfunction score of 2.9 versus 1.5 and 1.8, respectively and 1.8 in urogynaecological patients. Sexual dysfunction was common in all surgical groups. 38% considered their vagina too short which was significantly associated with deep dyspareunia. Compared with controls, surgical groups had significantly increased PFQ scores. CONCLUSION: Pelvic floor dysfunction commonly deteriorates and negatively impacts on quality of life after minimally invasive radical hysterectomy, especially bowel function after TMMR. Pelvic floor symptoms should routinely be addressed pre- and postoperatively.

Safety of early discharge in patients undergoing laparoscopic hysterectomy in a high complexity center in Bogotá, Colombia, 2013 - 2019. Historical cohort / [Seguridad del alta temprana en pacientes con histerectomía laparoscópica en una institución de alto nivel de complejidad en Bogotá, Colombia, 2013 - 2019. Cohorte histórica].

Objective: To describe the safety of early discharge in the first 12 hours of the postoperative period in women undergoing laparoscopic hysterectomy for benign uterine disease. Materials and methods: Descriptive historical cohort study. The study included all women undergoing laparoscopic hysterectomy due to benign disease and discharged after 12 hours of the procedure in a high complexity hospital in Bogota Colombia, between January 2013 and April 2019. Patients with comorbidities (diabetes, cardiovascular disease and chronic obstructive pulmonary disease) mobility limitations and intraoperative complications were excluded. Consecutive sampling was used. The variables assessed included demographics and safety variables such as readmission through the emergency service and complications classified according to the Dindo scale on the fifteenth postoperative day. A descriptive analysis is made. Results: Of 860 laparoscopic hysterectomies performed during the study period, 67 (7.8%) met the selection criteria. Eleven patients (16.4%) were readmitted through the emergency service, one (9%) due to active bleeding, and two (18%) because of urinary symptoms. There were six (8.9%) postoperative complications, including vaginal vault hematoma in two patients (2.9%), hemoperitoneum in two cases (2,9%), one (1.4%) urinary infection and one (1.4%) ureteral injury; four patients (5.9%) required hospitalization and were classified as stage IIIb on the Dindo scale. Conclusions: Early discharge emerges as an alternative to in-hospital care for this type of population. Randomized controlled studies are needed to produce additional evidence regarding this management approach.

Objetivo: describir la seguridad del alta en las primeras 12 horas del posoperatorio en mujeres cometidas histerectomía por laparoscopia por patología benigna de útero. Materiales y métodos: estudio de cohorte histórica descriptiva. Se incluyeron todas las mujeres llevadas a histerectomía laparoscópica por patología benigna, quienes fueron dadas de alta después de 12 horas del procedimiento en un hospital de alta complejidad en Bogotá, Colombia, entre enero del 2013 y abril del 2019. Se excluyeron pacientes con comorbilidades (diabetes, enfermedad cardiovascular y pulmonar obstructiva crónica), limitaciones para la movilización y aquellas que presentaron complicaciones intraoperatorias. Se realizó un muestreo consecutivo. Se evaluaron variables demográficas, y como variables de seguridad, el reingreso por urgencias y complicaciones clasificadas según la escala de Dindo a los 15 días del postoperatorio. Se hace análisis descriptivo. Resultados: durante el período de estudio se realizaron 860 histerectomías por laparoscopia, de estas, 67 (7,8%) cumplieron con los criterios de selección. Once pacientes (16,4%) reingresaron por el servicio de urgencias, de las cuales, siete (63,6%) acudieron por dolor, una (9%) por sangrado activo, una (9%) por fiebre, y dos (18%) por síntomas urinarios. Se presentaron seis (8,9%) complicaciones postoperatorias de las cuales dos pacientes (2,9%) tuvieron hematoma de cúpula vaginal, dos (2,9%) hemoperitoneo, una (1,4%) infección urinaria y una (1,4%) lesión ureteral; cuatro pacientes (5,9%) requirieron hospitalización, estas últimas se clasificaron en el estadio IIIb de Dindo. Conclusiones: el alta temprana surge como alternativa al cuidado hospitalario para este tipo de población. Se requieren estudios con grupo control y asignación aleatoria para aportar mejor evidencia respecto a este manejo.

5,926 hysterectomies: complications described by Clavien-Dindo classification.

Hysterectomy is the most common major gynaecological surgery. Due to its high volume, the analysis of its results is relevant. The objective of this study was to describe intraoperative complications and reoperations, for both benign and malignant causes, using the Clavien-Dindo classification (approved by local ethics committee, number 100220). Between 2000 and 2019, 5926 elective hysterectomies were performed, of which 90.2% were for benign aetiology and 9.8% for malignant causes. The abdominal route was 52.7%, vaginal 40.1% and laparoscopic 7.2%. Intraoperative complications and reoperations (grade III Clavien-Dindo) were 4% and 2.1%, respectively. Oncological surgery had significantly more intraoperative complications (10% vs. 3.4%) and reoperations (3.6% vs. 1.9%) than benign procedures. Noteworthy, intraoperative complications required a new operation in only 3.4% for malignant and 2.8% for benign surgery. Our data showed the relevance of detecting and rectifying intraoperative complications during surgery, which consequently leads to a lower reoperation rate, minimising postoperative morbidity and mortality for patients.Impact StatementWhat is already known on this subject? The surgical complications of hysterectomy, both intraoperative and postoperative, are extensively described. However, this information is not well systematised, in which elective and emergency surgery are mixed. In addition to the above, there are few documents comparing the results of hysterectomies due to benign versus malignant causes.What the results of this study add? Using the Clavien-Dindo classification, this study adds an organised description of intraoperative complications and reoperations of hysterectomy in the context of elective surgery. In addition, it provides information on the comparison between surgery for benign versus malignant causes, as well as information on intraoperative complications requiring a new operation.What the implications are of these findings for clinical practice and/or further research? These findings provide clear and orderly data about the risks of elective hysterectomy and showed the relevance of detecting and rectifying intraoperative complications during the procedure. This is useful for specialists to preoperatively identify the risks for each hysterectomy group and provide their patients with more detailed information during informed consent.

Natural Orifice Transluminal Endoscopic Surgery for Correction of Vesicovaginal Fistulas after Hysterectomy Due to Morbidly Adherent Placenta.

BACKGROUND: Vesicovaginal fistula (VVF) is a difficult-to-treat complication of obstetric hysterectomy. There are multiple management options, with a preference for surgical repair via abdominal or vaginal approach. We describe a transurethral natural orifice transluminal endoscopic surgery (NOTES) using barbed suture, in 3 cases of VVF after hysterectomy due to morbidly adherent placenta (MAP). CASES: Three patients with VVFs after hysterectomy due to MAP underwent a transurethral endoscopic suture repair. Two patients had complete resolution of the fistula, and the third required additional repair by laparotomy; however, a decrease was observed in the size of the VVF after the initial endoscopic repair. CONCLUSION: The transurethral NOTES approach for VVF after MAP hysterectomy is a minimally invasive procedure that is valid as an initial approach for this type of complication.

Histerectomía total vía abdominal: revisión de la literatura / Total abdominal hysterectomy: a literature review

Hysterectomy is the most common gynecological surgery in non-pregnant women. There are different surgical approaches for total hysterectomy, abdominal, vaginal, laparoscopic and robotic routes. The choice is determined by different factors such as uterine size, malformations, surgical risks, skill of the surgeon, expected postoperative quality of life, and monetary costs. The surgical technique is well described in the literature, however, there are certain anatomical and functional considerations that must be known before performing the hysterectomy to avoid complications. The most frequent complications are hemorrhage, infections, thromboembolism, urinary and gastrointestinal tract injuries. Majority can be avoided with an adequate procedure and management of pre-existing comorbidities. (AU)