RESUMO
OBJECTIVE: To evaluate the safety and efficacy of vaginal hysterectomy for benign conditions (excluding prolapse) using the BiClamp (Erbe Elektromedizin, Tübingen, Germany) bipolar electrocoagulation system. METHODS: The present study was a prospective audit of a consecutive case series of patients who underwent vaginal hysterectomy for benign conditions, performed using the BiClamp between March 1, 2015, and June 30, 2016, at Norfolk and Norwich University Hospital, Norwich, UK. Surgeries performed for benign conditions were eligible, excluding prolapse; severe endometriosis with pelvic adhesions was an exclusion criterion. Patient demographics and past history were recorded, along with intraoperative findings and adverse events. Follow-up data were obtained via telephone interviews 24 hours after surgery and a nurse-led postoperative clinic 8 weeks postoperatively. RESULTS: The series included 75 patients; 32 (43%) were discharged on the same day as surgery and 70 (93%) within 23 hours. There were two patients who experienced vault hematomas and remained admitted for more than 24 hours. There was one intraoperative bladder injury that was repaired vaginally. No delayed adverse events occurred within 8 weeks. No patient required patient-controlled analgesia or an epidural injection for postoperative analgesia. CONCLUSION: Patients experienced low postoperative pain following BiClamp treatment and 93% were was discharged within 23 hours.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/instrumentação , Eletrocoagulação/instrumentação , Histerectomia Vaginal/instrumentação , Alta do Paciente/estatística & dados numéricos , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Eletrocoagulação/efeitos adversos , Estudos de Viabilidade , Feminino , Alemanha , Hematoma/etiologia , Humanos , Histerectomia Vaginal/efeitos adversos , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Bexiga Urinária/lesõesRESUMO
This is a case report of a spontaneous pneumomediastinum and surgical emphysema in a 32-year-old woman presenting a few hours after forceps vaginal delivery with symptoms of chest tightness, shortness of breath and swelling in the neck, which resolved with conservative management. It is a rare but potentially dangerous complication of labour, which can be accurately diagnosed with clinical features and chest X-ray. The treatment is conservative as it is usually self-limiting and recurrence in subsequent pregnancies is extremely rare.