Taking the tube: Uptake of salpingectomy at the time of hysterectomy for benign indications.

BACKGROUND: International guidelines recommend the fallopian tubes be removed at the time of hysterectomy, to lower the incidence of ovarian cancer in women. AIMS: To determine the rate of salpingectomy at the time of hysterectomy at our institution and to discuss a standard rate. MATERIALS AND METHODS: Hysterectomies (n = 200) performed for benign indications from 13 January 13, 2015 until 26 April 26, 2016 were reviewed. RESULTS: The overall rate of salpingectomy was 76.0%. Factors associated with non-completion were uterovaginal prolapse indication and vaginal surgical approach. CONCLUSIONS: Rates of completing salpingectomy with hysterectomy are high. There may be additional opportunity for ovarian cancer reduction. No standard rate has been published but considering difficulty with removal of fallopian tubes in certain cases, it may not be 100%. Our data allows for comparison by other units performing similar studies. We recommend the formal adoption of local guidelines regarding salpingectomy at the time of hysterectomy for benign indications in order to keep local practice up to date with international recommendations.

Validity and reliability of a pain location tool for pediatric abdominal surgery.

For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p < .0001). In children with acute appendicitis, pain scores were higher in the right iliac fossa than in upper abdominal sites, mean (SD) 3.3 (2.5) and 0.4 (0.7), respectively (p = .001). In children with perforated appendicitis, Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.