Progress in gynecologic surgery.
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The authors studied the incidence of postoperative nausea and vomiting (PONV) and the effect of prophylactic tropisetron, a 5-HT3 antagonist, during the first 24 h following elective gynecologic laparoscopic surgery. Thirty-two of 68 (47%) of the patients experienced nausea or vomiting some time during the observation period. Sixteen of the 32 PONV patients (50%) had their first emetic symptoms after discharge from the recovery room. We could see no difference in the frequency of PONV in the patients who were given prophylactic tropisetron 5 mg orally before anesthesia.
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We have studied the incidence of postoperative nausea and vomiting (PONV) and the effect of prophylactic tropisetron, a 5-HT3 antagonist, during the first 24 hr after elective gynecologic laparoscopic surgery. Thirty-two of 68 patients (47%) experienced nausea or vomiting some time during the observation period. Sixteen of these patients (50%) had their first emetic symptoms after discharge from the recovery room. We could see no difference in the frequency of PONV in the patients who were given prophylactic tropisetron 5 mg orally before anesthesia.
The transverse muscle-splitting Maylard incision was used in 175 gynecologic patients who required pelvic-abdominal surgery. One hundred fifty-three patients (87%) had pelvic malignancy; other indications for operation included uterine myomas, endometriosis, tuboovarian abscess, and benign ovarian cysts. Exposure was excellent: 54% of patients underwent pelvic lymphadenectomy and 17% underwent paraaortic lymphadenectomy. Twelve patients (6.9%) had wound complications, but there was neither long-term morbidity nor mortality associated with the incision. Fifty-six patients (32%) received preoperative or postoperative pelvic radiation therapy with no detrimental effect on wound healing. The Maylard incision is cosmetic, strong, easily learned, and has an acceptable complication rate. Unless a vertical incision is indicated, the Maylard technique is preferred when optimal exposure and accessibility to the pelvis are required.