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At least 577 records · Page 32Linked to original sources
PubMed1976

[Comparative study on the question of systemic chemoprophylaxis following gynecological surgery].

The incidence of delayed wound healing and urinary tract infections was studied in 2 randomized groups of post-operative gynecological patients, one of which was given systemic antibiotic prophylaxis and the other not. 143 women were given Bactrim in a standard dose of 2 x 2 tablets or ampoules daily, commencing preoperatively during and continuing until the eighth postoperative day. The control group received placebos parenterally and orally for the same period. The incidence of complications in wound healing, of subfebrile and febrile states, urinary tract infections and micturition difficulties following removal of the catheter was significantly lower in the group who had undergone antibiotic therapy. 83% of this group, compared with 68% in the control group, were discharged after the normal hospital stay. In 51% of the control group a chemotherapy or antibiotic course had to be given secondarily to combat infection, the commonest indications being urinary tract infections or pyrexia for several days. The drawbacks were side effects of the systemic chemoprophylaxis, such as skin eczema (6%) and gastrointestinal disturbances, as well as a tendency to infections with problem bacteria requiring treatment with reserve antibiotics. It is concluded that routine postoperative antibiotic prophylaxis, despite its favourable effect on infections morbidity as a compromise between optimum treatment for the individual and general medical interest, must be prescribed on an individual basis.

Adult↗
PubMed1997

The use of mesh in gynecologic surgery.

The aim of this review was to compare properties of the most commonly used synthetic meshes and describe their use in gynecologic procedures. An Ovid search of the English literature from 1966 to the present was carried out, together with a hand search of Index Medicus from 1950 to 1965. Articles involving the use of mesh in surgical procedures or comparative studies of the different mechanical properties of mesh are included. Overviews from urogynecologic texts and surgical texts are also included. All studies in this review consisted of retrospective case series (21 suburethral sling articles, 15 sacrocolpopexy articles, and five pelvic sling articles). No randomized prospective trials were available. Outcome variables, including cure rates and mesh-related complications, are reviewed and compared. Conclusions show that long-term success of the suburethral sling with synthetic mesh ranges from 61% to 100%, and the success rate of the abdominal sacrocolpopexies using mesh ranges from 68% to 100%. Mesh-related complications rates are frequent, with up to a 35% removal rate and 10% sinus tract formation for suburethral slings and 9% erosion rate for sacrocolpopexy. The ideal synthetic mesh material for pelvic surgery, one that induces minimal foreign-body reaction with minimal risk of infection, rejection and erosion, has yet to be developed.

Female↗
PubMed2000

Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine.

UNLABELLED: We tested the hypothesis that local anesthetics instilled at the end of laparoscopic gynecologic procedures are able to prevent postoperative pain at wake-up and during the first 24 h. A total of 180 patients were randomly assigned into three groups to receive an intraperitoneal instillation of 20 mL of either bupivacaine 0.5% (Group B), ropivacaine 0.75% (Group R) or saline (Group S) at the end of surgery. All patients received analgesia with acetaminophen and ketoprofen IV infusions. Pain was assessed by using a 0-10 graded numerical scale (NS) every 5 min in the postanesthesia care unit and IV morphine was administered if NS was >4. Assessment of pain was continued every 4 h on the ward, and subcutaneous morphine was injected if needed to keep the NS score < 4. Postoperative nausea and vomiting (PONV) was rated on a 4-point scale. The morphine consumption at wake-up and over the first 24 h was significantly lower (P < 0.05) in Group B (mean, 0.92 mg at wake-up; 3.08 mg over 24 h) and in Group R (mean, 0.25 mg at wake-up; 0.69 mg over 24 h), than in Group S (mean, 4.18 mg at wake-up; 12.93 mg over 24 h). The morphine-sparing effect of ropivacaine was significantly greater than that of bupivacaine. Both local anesthetics were effective in the prevention of PONV. We concluded that local anesthetics should be instilled in all gynecologic patients at the end of all laparoscopic procedures. IMPLICATIONS: Local anesthetic instillation (ropivacaine rather than bupivacaine) at the end of laparoscopy prevents postoperative pain and dramatically decreases the need for morphine. This technique, compared with placebo, is safe, improves patient comfort, shortens the stay in the postoperative care unit and decreases nursing care in the ward.

Adolescent↗
PubMed2004

Gynecological surgery in octogenarians and nonagenarians.

OBJECTIVE: The study analyzed morbidity and mortality rates among octogenarian and nonagenarian patients who underwent operations for gynecologic indications. STUDY DESIGN: A retrospective chart review was performed for patients, aged >or=80 years, who underwent gynecologic procedures between January 1, 1995, and September 30, 2000. Information obtained included a complete medical history, type of surgical procedure, length of hospital stay, and discharge disposition. Simple demographic statistics were used. RESULTS: Sixty-two patients (mean age, 83.6 years) were identified. Seventy-seven operative procedures, 49 major and 28 minor, were performed. All patients were discharged home, except 2, who were discharged to nursing homes. Sixteen patients, who underwent minor procedures, were discharged the same day, and 6 patients were admitted for "23" hour stays. There were 11 perioperative complications and no perioperative deaths. CONCLUSION: Successful gynecologic surgical outcomes with minimal morbidity are achievable in octogenarian patients and nonagenarian patients with optimization of co-medical conditions and careful perioperative treatment. Age should not be the sole determinant in the decision-making process.

Age Factors↗