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PubMed1995

Are ureteral catheters in gynecologic surgery beneficial or hazardous?

STUDY OBJECTIVE: To evaluate the use of ureteral catheters in gynecologic surgery. DESIGN: A prospective study. SETTING: A university-affiliated private hospital. PATIENTS: A series of 317 women undergoing a variety of gynecologic surgeries who were at high risk for ureteral injury. INTERVENTIONS: The procedures ranged from radical oncologic surgery to difficult operations for benign disease. In 273 patients the ureteral catheters were inserted prophylactically, and in 44 they were inserted postoperatively to confirm ureteral patency. Nineteen were lighted catheters used during laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Only 3 of 546 ureters could not be catheterized preoperatively. The average time to insert the catheters was 6 minutes (range 2-21 min). All ureters were easily identified, and their dissection was facilitated by the catheters. Two asymptomatic cases of transitional cell cancer of the bladder were diagnosed. One case of ureteral obstruction was identified at postoperative ureteral catheter insertion. No immediate or delayed problems were identified. The frequency of urinary tract infection was 3.2%. CONCLUSION: Ureteral catheters are safe and are simple to insert. They enhance identification of ureters and facilitate ureteral dissection.

Equipment Safety↗
PubMed1997

Optimal dose of granisetron for prophylaxis against postoperative emesis after gynecological surgery.

UNLABELLED: We previously reported that 20 and 40 microg/kg of granisetron given during anesthesia prevented postoperative emesis with no severe complications. The aim of the current study was to determine the optimal dose of granisetron for the prevention of postoperative nausea and vomiting (PONV) after gynecological surgery. Two hundred female patients (ASA physical status I) were randomly allocated to one of five groups (n = 40 for each): saline (as a control), granisetron 2 microg/kg, granisetron 5 microg/kg, granisetron 10 microg/kg, and granisetron 20 microg/kg. Saline or granisetron was given intravenously immediately after induction of anesthesia. PONV was assessed 24 h after surgery. The percentage of emesis-free patients was significantly greater in the 5- to 20-microg/kg granisetron groups than in the control and 2-microg/kg granisetron groups (18%, 23%, 68%, 78%, and 75% of patients receiving saline or granisetron 2 microg/kg, 5 microg/kg, 10 microg/kg, and 20 microg/kg, respectively). Granisetron doses of 5 microg/kg or larger were also superior to the saline and 2-microg/kg granisetron treatment for the prevention of nausea over the 24-h study period (nausea visual analog scales 24 h after surgery: 49, 41, 18, 16, and 14 mm in the control and granisetron 2 microg/kg, 5 microg/kg, 10 microg/kg, and 20 microg/kg groups, respectively). A smaller proportion of patients received "rescue" antiemetic in the 5-microg/kg or larger granisetron groups than in the control and 2-microg/kg granisetron groups (48%, 40%, 18%, 13%, and 10% of patients in the control and granisetron 2 microg/kg, 5 microg/kg, 10 microg/kg, and 20 microg/kg groups, respectively). The antiemetic effect of granisetron was similar among the groups who received 5-microg/kg or larger doses. In conclusion, we suggest that the optimal dose of granisetron is 5 microg/kg for the prevention of PONV after gynecological surgery. IMPLICATIONS: Nausea and vomiting postoperatively after gynecologic surgery is a significant problem. The authors found that granisetron, a selective antagonist of serotonin, markedly decreases the incidence of postoperative nausea and vomiting at doses of 5 microg/kg or larger.

Adult↗
PubMed1998

Panniculectomy: a useful technique for the obese patient undergoing gynecological surgery.

OBJECTIVES: To establish the safety and efficacy of panniculectomy at the time of surgery for benign and malignant gynecological disease. METHODS: Retrospective review of the course of 57 patients undergoing radical gynecological surgery and panniculectomy between January 1992 and January 1997 at the Mercy Hospital for Women, Melbourne. Data were collected regarding indication for treatment, operative details, and complications of surgery. RESULTS: Of 57 patients in the study, 32 had a primary gynecological malignancy, 11 had benign gynecological disease, 3 had cervical dysplasia, 5 had endometrial hyperplasia, and the remaining 6 had incisional hernia repair. The mean age of patients was 55 years with a mean weight of 101 kg (range 70-145 kg). The mean operative time was 2 h 24 min, and blood transfusion was undertaken in 23 (41%) patients. Four (7.1%) individuals had a minor wound infection and 3 (5.4%) a moderate wound infection. One patient experienced a nonfatal pulmonary embolus and 2 patients experienced a deep vein thrombosis. There were no postoperative deaths. Long term, 6 patients developed an incisional hernia. CONCLUSIONS: Panniculectomy is a useful technique in obese patients. It improves surgical access facilitating radical surgery and is cosmetically pleasing to the patient. It has acceptable morbidity when compared to conventional midline vertical or transverse incisions in comparable populations.

Adipose Tissue↗
PubMed2000

Ramosetron for preventing postoperative nausea and vomiting in women undergoing gynecological surgery.

UNLABELLED: In a prospective, randomized, double-blinded, placebo-controlled trial, we evaluated the efficacy of ramosetron at three different doses (0.15, 0.3, and 0.6 mg) for the prevention of postoperative nausea and vomiting (PONV) after gynecological surgery. One hundred twenty women, ASA physical status I or II, aged 21-63 yr, received IV either placebo or ramosetron 0.15, 0.3, or 0.6 mg (n = 30 of each) at the completion of surgery. A standard general anesthetic technique and postoperative analgesia were used. A complete response, defined as no PONV and no need for another rescue antiemetic, during 0-3 h after anesthesia occurred in 40%, 47%, 87%, and 90% of patients who had received placebo and ramosetron 0.15, 0.3, and 0.6 mg, respectively. Corresponding results during 3-24 h after anesthesia were 43%, 50%, 87%, and 90%, and 24-48 h after anesthesia were 50%, 53%, 90%, and 93% (P < 0.05). Patients who had received ramosetron 0.3 or 0.6 mg were satisfied compared with those who had received placebo (P < 0.05). There were no serious clinical adverse events caused by the study drug in any of the groups. In conclusion, ramosetron 0.3 mg is an effective antiemetic for preventing PONV during 0-48 h after anesthesia in female patients undergoing gynecological surgery. Increasing the dose to 0.6 mg provided no further benefit. IMPLICATIONS: This randomized, double-blinded, placebo-controlled trial in 120 women found the effective dose of ramosetron for preventing postoperative nausea and vomiting after gynecological surgery to be 0.3 mg.

Adult↗
PubMed2002

Symptomatic venous thromboembolism in Chinese patients after gynecologic surgery: incidence and disease pattern.

BACKGROUND: Venous thromboembolism is a common cause of postoperative morbidity and mortality in Caucasian populations, but it is widely believed that this complication is rare in Chinese. METHODS: We conducted a retrospective study from January 1998 to December 2000. Women with thromboembolic diseases after gynecologic surgery were identified and their medical records were reviewed. RESULTS: During the study period, thirty-one women were diagnosed as having thromboembolic disease after gynecologic surgery. Over the study period, the total number of operations was 6077, giving an incidence of 5.10/1000 operations. There were two cases of pulmonary embolism and the others had deep vein thrombosis of which 90% were limited to calf veins only. The incidences were significantly higher in 1999 and 2000 (7.59 and 6.85/1000 operations, respectively) than that in 1998 (1.7/1000 operations) (P = 0.015), after a case of maternal death due to pulmonary embolism in early 1999. Most cases of thromboembolism were diagnosed after major surgery for malignancy (n = 14) or benign conditions (n = 12). In the remaining cases, three had evacuation of the uterus for retained products of conception and two had laparoscopy for suspected ectopic pregnancies. CONCLUSIONS: Thromboembolic disease is not uncommon among Chinese women after gynecologic surgery. The incidence is similar to that of the Caucasian population, although the sites of vascular occlusion were different. The long belief that thromboembolism is rare among Chinese is at least partly due to under-diagnosis.

Asian People↗
PubMed1997

The effects of dexamethasone on antiemetics in female patients undergoing gynecologic surgery.

UNLABELLED: This randomized, double-blind study compared the effects of dexamethasone plus either droperidol, metoclopramide, or granisetron with each antiemetic alone for preventing postoperative nausea and vomiting (PONV) in 270 female patients undergoing general anesthesia for major gynecological surgery. Patients were randomly assigned to receive either droperidol 1.25 mg (Group D1, n = 45), droperidol 1.25 mg plus dexamethasone 8 mg (Group D2, n = 45), metoclopramide 10 mg (Group M1, n = 45), metoclopramide 10 mg plus dexamethasone 8 mg (Group M2, n = 45), granisetron 40 micrograms/kg (Group G1, n = 45), or granisetron 40 micrograms/kg plus dexamethasone 8 mg (Group G2, n = 45) immediately before the induction of anesthesia. A standard general anesthetic technique and postoperative analgesia were used throughout the study. Complete response, defined as no PONV and no administration of rescue antiemetic medication during the first 24 h after anesthesia, was 49% in Group D1, 60% in Group D2 (P = 0.199 versus Group D1), 51% in Group M1, 62% in Group M2 (P = 0.198 versus Group M1), 80% in Group G1, and 96% in Group G2 (P = 0.025 versus Group G1). Our results suggest that dexamethasone enhances the antiemetic efficacy of granisetron but does not potentiate the other antiemetics-droperidol and metoclopramide-in female patients undergoing major gynecological surgery. IMPLICATIONS: We compared the efficacy of dexamethasone plus three different antiemetics-droperidol, metoclopramide, and granisetron-for the prevention of nausea and vomiting after gynecologic surgery. The granisetron-dexamethasone combination was the most effective for preventing post-operative emetic symptoms.

Adult↗
PubMed2001

Common problems in pediatric and adolescent gynecologic surgery.

Clinical studies on the myriad of problems that are encompassed by pediatric and adolescent gynecologic surgery are extremely difficult to carry out due to the low numbers of patients with these diagnoses in any one location or institution. Our current understanding of diagnosis, treatment, and outcome is drawn from case reports and the sharing of information. Frequently, clinical practice embraces technology long before the reports of such technology appear in the literature. As clinicians join together to study the various pathologies seen in this group of patients, we may see some impressive studies in the future. This review will focus on the current information available, which may contribute to the treatment and understanding of pediatric and adolescent gynecologic surgery.

Adolescent↗
PubMed2002

Management of iatrogenic ureteric injuries associated with gynecological surgery.

OBJECTIVE: This retrospective study defines the presentation and management of iatrogenic ureteric injuries consequent upon gynecological surgery in a teaching hospital in Punjab, Pakistan. PATIENTS AND METHODS: 18 patients with median age 35 years (range 18-80 years) with iatrogenic ureteric injuries associated with gynecological surgery were referred to the department of urology at Nishtar Hospital Multan Pakistan. Main presenting symptoms were urinary incontinence, loin pain and anuria. Median time since injury and presentation was 3 weeks (range 1 day to 7 years). In 16 (88%) patients injury resulted from abdominal hysterectomy. Other causes included ovarian cystectomy (one patient) and vaginal hysterectomy (one patient). 11 (61%) patients had ureterovaginal fistula, 5 (28%) patients had complete unilateral ureteric obstruction and 2 (11%) patients had bilateral ureteric obstruction and anuria. In 11 patients with ureterovaginal fistula ureteroneocystostomy was performed. In five patients with unilateral ureteric obstruction, one had end to end anastomosis of ureter, three had ureteroneocystostomy only and one had ureteroneocystostomy and psoas hitch done. Two had anuria secondary to bilateral ureteric obstruction. In one of these patients Boari flap and ureteroneocystostomy was carried out. The second patient had deligation of catgut sutures on ipsilateral side and ureteroneocystostomy on the contra-lateral side. RESULTS: In 17 patients no major complication occurred. One patient who had deligation of catgut sutures, the distal ureter sloughed and re-exploration and ureteroneocystostomy was performed. Renal salvage was achieved in all cases. CONCLUSION: Open surgical procedures for repair of iatrogenic ureteric injuries are associated with good outcome. Strategies to prevent these injuries include adequate surgical training and meticulous surgical techniques.

Adolescent↗
PubMed2002

Preoperative administration of recombinant human erythropoietin in patients undergoing gynecologic surgery.

The effect of preoperative recombinant human erythropoietin (r-HuEPO) in anemic women undergoing gynecologic surgery for benign diseases was evaluated in this prospective, not randomized study. One hundred and twenty women were included in the study. Sixty women were treated preoperatively with r-HuEPO at three different cumulative doses: 80,000, 120,000 and 160,000 IU. Sixty nonanemic women were not treated. Baseline hemoglobin (Hb) levels were measured. Hb levels were also measured on the day of the surgery before starting the procedure, on postoperative day 1 and on the day of discharge from the hospital. Treatment with r-HuEPO significantly increased both preoperative Hb levels and Hb levels at discharge. Conversely, Hb levels at discharge were lower than baseline levels in untreated women. The effect of r-HuEPO on Hb levels was exerted in a dose-dependent fashion. No adverse and/or side effects of treatment were observed. Preoperative treatment with r-HuEPO in selected anemic patients undergoing gynecologic surgery for benign diseases seems to be a safe and useful tool to reduce the need for red blood cell transfusions.

Adult↗
PubMedDate not supplied

Cost analysis of propofol versus thiopental induction anesthesia in outpatient laparoscopic gynecologic surgery.

This study investigated the cost of propofol versus thiopental anesthesia in 243 patients who underwent outpatient laparoscopic gynecologic surgery. Patients records were analyzed for medication use, duration of surgery, anesthesia, recovery room stay, and associated costs. Despite the higher drug cost for propofol, the total mean cost was $273.00 less per patient for patients receiving propofol induction anesthesia. Extension of these data translates into cost savings of approximately $7900.00 if propofol had been used for all patients. Although the duration of surgery for the propofol group was shorter by nearly 12 minutes, the anesthesia duration and recovery room stay were both longer for the thiopental group, reflecting the longer duration of action of thiopental. Although the realized cost savings of drugs, surgery, anesthesia, and recovery time when propofol versus thiopental is used for outpatient laparoscopic gynecologic surgery are relatively small on an individual patient basis, cost savings may become more significant if larger patient populations are studied.

Adult↗
PubMed2006

Long-term outcome of women who undergo panniculectomy at the time of gynecologic surgery.

OBJECTIVE: While panniculectomy has been shown to be a useful technique in obese women undergoing gynecologic surgery, the long-term outcome of these patients has been poorly described. The goal of this study was to determine the long-term outcomes and patient satisfaction of women who underwent panniculectomy at the time of pelvic surgery. METHODS: A retrospective review of patients who underwent panniculectomy at the time of pelvic surgery between 1996 and 2004 was performed. Postoperative complications and long-term trends in weight were evaluated. Patient satisfaction was assessed by telephone survey. RESULTS: Forty-two patients were identified. The mean EBL was 522 ml, the mean operating time was just over 4 h. Wound complications were noted in 36% of the subjects. Two weeks after the procedure, 86% of the women had a weight that was lower than their preoperative weight. Weight loss peaked 3 months postoperatively, 97% of the subjects had a net lower weight, with a mean loss of nearly 20 lb. Over the ensuing 2 years, weight loss gradually declined. After 2 years of follow-up, 62% of the women were below their preoperative body weights. The mean weight loss at 24 months was 7 lb. Overall patient satisfaction with the procedure was high. Eighty-six percent of the subjects responded that they would undergo the procedure again given their outcome. CONCLUSIONS: Panniculectomy is well tolerated and associated with a high rate of patient satisfaction. Panniculectomy is a valuable component of gynecologic surgery in morbidly obese women.

Abdomen↗
PubMed2003

Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery.

Our objective was to review our experience and attempt to identify risk factors for ureteral injury during gynecologic surgery for benign conditions. A retrospective chart review was performed of all cases of ureteral injury during gynecologic surgery for benign conditions, at Temple University Hospital, from January 1992 to September 2002. We analyzed hospital records to determine whether the injury was diagnosed intraoperatively, with postprocedure cystoscopy, or if cystoscopy was ineffective in diagnosing the injury. There were nine ureteral injuries during the study period. Of these, two were diagnosed during the procedure, two were discovered by immediate postprocedure cystoscopy, and the other five were discovered during the postoperative period. Of these five, three patients had immediate postprocedure cystoscopy and the injuries were not detected. Risk factors associated with ureteral injury included: a large uterus (5), high-grade cystocele (3), ectopic insertion of the ureter into the bladder (1), and previous surgeries (4). Our conclusion was that negative cystoscopy cannot be solely relied on to rule out ureteral injury, as cases with partial obstruction and ureteral patency can be missed.

Adult↗
PubMed2006

Postoperative voiding, bacteriuria and urinary tract infection with Foley catheterization after gynecological surgery.

BACKGROUND: The use of bladder drainage to avoid urinary retention after gynecological surgery is more or less custom based, and duration of drainage varies considerably. In this paper the use of 1-day drainage by transurethral Foley catheter was investigated with regard to impaired voiding, asymptomatic bacteriuria, and urinary tract infection. Furthermore, the use of methenamine hippurate was studied with regard to postoperative asymptomatic bacteriuria and urinary tract infection. METHODS. This summary is based on six published papers totaling 917 patients. In three case series, 1-day catheterization was used in women undergoing gynecological laparotomy, colposuspension, or vaginal plastic surgery. To compare 1- and 3-day Foley catheterization, two open, randomized trials were performed on women undergoing vaginal plastic surgery or colposuspension. The last study was a double-blind trial between methenamine hippurate and placebo as prophylaxis against urinary tract infection and asymptomatic bacteriuria using 1-day catheterization. RESULTS: Postoperative voiding problems and urinary tract infection occurred infrequently with 1-day catheterization, and no more frequently than with catheterization for three days. Methenamine hippurate decreased the incidence of urinary tract infection and asymptomatic bacteriuria by 80 and 40%, respectively. CONCLUSIONS: One-day bladder drainage by transurethral Foley catheter may be used routinely in common gynecological surgery with a low rate of voiding problems, asymptomatic bacteriuria, and urinary tract infection. Methenamine hippurate prophylaxis effectively reduces postoperative urinary tract infection.

Anti-Infective Agents, Urinary↗
PubMed2003

Intraoperative and postoperative morbidity associated with cystoscopy performed in patients undergoing gynecologic surgery.

OBJECTIVE: The purpose of this study was to evaluate the role of cystoscopy during major gynecologic surgery and to describe an interesting and rare complication that was encountered. STUDY DESIGN: This was an observational descriptive study. A retrospective review was performed. Data collected included intraoperative lower urinary tract injuries, injuries that were related directly to cystoscopy, and postoperative morbidity. RESULTS: One hundred one cases were evaluated. Eight lower urinary tract injuries were noted, 4 of which were detected at cystoscopy and 3 of which (2.97%) were detected intraoperatively before cystoscopy. There was one complication that was linked directly to cystoscopy. There were nine postoperative urinary tract infections. Total cost per case excluding anesthesia time was $54.42. CONCLUSION: Liberal use of cystoscopy in gynecologic surgery is recommended. The procedure is safe, easily learned, and inexpensive to perform.

Adult↗
PubMed1994

Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention.

Postoperative adhesions occur in 60% to 90% of patients undergoing major gynecologic surgery and represent one of the most common causes of intestinal obstruction in the industrialized world. The incidence of adhesion-related intestinal obstruction after gynecologic surgery for benign conditions without hysterectomy is approximately 0.3%, increasing to 2% to 3% among patients who undergo hysterectomy, and is as high as 5% if a radical hysterectomy is performed. Other adhesion-related complications include chronic pelvic pain, ureteral obstruction, and voiding dysfunction. Intraperitoneal adhesions also can limit the effectiveness of intraperitoneal therapeutic agents used in cancer treatment. Postoperative adhesions are sequelae of impaired fibrinolysis of the fibrin and cellular exudate after peritoneal injury. Adequate blood supply is essential for normal fibrinolysis. Therefore factors that increase ischemia and potentiate adhesion formation include thermal injury, infection, presence of a foreign body, and radiation-induced endarteritis. Only recently, appropriate animal models have been developed to study the process of adhesion formation and prevention. Until clinical confirmation of findings from these investigations exists, only a meticulous surgical technique can be advocated to minimize these untoward effects of surgery.

Animals↗
PubMed1995

[Prevention of thromboembolic disease in gynecologic surgery].

We presented two groups of patients gynecologically operated and examined in a five year period; the first group of 11536 patients was under thromboembolic protection, whereas the second group of 8532 patients was without thromboembolic protection. Protective measures concerning thromboembolic disease were carried out by applying elastic stockings 24 hours before operation and by early post-operative getting up from bed. Low-molecular dextran was applied before operation as well as during the operation in the amount of 500-1000 ml. In risky patients with varicosities, recidive thrombophlebitis and cardiovascular diseases, we applied small doses of heparin subcutaneously two hours before the operation and after the operation every eight hours five days long. With such prevention of thromboembolic disease in gynecologic surgery, we achieved very favorable effects in reducing mortality to 0.05% concerning the operated, while it amounts to 0.3% in those who were without this kind of protection.

Female↗
PubMed2004

[Effects of fentanyl on EC50 of ropivacaine for postoperative epidural analgesia after gynecological surgery].

OBJECTIVE: To determine the effect of fentanyl on 50% effective concentration (EC50) of ropivacaine for postoperative epidural analgesia following gynecological surgery. METHODS: Sixty-five patients (ASA class I to II) scheduled for elective gynecological surgery were randomly divided into two groups to receive 20 ml ropivacaine (group R, n=33) or ropivacaine combined fentanyl (group RF, n=32) for postoperative epidural analgesia. The concentration of ropivacaine was adjusted according to double-blinded up-down sequential allocation. The efficacy was assessed using visual analog scores (VAS) and EC50 calculated using method of Dixon. RESULTS: The EC50 of ropivacaine was 0.098% in group R and 0.069% in group RF, showing significant difference (P<0.01). CONCLUSION: EC50 of ropivacaine for postoperative epidural analgesia determined by up-down sequential allocation is 0.098%, which can be decreased by the use of fentanyl.

Amides↗
PubMed2001

Operative complications in HIV-infected women undergoing gynecologic surgery.

OBJECTIVE: To examine complications in HIV-positive women and controls undergoing gynecologic surgery and to evaluate the prognostic value of immune function for postoperative morbidity. STUDY DESIGN: A review of patients undergoing surgery by the gynecology faculty at the Johns Hopkins Medical Institutions from February 1994 through November 1998 was performed. Fifty-three HIV-positive women were matched with 58 controls. Information on demographics, medical conditions, indication for surgery, surgery, blood loss, length of stay, perioperative hemoglobins, postoperative white blood cell counts and complications was collected. Data on HIV clinical stage, immune function and use of HIV medications were collected for HIV-positive patients. Odds ratio and chi 2 or two-sided t tests were used. Complication rates were also compared by CD4 counts and by HIV RNA levels. RESULTS: The only difference in demographics was by type of insurance (P < .001). Overall, 9 of 53 HIV-positive women had a complication as compared with 5 of 58 controls. There was no difference in the overall rate of complications or in specific complications, even when stratified by minor or major procedures. There were no differences between CD4 and HIV RNA groups for individual complications. CONCLUSION: The study found no differences in complications between HIV-positive and control patients and no association with immune status or viral load.

Adult↗