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At least 19 recordsLinked to original sources
PubMed1977

Surgical complications of gynecologic surgery.

Complications of gynecological surgery are considerable and when reviewed in detail are almost frightening. There is no substitute for experience and intimate knowledge of the intricate pelvic structures in health and disease.Anyone who is active in the field is sooner or later going to experience some difficulty whether it be due to his miscalculation or to innate conditions in the patient which are beyond his/her control.It is the responsibility of the pelvic surgeon to recognize the complication and apply proper corrective measures. The patient should not be given false hopes of sure success nor should she be deprived of whatever hope for success does exist.

Abortion, Spontaneous↗
PubMed1976

Ureteral injuries associated with gynecologic surgery: prevention and management.

Gynecologic surgery is responsible for most of the ureteral injuries that occur. The "easy" operation--the "simple" abdominal hysterectomy--and not the technically difficult pelvic one, is responsible for most ureteral injuries. Total abdominal hysterectomy accounts for almost 50% of the genitourinary fistulas and perhaps 80-99% of all surgical ureteral injuries. This problem will persist until a most important surgical axiom is applied routinely during the accomplishment of all pelvic operations: With all dissections, the contiguous structures subject to injury must be exposed. This step not only will avoid injuries to the ureter but also will facilitate an equally important aspect, that is, urinary tract injuries must be recognized at the time of operation. With recognition and adequate repair, problems such as fistula formation and serious morbidity (and litigation) can be avoided almost entirely. Because the gnecologic surgeon frequently will find that urologic consultation is not available at the time of urinary tract injury, he or she must be aware of and familiar with the various ureteral reconstructive procedures that may be required. The gynecologic surgeon must devote time and study to the management of urinary tract injuries before their occurrence. All pelvic surgeons eventually will encounter ureteral problems. The methods of bladder mobilization and ureteroneocystostomy should be within the ability of all who operate within the pelvis. When extensive damage has occurred and a urologist is not available, the gynecologist who is unfamiliar with the more demanding techniques (that is, ureteroureterostomy, bladder flaps, ileal conduits) should avoid additonal damage to the urinary tract and accomplish a simple catheter ureterostomy, deffering the definitive repair for a urologist.

Female↗
PubMed1976

Perineovulvovaginal preoperative preparation in minor gynecological surgery.

Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued.

Adult↗
PubMed2026

HSK21542 for Postoperative Analgesia in Gynecological Surgery: A Pooled Post-Hoc Analysis of Two Phase III Randomized Controlled Trials.

BACKGROUND: Effective postoperative pain management in gynecological surgery is challenging because of complex visceral-somatic pain interactions and the adverse effects of conventional analgesics. HSK21542, a novel peripherally restricted kappa-opioid receptor (KOR) agonist that selectively targets visceral pain pathways enriched with KORs, may provide adequate analgesia without systemic adverse events. METHODS: We conducted a pooled post-hoc analysis of data from two phase III, multicenter, triple-blinded, randomized controlled trials (Study 301, HSK21542 vs placebo; Study 303, HSK21542 vs tramadol vs placebo). Eligible patients undergoing elective gynecological surgery were included. The primary outcome was the summed pain-intensity difference over 12 and 24 hours (SPID 12h and SPID 24h ). Secondary outcomes were pain-relief quality (proportion of patients relieved from severe pain with a pain numerical rating score &#x2264; 3 between 0 and 24 hours) and rescue-analgesic requirements (number of doses and time to first rescue analgesic). Adverse events were also assessed. RESULTS: A total of 370 patients were analyzed: 150 received HSK21542, 139 received a placebo, and 81 received tramadol. After inverse probability of treatment weighting (IPTW) adjustment, baseline characteristics were well-balanced across treatment groups (all standardized mean differences [SMD] <0.1; see Table 1 for 95% CIs). HSK21542 produced greater reductions in pain intensity over 12 and 24 hours than placebo (least-squares mean differences -8.1 and -16.3 for SPID 12h and SPID 24h , respectively. Both P < .001) and no statistically significant difference was observed between HSK21542 and tramadol ( P > .05). Significantly more patients in the HSK21542 group were relieved from severe pain at 0 to 12 hours (92.7% vs 82.7%, P < .001) and required fewer rescue doses at 0 to 12 hours (0.00 [IQR 0.00-1.00] vs 1.00 [IQR 0.00-2.00], P < .001) and 0 to 24 hours (0.00 [IQR 0.00-1.00] vs 1.00 [IQR 0.00-2.00], P < .001) than those in the placebo group, whereas no significant differences with tramadol both in 0 to 12 and 0 to 24 hours. HSK21542 was also associated with significantly lower incidences of nausea (24.7% vs 66.7%) and vomiting (21.3% vs 60.5%) than tramadol. Only one case of dizziness occurred in the tramadol group. CONCLUSIONS: HSK21542 could provide adequate postoperative analgesia with few adverse events in patients undergoing gynecological surgery.

Humans↗
PubMed1976

[Influence of gynecologic surgery on the blood concentration of adenosine phosphate].

Blood concentrations of ATP, ADP and AMP studied before and immediately after incomplicated gynecologic surgery due to not malignant indications showed the following changes: 1. The initial blood concentration values ranged within the physiological limits and were not therefore essentially influenced by gynecologic diseases. 2. There was a short-term non significant increase of ATP blood concentrations after the operation. 3. After more extensive surgical operations there was a significant short-term decrease of ADP and AMP concentrations that however, approached pre-operation values within 24 hours. 4. The values of ATP/ADP and ATP/AMP coefficients increased significantly after the operation but decreased again within 24 hours. It may be concluded that gynecologic surgery itself as well as attendant circumstances do not induce metabolic changes unfavorably influencing the adenosinephophate system in the blood.

Adenosine Diphosphate↗
PubMed1977

Pulmonary thromboembolism associated with gynecologic surgery and pregnancy.

Pulmonary thromboembolism continues to be an infrequent but serious complication of gynecologic surgery and pregnancy. The record of each patient with such a complication treated in two community hospitals during the 10 year period to 1976 was examined in detail. An attempt was made to identify weaknesses in past management and suggest changes to improve future care. Embolism will continue to occur unexpectedly and be of such magnitude as to cause death before effective treatment. can be instituted. Patients at risk can often be identified and prophylactic anticoagulants and antibiotics are appropriate in selected cases. An understanding of the pathology of embolism of and principles of genital sepsis combined with vigorous treatment will save some patients who now would die. If the risks are appreciated, anticoagulants may be used in pregnant patients who are closely monitored. These patients must be alerted to the dangers of both embolism and the treatment.

Anticoagulants↗
PubMed2026

Esketamine vs. sufentanil for quality of recovery after outpatient gynecological surgery: a randomized clinical trial.

BACKGROUND: Perioperative administration of esketamine has been reported to improve early quality of recovery (QoR). However, data on its effects in outpatient surgery are limited. This study aimed to assess the impact of esketamine on QoR in patients undergoing outpatient gynecological procedures. METHODS: In this investigator-initiated, double-blind, randomized clinical trial, patients aged 18-65&#x2009;years scheduled for outpatient gynecological surgery under sedation were allocated to receive esketamine (0.2&#x2009;mg/kg) or sufentanil (0.1&#x2009;&#x3bc;g/kg) combined with propofol (1.5-3&#x2009;mg/kg). The primary outcome was quality of recovery on postoperative day (POD) 1. Secondary outcomes included quality of recovery on POD2, sedation success rate, length of post-anesthesia care unit (PACU) stay, injection pain, postoperative pain, nausea and vomiting, fatigue, patient and clinician satisfaction, sleep quality, and anxiety and depression. RESULTS: A total of 126 patients were randomized, with 63 assigned to the esketamine group and 63 to the sufentanil group. Of these, 125 patients were included in the final analysis (62 in the esketamine group and 63 in the sufentanil group), as one patient lacked follow-up data. The mean (SD) QoR-15 score on POD1 was 137.9 (14.5) in the esketamine group and 137.8 (10.7) in the sufentanil group, with no significant difference between groups (absolute difference, 0.2; 95% CI, -4.2 to 4.6; p&#x2009;=&#x2009;0.93). For secondary outcomes, the esketamine group had a longer PACU stay (median, 28.0 vs. 23.0&#x2009;min; p&#x2009;<&#x2009;0.001), a lower incidence of severe injection pain (22.6% vs. 50.8%; p&#x2009;=&#x2009;0.002), a higher proportion of patients with pain scores &#x2265; 4 at 30&#x2009;min postoperatively (30.6% vs. 6.3%; p&#x2009;=&#x2009;0.001), and higher fatigue scores (median, 3.0 vs. 2.0; p&#x2009;=&#x2009;0.01). Other secondary outcomes did not differ significantly between groups. CONCLUSION: Among patients undergoing sedation for outpatient gynecological procedures, esketamine did not significantly improve quality of recovery on POD1 compared to sufentanil. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2500098466.

Humans↗
PubMed1978

Wound infections and systemic antibiotic prophylaxis in gynecologic surgery. A review.

The gynecologic literature was reviewed and yielded 11 well-designed and well-conducted studies since 1960 involving the use of systemic prophylactic antibiotics. Five had significant results that support using prophylactic antibiotics in vaginal hysterectomy while three supported prophylaxis in cesarean sections. A cephalosporin agent is effective as a prophylactic agent and should be administered 2 hours before surgery by the intravenous route and discontinued 24-72 hours after surgery. A change in the bacteriologic flora of the cervical cuff occurs after surgery with an increase in E. coli and enterococci and a decrease in coagulose negative staphylococci and steptococci. Future studies should be randomized, prospective, and performed in a double-blind manner with antibiotics begun preoperatively. Special attention should be given to bacteriologic techniques, especially the search for anaerobic pathogens.

Anti-Bacterial Agents↗
PubMed1979

Coagulation studies of patients taking low-dose heparin during and after major gynecologic surgery.

In February, 1975, a prospective, randomized study of 75 patients undergoing major gynecologic surgery was undertaken. Patients were randomly assigned to three groups regardless of diagnosis and surgery contemplated. Coagulation studies were performed preoperatively and postoperatively in a control group, a receiving 2,000 U heparin/12 hr subcutaneously, and a third group receiving 5,000 U/12 hr via the same route. There was a statistically significant increase noted in fibrin degradation products in the group treated with 5,000 U heparin/12 hr as compared to the control group. Excessive bleeding intraoperatively or postoperatively was not encountered.

Antifibrinolytic Agents↗
PubMed1979

[Postoperative analgesia by constant flow injection of lignocaine in obstetrical and gynecologic surgery].

154 surgical patients were given post-operative analgesia by peridural injection at a constant flow in the post-operative period after obstetric or gynecological surgery. These patients received 536.2 +/- 105.3 mu mol.h-1 (145.2 +/- 28.5 mg.h-1) of lignocaine for 46.97 +/- 15.56 h through a catheter omserted between L1-L2. The drug was given in concentrations which varied between: 27.7 to 18.5 m mol.l-1 (0.75 to 0.50 p. 100) depending on the age; and the volume varied between 17.5 to 30 ml.h-1 depending on the height. Satisfactory analgesia in 87 p. 100 of cases allowed all supplementary analgesia to be stopped. The only significant hemodynamic effect was a slight tachycardia (+ 15 p. 100). Two undesirable side effects were noted: a transitory but well-defined (type 2 or 3) motor paralysis, and an accumulation of plasma lignocaine (40 mu mol.l-1 (1.1 microgram.ml-1) at 48 h).

Analgesia↗
PubMed2026

Application of SPI-guided analgesia in laparoscopic gynecologic surgery: a randomized controlled trial evaluating the remifentanil-sparing effect and predictive value of time-weighted SPI.

This study aimed to achieve two primary objectives: (1) to evaluate the opioid-sparing effect of Surgical Pleth Index (SPI)-directed analgesia during surgery via a randomized controlled trial (RCT), and (2) to propose and preliminarily assess a novel dynamic metric, Threshold-based Time-Weighted SPI (Tb-TW-SPI), which integrates stimulus intensity and duration, for its predictive efficacy regarding postoperative moderate-to-severe pain. Employing an RCT combined with exploratory analysis, 61 patients undergoing elective laparoscopic gynecologic surgery were randomized into an SPI-directed analgesia group or a conventional analgesia group. The primary outcome was total intraoperative remifentanil consumption. Postoperatively, an exploratory analysis of the control group data evaluated the correlation between Tb-TW-SPI and Numeric Rating Scale (NRS) pain scores in the post-anesthesia care unit (PACU), calculating its predictive value for moderate-to-severe pain (NRS&#x2009;&#x2265;&#x2009;4). Results: The SPI-directed group required significantly less intraoperative remifentanil than the conventional group [median (IQR): 5.84(5.02,6.62)vs. 6.96(5.81,8.19)&#xb5;g/kg/h; P&#x2009;=&#x2009;0.016]. Postoperative pain scores did not differ significantly between groups (P&#x2009;>&#x2009;0.05). Exploratory analysis of the conventional analgesia group revealed that Tb-TW-SPI values were significantly higher in patients with moderate-to-severe postoperative pain (NRS&#x2009;&#x2265;&#x2009;4) compared to those without (P&#x2009;=&#x2009;0.0417).The area under the ROC curve for Tb-TW-SPI predicting this pain was 0.74 (95% CI: 0.52-0.96), with 67% sensitivity and 76% specificity at an optimal cutoff of 1210. This RCT suggests that SPI-directed analgesia can safely and moderately reduce intraoperative remifentanil consumption. Furthermore, the proposed Tb-TW-SPI metric, in this exploratory analysis, suggests potential for predicting postoperative pain, though this finding requires validation in larger cohorts with higher-frequency SPI sampling, offering a new direction for SPI interpretation. Large-scale, multicenter trials are warranted to validate the predictive utility of Tb-TW-SPI. Clinical Trial Registration, China Clinical Trial Registry: ChiCTR2400088444.

Humans↗
PubMed1978

[Risks and trends in geriatric gynecologic surgery].

A comparative study of the geriatric gynecological operations of the two periods from 1958 to 1967 and 1968 to 1977 in the Universitäts-Frauenklinik Jena showed an increase of the number of women aged 60 years and more from 6.8% to 8.9% and in the last four years to more than 10%. In 52% a malignant tumor was the main disease. Prolapsed uterus and vagina occured in about 23%. Abdominal hysterectomy was the mostly performed operation. The mortality decreased from 6.6% to 3.3%. Pulmonary embolie was the most frequent cause of death.

Age Factors↗
PubMed1977

Early treatment of ureteral injuries found after gynecological surgery.

Five consecutive patients with 7 ureteral injuries found after gynecological operations were treated conservatively. The complications ensuing this type of management are reported briefly. Twenty more consecutive patients with 27 ureteral injuries were treated immediately after diagnosis and definitively. Important points of technique are 1) little attempt to stay extraperitoneally, 2) sacrifice of all abnormal ureter, 3) re-establishment of ureteral continuity between a normal ureter and the bladder by usual means, 4) peritoneal closure only when easy, 5) adequate drainage and 6) use of antibiotics. The results obtained were excellent. Early and definitive treatment of ureteral injuries found after gynecological operations seems to be the safest and easiest type of management in all cases.

Adult↗
PubMedDate not supplied

[Transverse laparotomy by supre-pubic detachment of the recti muscles in gynecologic surgery. Apropos of 266 cases].

The authors have studied 266 case histories where supra-pubic detachment of rectus muscles was used according to Cherny's method. This allowed aseptic gynaecological surgery to be carried out in all its forms by a true transverse incision. The advantages are great : it is aesthetic and the incision can be enlarged if necessary indefinitely. This means that surgery can be carried out easily and explains the great rarity of intra-abdominal complications. On the other hand two relatively rare complications do occur with this incision : peritoneal haematomata and lateral herniations. Details have been given of the methods necessary to avoid these complications.

Female↗
PubMed1976

[Serum glutamate oxalacetate transaminase following gynecologic surgery].

1. Changes occuring in the activity of SGOT after uncomplicated gynecological operations conducted for benign diseases are not extensive. They manifest themselves in form of a moderate SGOT activity increase which was not statistically significant in the present sample. 2. In about half the number of patients of women operated per laparotomiam there was a fairly marked increase in the activity of SGOT which reached in fairly frequent instances the upper physiological limit. 3. Even a completely smooth and uncomplicated preoperative and postoperative course may be associated in some patients with a tissue lesion and liver function change reaching a level which causes the SGOT activity to increase. The above finding should be taken into account during postoperative treatment in particular in women in whom a change of this might produce exacerbation of an associated disease (liver disease) or lead to the rise of complications.

Aspartate Aminotransferases↗