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At least 19 recordsLinked to original sources
PubMed1993

Urological injury during gynecologic surgical procedures.

Urological injury during gynecologic surgical procedures is an infrequent but serious complication. The incidence from this study is less than other studies. There are 25 cases of urological injuries consisting to twenty-one bladder injuries and four ureteral injuries. The associated factors of the urological injury are previous pelvic operation, distorted anatomy in the pelvis from various diseases and full bladder. Prompt intraoperative recognition of the injury is the best way to prevent serious postoperative complication. Four had vesicovaginal fistulae that were recognized postoperatively. Three had spontaneous closure of fistulae with conservative management and one required surgical management. Patients who had urological injury during the gynecologic surgical procedures had a longer hospital stay. The most important factor in prevention of this injury is a clear exposure of structures at risk.

Adult↗
PubMed1984

Combined gynecologic surgical procedures and cholecystectomy.

This report presents our experiences with combined gynecologic surgical procedures and cholecystectomy from 1976 to 1983. The review evaluated risks, cost, and hospital stay in combined surgical procedures. Hospital charts were reviewed in 46 cases. The patients were compared with 178 patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy in 1981. Of the 46 patients reviewed, 22 (47.8%) had preoperative diagnosis of cholelithiasis. We believe it appropriate to combine gynecologic surgical procedures with cholecystectomy when indicated. This eliminates a significant postoperative complication, cholecystitis, a second general anesthetic, and future hospitalization with additional time off work and patient recovery time.

Castration↗
PubMed1988

Multidisciplinary program for promoting single prophylactic doses of cefazolin in obstetrical and gynecological surgical procedures.

A multidisciplinary cost-containment program for promoting the use of single prophylactic doses of cefazolin for obstetrical and gynecological surgical procedures is described. Following a one-month review of patient charts to identify the antimicrobial regimens used most frequently for prophylaxis in obstetrical and gynecological surgical procedures, the department of pharmacy services, with the cooperation of the pharmacy and therapeutics (P&T) committee and the departments of obstetrics and gynecology and infectious diseases, implemented an educational program to promote the use of single doses of cefazolin for surgical prophylaxis. The program included inservice education and distribution of letters of support and a therapeutics newsletter. Drug stocking patterns in the operating and delivery rooms were changed to make cefazolin more accessible, and the P&T committee formally restricted the use of prophylactic antimicrobial agents in obstetrical and gynecological surgical procedures to single doses of cefazolin unless a consulting infectious-disease physician recommended otherwise. Compliance with the program increased as each step was implemented; data collected 16 months after the program was initiated demonstrated a compliance rate of 78.8%. Based on comparison of data collected before initiation and six months after initiation of the program, an actual cost savings of +7,125 was realized, which extrapolates to +14,250 annually. No apparent adverse effects on patient care were noted. The multidisciplinary approach to promoting the use of single doses of cefazolin was effective.

Cefazolin↗
PubMed1988

Combined plastic and gynecological surgical procedures.

The purpose of the present study was to determine the extent to which the planned combination of one of several major plastic and gynecological surgical procedures may alter patient morbidity and postoperative hospitalization when compared with similar procedures carried out separately. A review of 10 consecutive years of operative procedures produced 63 patients who underwent combined gynecological and plastic surgical procedures. Thirty-three of the combined-surgery patients could be suitably matched with 2 control patients each to compare complications and length of hospital stay. The requirement for transfusion was significantly greater (p = 0.01) in the combined-surgery versus the paired-control groups. No other complications, however, were increased in the combined-surgery patients. There was a significant reduction (p = 0.005) in hospital stay of 1.92 postoperative days for two groups of combined-surgery patients versus the control groups. In all combined-surgery patients, patient response was favorable. Recommendations on preoperative planning and intraoperative and postoperative management are discussed. There is a perception in the surgical community that combining procedures unacceptably increases morbidity. For the past 12 years plastic and gynecological surgeons in our institution have offered combined procedures to our patients, with positive results and favorable patient response. A search of recent medical literature demonstrated several references to the planned combination of plastic and gynecological or general surgical procedures [2, 4, 5]. However, the only study with matched control patients dealt exclusively with abdominoplasty in association with one of five major gynecological procedures.

Blood Transfusion↗
PubMed1978

Major gynecologic surgical procedures in the aged.

The results of major gynecologic operations in 160 women over the age of 65 were reviewed and compared with the results in 120 younger women 40--55 years old. Most of the complaints of the elderly group were related to genital prolapse. These conditions caused daily discomfort and anxiety. Contrary to the practice in the younger group, most of the operations in the elderly were vaginal. Vaginal hysterectomy was the preferred procedure in most cases of uterine prolapse. Spinal anesthesia was used, as it is rarely contraindicated in the elderly. Postoperative complications were few and did not cause prolongation of hospital stay. There was only one postoperative death, a mortality rate of 0.6 percent. When care is exercised in medical evaluation, choice of anesthesia, and performance of the operation, the elderly patient usually can tolerate major gynecologic surgical procedures well, and should not be lightly disqualified from receiving the benefits.

Adult↗
PubMed1988

Extensive gynecologic surgical procedures upon patients more than 75 years of age.

A series of 110 patients upon whom extensive gynecologic surgical procedures were performed between 1971 and 1986 are presented. All of the patients were 75 years of age or older at the time of operation. Abdominal surgical procedures were performed upon 49, and vaginal hysterectomies were performed upon the remaining 61. Among patients undergoing abdominal procedures, three deaths occurred; among those undergoing vaginal hysterectomies, one patient died (6.2 versus 1.6 per cent). Morbidity was high among both groups (43.5 per cent, abdominal group). Patients undergoing the vaginal procedure stayed in the hospital fewer days (9.6 versus 14.5 days). From this data, it is concluded that, if there is a clear indication for surgical procedure, it should be performed, regardless of the age of the patient, if there is no equal or superior medical alternative and if there is no absolute contraindication to anesthesia.

Age Factors↗
PubMed1993

Sexual counseling of women having gynecologic surgical procedures.

A feminist, women's health perspective is described to aid nurses in providing sexual counseling to women having gynecologic surgical procedures. Suggestions are given concerning areas of sexual assessment, resource development, and when and what to teach women about the sexual effects of gynecologic operations.

Female↗
PubMed2002

Rates of postoperative complications among human immunodeficiency virus-infected women who have undergone obstetric and gynecologic surgical procedures.

Clinical observations indicate that human immunodeficiency virus (HIV)-positive women experience more postoperative problems than do HIV-negative women. To obtain a better estimate of the individual risk of postoperative morbidity among HIV-infected women, and to determine which procedures pose the greatest risk, we performed a retrospective case-control study in which we assessed the outcomes after 235 obstetric and gynecologic surgical procedures. For purposes of comparison, an HIV-negative control patient was matched for each of the 235 surgical procedures performed, on the basis of the type of procedure and patient age. We found a significantly greater number of postoperative complications among the HIV-positive women. Higher complication rates occurred after abdominal surgery (odds ratio [OR], 3.6; P=.001) and curettage (OR, 7.7; P=.06). Among HIV-infected women, the risk of complications was associated with immune status. Antiretroviral therapy and standard perioperative antibiotic prophylaxis did not decrease the risk of complications. Indications for performing abdominal surgery and curettage on HIV-infected women should be carefully weighed against the potential risk of postoperative complications.

Adult↗
PubMed1990

Perioperative warfarin therapy in combined abdominal lipectomy and intraabdominal gynecological surgical procedures.

The combination of multiple surgical procedures is attractive and convenient to the patient. Increased awareness of wound healing difficulties and pulmonary complications, however, suggest caution with this approach, particularly when combining abdominal lipectomy with intraabdominal procedures. This study confirms the high risk of pulmonary emboli in patients with combined abdominal lipectomy and intraabdominal gynecological procedures. The use of perioperative warfarin may reduce the incidence of pulmonary embolism in patients who have combined abdominal lipectomy and gynecological surgical procedures, and it is not associated with increased bleeding or other postoperative complications.

Adult↗
PubMed1988

Injury to the ureter during gynecologic surgical procedures.

This retrospective study examined ureteral injuries during gynecologic operations from January 1980 to August 1985. The study was conducted at two private hospitals that are involved in resident teaching programs. Each patient was reviewed for predisposing factors, location and type of injury and time and method of recognition. Sixteen injuries were documented in 1,093 extensive procedures. Twelve injuries occurred at the pelvic brim and four others occurred elsewhere in the pelvis. Risk factors included previous surgical procedures in the pelvis, endometriosis, ovarian neoplasm, pelvic adhesions, distorted anatomic features of the pelvis and repair of the bladder. The anatomic structure of the ureter is reviewed, and recommendations are made to help prevent ureteral injury during surgical procedures in the pelvis.

Adult↗
PubMed2005

Panniculectomy in gynecologic cancer surgical procedures by using a harmonic scalpel.

OBJECTIVE: To demonstrate that panniculectomy in obese gynecologic oncology patients undergoing surgical gynecologic procedures reduces operative time, gives better surgical exposure and does not increase the number of operative complications. METHODS: A retrospective review of 90 patients who had panniculectomy at the time of gynecologic surgery between 1992 and June 2003. Analyzed data included indication for surgery, patient's weight, operative times, blood loss and complications. RESULTS: Panniculectomy was performed in 20 patients operated because of uterine cervix cancer and 70 because of uterine body cancer. The mean age was 57.3 years, weight 126.7 kg and body mass index (BMI) 47 kg/m(2). The following procedures were performed: radical hysterectomy by the Wertheim-Meigs method (22 cases), total hysterectomy (68 cases) with bilateral salpingoophorectomy, pelvic lymphadenectomy and also periaortal lymphadenectomy (four cases). The mean operative time was 169 min, including from 20 to 25 min opening and closing time, and blood transfusion was undertaken in 15.6% of patients. The average weight of removed panniculus was 4900 g. In 82.2% of patients there were no wound complications, in 17.8% the healing was delayed. Daily drains secretion was 65.3 mL (range 0-300 mL). One patient died because of pulmonary embolism, and another because of myocardial infarction. There were no cases of damage to the urinary tract, intestines or large vessels. During the histopathological examination metastatic carcinoma in lymph nodes was found in 29.3% of the cases. CONCLUSIONS: Massively obese women can safely undergo gynecologic oncological surgery with simultaneous panniculectomy. Panniculectomy improves surgical access and facilitates radical surgery.

Abdomen↗
PubMed2003

Pre-emptive analgesia in gynecologic surgical procedures: preoperative wound infiltration with ropivacaine in patients who undergo laparotomy through a midline vertical incision.

OBJECTIVE: We tested the hypothesis that local anesthetic that is injected before a vertical midline abdominal incision would decrease the use of postoperative opioids. STUDY DESIGN: Patients who would undergo abdominal surgical procedures with general anesthesia by a planned vertical midline incision were enrolled in the study. Patients were assigned randomly to receive either 0.5% ropivacaine or normal saline solution placebo that was injected in the subcuticular tissue and fascia before the incision of each. All patients received morphine after the operation with a patient-controlled analgesia device. Morphine consumption was measured during the postoperative period at intervals of 0 to 6 hours, 6 to 12 hours, 12 to 24 hours, and 24 to 48 hours. Postoperative pain was assessed at 6, 12, 24, and 48 hours after the conclusion of the procedure with a visual analog scale. RESULTS: Eighty-four patients were enrolled in the study; 16 patients were excluded; therefore, 68 patients had useable data. The two treatment groups did not differ in age, height, weight, the length of the operation, the length of the incision, the position of the incision, the placement of drains, or the procedure that was performed. There was no significant difference in morphine consumption for any of the four intervals. The visual analog scale was not significantly different between the two groups at 6, 12, or 24 hours after operation. The visual analog scale at 48 hours was lower in the group that received ropivacaine (2.69 vs 4.26, P =.02). Data were analyzed by the Student t test. CONCLUSION: Pre-emptive analgesia with 0.5% ropivacaine given before skin incision does not decrease the postoperative analgesic use in patients who undergo laparotomy by a midline vertical skin incision.

Amides↗
PubMed1986

Abdominoplasty combined with gynecologic surgical procedures.

Cosmetic surgery of the abdomen is requested frequently by patients and is being performed increasingly at the time of elective gynecologic surgery. However, little information is available regarding the safety of combining these procedures. In this study intraoperative and postoperative morbidity was compared in the following groups of patients: 1) abdominoplasty plus one of five common gynecologic procedures (N = 76); 2) one of the five gynecologic procedures alone, matched for age, weight, and time of operation (N = 76); and 3) abdominoplasty alone (N = 70). Patients in group 1 experienced significantly longer operative time, longer hospital stays, and greater blood loss, which required more transfusions than group 2 or 3. These problems were accentuated in patients who weighed more than 70 kg or were older than age 35. In addition, five patients (6.6%) in group 1 had a documented pulmonary embolus within 18 days of surgery, whereas no pulmonary emboli occurred in group 2 or 3. Because of the increased morbidity, careful patient selection is necessary when abdominoplasty and gynecologic procedures are performed at the same time.

Abdomen↗
PubMed1997

Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures--New York City, March 1993-June 1994.

Infections with bloodborne pathogens resulting from exposures to blood through percutaneous injuries (PIs) (e.g., needlestick injuries and cuts with sharp objects) are an occupational hazard for health-care workers (HCWs). PIs have been reported during 1% - 15% of surgical procedures, mostly associated with suturing. Most suturing is done using curved suture needles, although straight needles are used by some surgeons for suturing skin. Blunt suture needles (curved suture needles that have a relatively blunt tip) may be less likely to cause PIs because they do not easily penetrate skin. Based on small studies and anecdotal experience, blunt suture needles appear able to replace conventional curved suture needles for suturing many tissues, although they may require more pressure to penetrate the tissues. This report summarizes results of a study in which CDC collaborated with three teaching hospitals in New York City during 1993-1994 to evaluate a safety device (a blunt suture needle) in gynecologic surgery. The findings indicate that use of blunt needles was associated with statistically significant reductions in PI rates, minimal clinically apparent adverse effects on patient care, and general acceptance by gynecologic surgeons in these hospitals.

Accidents, Occupational↗