Feasibility and Outcomes of Opportunistic Bilateral Salpingectomy in Patients with Traditional Relative Contraindications to Vaginal Hysterectomy
Publication date: Available online 5 December 2019Source: Journal of Minimally Invasive GynecologyAuthor(s): Anna M. Chichura, Meng Yao, Carol Emi Bretschneider, Beri Ridgeway, Rosanne M KhoABSTRACTStudy ObjectiveTo compare the feasibility of opportunistic bilateral salpingectomy (OBS) at the time of vaginal hysterectomy (VH) for benign disease in patients with and without relative contraindications (RC) to the vaginal approach and to evaluate the factors that contribute to inability to perform OBS.DesignRetrospective chart reviewSettingTertiary medical centerPatientsWomen undergoing hysterectomy for benign indications between November 2014 and October 2017 that were consented for either “VH with or without removal of tube(s)" and/or “bilateral salpingectomy.”InterventionRC to the vaginal approach are defined as lack of prolapse (“cervix high, cervix not visualized, cervix tucked underneath pubis, minimal descent”), enlarged uterus (≥ 250 g or ≥ 12 week size uterus), nulliparity, obesity (BMI ≥ 30 kg/m2), prior cesarean section (CS), known adhesions, and known adnexal pathology.Measurements and Main resultsA total of 258 patients underwent VH and attempted OBS within the study period of whom 112 (43.4%) had no RC and 146 (56.6%) had one or more RC. Overall, successful salpingectomy was performed in 86.8% of patients. There was no significant difference in the rate of success in patients without or with one or more RC (84.9% vs 89%, ...
ConclusionNOTES allows the surgeon to survey the pelvis for pathology and to complete other pelvic procedures transvaginally during TVH with no additional abdominal incisions. Transvaginal NOTES can be considered a “rescue” approach and can be a helpful tool for the pelvic surgeon.
Surgical infection less likely if obese women take prophylactic antibiotics for 48h after C-section Related items fromOnMedica Infection risk after caesarean 2.4 times higher in obese women Caesareans associated with increased risk of complications from hysterectomy Antibiotics during pregnancy increases risk of childhood obesity Wide European variations in C-section rates Antibiotics for women in early labour to combat Group B Strep
Conclusions VH is a surgical option for patients with the conditions perceived as contraindications for vaginal surgery evaluated herein.
Conclusion The application of these recommendations should minimize risks associated with hysterectomy.
CONCLUSION: The application of these recommendations should minimize risks associated with hysterectomy. PMID: 26530174 [PubMed - as supplied by publisher]
September’s Man of the Month is Dr. Neel Shah. Dr. Shah gave us permission to crosspost his article below which was first published in June on The Conversation. Dr. Shah was also recently featured in this Boston Globe article. In the article below he makes the argument that giving birth outside a hospital with a midwife could be safer and cheaper for many American women. Are hospitals the safest place for healthy women to have babies? An obstetrician thinks twice There is a good chance that your grandparents were born at home. I am going to go ahead and assume they turned out fine, or at least fine enough, sinc...
ConclusionThe studied obstetric complications are rare. Uniform definitions and valid reporting are essential for international comparisons. The main risk factors include previous cesarean section. The detailed information collected in the NOSS database provides a basis for epidemiologic studies, audits, and educational activities.
ConclusionThe studied obstetric complications are rare. Uniform definitions and valid reporting is essential for international comparisons. The main risk factors include previous cesarean section. The detailed information collected in the NOSS database provides a basis for epidemiologic studies, audits and educational activities.This article is protected by copyright. All rights reserved.