Maq -final-1
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AQUA DISSECTION IN NON-DESCENT VAGINAL HYSTERECTOMY (100 CASES) - AN OBSERVATION OF FENI PVT. HOSPITAL, BANGLADESH.
Dr. Mohammad Abdul Quayyum consultant (OBS & GYN) Feni pvt. Hospital. Bangladesh.
AIMS & OBJECTIVES To study the outcome of performing the aqua dissection in case of nondescent vaginal hysterectomy.
Introduction Hysterectomy is the major gynecological operation. The best route for hysterectomy in case of nondescent uterus is the vaginal route. Minimizing blood loss during vaginal hysterectomy is important because of the associated morbidity.
Introduction - cont The aqua dissection with or without adrenaline is the best technique in NDVH that minimized bleeding,operative time and morbidity.
Material and Methods It was a retrospective study conducted at the Feni pvt. Hospital in Bangladesh. One hundred patients of non- descent uterus requiring hysterectomy were included in this study. The patients were selected on the basis of questioner, clinical examination & counseling. The preference of anesthesia was determined by anesthesiologist .
Material & Methods (contd.) Inclusion Criteria: Patients with non-descent uterus with - Chronic PID - DUB - Adenomyosis. - Fibroid- up to 20wks GA.
Material & Methods (contd.) Exclusion Criteria: - Malignancy of uterus & cx. - Suspected dense adhesion in the pelvis. - Complex adnexal mass including endometriosis. - Android pelvis.
Material & Methods (contd.) Operative technique.
Instruments trolly
Material & Methods (contd.) Operative technique.
150 – 200 ml normal saline with or without adrenaline was injected in the loose vaginal submucosa,1-2 cm away the os.both anteriorly & lateraraly but not posteriorly and operative field becomes pale.
Material & Methods (contd.) Operative technique.
A transverse incision given below the bladder ridge & the area easily separable during dissection
Material & Methods (contd.) Data regarding age, parity, uterine size, perioperative blood loss ,duration of operation, operative & post operative complication and hospital stay were analyzed & evaluated. All patients received a course of broad spectrum antibiotics for 7days.
RESULTS TABLE-1 PATIENTS CHARACTERISTIC
PARAMETER
MEAN +/- SD
AGE
35.2 +/- 5.2 YERS
PARITY
4.17 +/- 1.5
TABLE II INDICATION OF OPRATION INDICATION
NUMBER PERCENTAGE (N=100)
CHRONIC PID
53
53
DUB
20
20
FIBROID
13
13
ADENOMYOSIS
7
7
ADNEXAL MASS
5
5
CX. POLYP
2
2
TABLE III UTERINE SIZE SIZE OF UTERUS NUMBER (WKS) (N=100)
PERCENTAGE
6 GA
9
9
8 GA
31
31
10 GA
34
34
12 GA
12
12
14 GA
5
5
16 GA
5
5
18 GA
2
2
20 GA
2
2
TABLE IV TYPES OF ANESTHESIA ANESTHESIA
Number (N=100)
Percentage %
G/A
17
17
SPINAL
83
83
TABLE IV TYPES OF OPRATION NAME OF OPRATION NUMBER PERCENTAGE (N=100) HYSTERECTOMY
84
84
HYSTERECTOMY WITH UNIL. SO
11
11
HYSTERECTOMY WITH BILAT. SO
5
5
TABLE IV SURGICAL RESULT PARAMETARS EASY DISSECTION
91 %
DIFFICULT DISSECTION
8%
MEAN DURATION OF OPN (min)
35.5 +/- 15.3
MEAN BLOOD LOSS (ml)
166 +/- 55
MEAN HOSPITAL STAY (day)
3.1 +/- 1.1
CONVERSION IN TO LAPROTOMY DIGNOSTIC & OPERATIVE LAP.
0 6%
TABLE IV SURGICAL COMPLICATION COMPLICATION
NUMBER (N=100)
PERCENTAGE
INT.OP.HAEMORRHAGE
1
1
BLADDER INJURY
2
2
URETER INJURY
0
0
BOWEL INJURY
0
0
POST.OP.HAEMORRHAGE
1
1
VAULT HEAMOTOMA
4
4
UNEXPLINE FEVER
6
6
VAULT ABSSES
1
1
VAGINAL DISCHARGE
7
7
TABLE V CONCOMITANT SURGICAL OPERATION NAME OF OPN.
NUMBER PERCENTAGE
ANT.-POST.COLPO.
6
6
POST.COLPO.
5
5
TVT
5
5
Discussion Main problems in NDVH : Inadequate vaginal access . Enlarged uterus. Inadequate access to overies.
Discussion (contd.) The aim of this study was determined the outcome of acceptability of aqua dissection in NDVH. Normal saline with or without adrenalin compress the minute vessels and making the operative field blood less. & easily separable. That is why the ultra modern concept of aqua dissection in NDVH is better than conventional technique.
COMPRISONS
ABDOMINAL HYSTERECTOMY
AQUA DISSECTION NDVH
With stitch
stitch less
SCAR ON ABDOMEN
4 to 6 inch scar
No scar
DURATION OF OPN.
90-150 minutes
25 - 45 minutes
ANAESTHASIA
Long duration
Short duration
BLOOD LOSS
Moderate to heavy
Very minimum
TRANSFUSION
Required
Rarely required
POST OPN. PAIN
Yes
Very minimum
HOSPITAL STAY
7 Days
24 to 72 hours
REST
45 Days
7 days
Discussion (contd.) There are many studies with using vasopressin in the NDVH operation but it associate with infection and potential adverse cardiovascular effect. But aqua dissection in vaginal hysterectomyis associated with decreased blood loss, does not increase risk of infection, and decrease operative time.
Conclusions -Aqua dissection in NDVH is a simplication of vaginal hysterectomy . -This is a inovative technique that minimized the bleeding during operation -It is safe and economically acceptable for patient compliance
Dr. Mohammad Abdul Quayyum consultant (OBS & GYN) Feni pvt. Hospital. Bangladesh.
AIMS & OBJECTIVES To study the outcome of performing the aqua dissection in case of nondescent vaginal hysterectomy.
Introduction Hysterectomy is the major gynecological operation. The best route for hysterectomy in case of nondescent uterus is the vaginal route. Minimizing blood loss during vaginal hysterectomy is important because of the associated morbidity.
Introduction - cont The aqua dissection with or without adrenaline is the best technique in NDVH that minimized bleeding,operative time and morbidity.
Material and Methods It was a retrospective study conducted at the Feni pvt. Hospital in Bangladesh. One hundred patients of non- descent uterus requiring hysterectomy were included in this study. The patients were selected on the basis of questioner, clinical examination & counseling. The preference of anesthesia was determined by anesthesiologist .
Material & Methods (contd.) Inclusion Criteria: Patients with non-descent uterus with - Chronic PID - DUB - Adenomyosis. - Fibroid- up to 20wks GA.
Material & Methods (contd.) Exclusion Criteria: - Malignancy of uterus & cx. - Suspected dense adhesion in the pelvis. - Complex adnexal mass including endometriosis. - Android pelvis.
Material & Methods (contd.) Operative technique.
Instruments trolly
Material & Methods (contd.) Operative technique.
150 – 200 ml normal saline with or without adrenaline was injected in the loose vaginal submucosa,1-2 cm away the os.both anteriorly & lateraraly but not posteriorly and operative field becomes pale.
Material & Methods (contd.) Operative technique.
A transverse incision given below the bladder ridge & the area easily separable during dissection
Material & Methods (contd.) Data regarding age, parity, uterine size, perioperative blood loss ,duration of operation, operative & post operative complication and hospital stay were analyzed & evaluated. All patients received a course of broad spectrum antibiotics for 7days.
RESULTS TABLE-1 PATIENTS CHARACTERISTIC
PARAMETER
MEAN +/- SD
AGE
35.2 +/- 5.2 YERS
PARITY
4.17 +/- 1.5
TABLE II INDICATION OF OPRATION INDICATION
NUMBER PERCENTAGE (N=100)
CHRONIC PID
53
53
DUB
20
20
FIBROID
13
13
ADENOMYOSIS
7
7
ADNEXAL MASS
5
5
CX. POLYP
2
2
TABLE III UTERINE SIZE SIZE OF UTERUS NUMBER (WKS) (N=100)
PERCENTAGE
6 GA
9
9
8 GA
31
31
10 GA
34
34
12 GA
12
12
14 GA
5
5
16 GA
5
5
18 GA
2
2
20 GA
2
2
TABLE IV TYPES OF ANESTHESIA ANESTHESIA
Number (N=100)
Percentage %
G/A
17
17
SPINAL
83
83
TABLE IV TYPES OF OPRATION NAME OF OPRATION NUMBER PERCENTAGE (N=100) HYSTERECTOMY
84
84
HYSTERECTOMY WITH UNIL. SO
11
11
HYSTERECTOMY WITH BILAT. SO
5
5
TABLE IV SURGICAL RESULT PARAMETARS EASY DISSECTION
91 %
DIFFICULT DISSECTION
8%
MEAN DURATION OF OPN (min)
35.5 +/- 15.3
MEAN BLOOD LOSS (ml)
166 +/- 55
MEAN HOSPITAL STAY (day)
3.1 +/- 1.1
CONVERSION IN TO LAPROTOMY DIGNOSTIC & OPERATIVE LAP.
0 6%
TABLE IV SURGICAL COMPLICATION COMPLICATION
NUMBER (N=100)
PERCENTAGE
INT.OP.HAEMORRHAGE
1
1
BLADDER INJURY
2
2
URETER INJURY
0
0
BOWEL INJURY
0
0
POST.OP.HAEMORRHAGE
1
1
VAULT HEAMOTOMA
4
4
UNEXPLINE FEVER
6
6
VAULT ABSSES
1
1
VAGINAL DISCHARGE
7
7
TABLE V CONCOMITANT SURGICAL OPERATION NAME OF OPN.
NUMBER PERCENTAGE
ANT.-POST.COLPO.
6
6
POST.COLPO.
5
5
TVT
5
5
Discussion Main problems in NDVH : Inadequate vaginal access . Enlarged uterus. Inadequate access to overies.
Discussion (contd.) The aim of this study was determined the outcome of acceptability of aqua dissection in NDVH. Normal saline with or without adrenalin compress the minute vessels and making the operative field blood less. & easily separable. That is why the ultra modern concept of aqua dissection in NDVH is better than conventional technique.
COMPRISONS
ABDOMINAL HYSTERECTOMY
AQUA DISSECTION NDVH
With stitch
stitch less
SCAR ON ABDOMEN
4 to 6 inch scar
No scar
DURATION OF OPN.
90-150 minutes
25 - 45 minutes
ANAESTHASIA
Long duration
Short duration
BLOOD LOSS
Moderate to heavy
Very minimum
TRANSFUSION
Required
Rarely required
POST OPN. PAIN
Yes
Very minimum
HOSPITAL STAY
7 Days
24 to 72 hours
REST
45 Days
7 days
Discussion (contd.) There are many studies with using vasopressin in the NDVH operation but it associate with infection and potential adverse cardiovascular effect. But aqua dissection in vaginal hysterectomyis associated with decreased blood loss, does not increase risk of infection, and decrease operative time.
Conclusions -Aqua dissection in NDVH is a simplication of vaginal hysterectomy . -This is a inovative technique that minimized the bleeding during operation -It is safe and economically acceptable for patient compliance
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