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Surgical morbidity of hysterectomy for benign gynecologic disease
Surgical Morbidity of Hysterectomy for Benign Gynecologic Disease Thomas F. Baskett, MB, FRCS Dalhousie University, Halifax, Nova Scotia Objective: To assess the surgical morbidity associated with abdominal and vaginal hysterectomy for benign gynecologic disease. Methods: Over a 5-year period in one gynecology unit with 10 surgeons, perioperative complications associated with abdominal and vaginal hysterectomy for benign gynecologic disease were reviewed. Surgical morbidity included inadvertent cystotomy, ureteric trauma, vesicovaginal fistula, bowel trauma, hemorrhage 3 OR, blood transfusion, hematoma, and reoperation. Associated surgical morbidity included infection, bowel ileus/obstruction, thromboembolism, readmission, and admission to the ICU. Results: For the 5 years (1992–1996), there were 2,088 hysterectomies: 1,244 (60%) abdominal and 844 (40%) vaginal.
Morbidity (%) Surgical
Associated
Total
6.2 3.2
4.0 0.9
10.2 4.1
Abdominal Vaginal
Conclusions: The overall morbidity associated with hysterectomy for benign disease is low. These figures have been further refined to delineate the complications of additional operative procedures performed at the time of hysterectomy. Overall, additional procedures increased morbidity by 20% in association with abdominal hysterectomy and by 46% with vaginal hysterectomy. In addition, a profile can be provided for each surgeon.
Effects of Miphil, A New Polycarbophil Vaginal Gel, in Suspected Bacterial Vaginosis: A Randomized Study Versus Vaginal Douche Massimo Milani, MD “Borella” Hospital, Milan, Italy
Bruno Molteni, MD Background: Vaginal pH is an important factor in maintaining a normal vaginal flora. Miphil (Mi) (Mipharm, Italy) is a new polycarbophil-based vaginal gel with high bioadhesivity and a long-lasting (⬎72 h) pH-lowering effect. 58S Tuesday Posters
Objective: To evaluate the effects on vaginal pH and odor of Mi in comparison with a vaginal douche (Lactacid) (L) in suspected bacterial vaginosis. Patients and methods: Thirty women (mean age 38 ⫾ 8 years) (15 per arm) with a vaginal pH ⬎4.5 plus vaginal discharge or a positive whiff test (WT) or presence of clue cells (CC) were enrolled in a randomized, 6-week trial comparison with L. Mi (2 g) or L were applied twice weekly. Vaginal pH was measured by means of a pH meter (Krison PAKOI) at baseline, at week 3, and at week 6. Results: In comparison with baseline, Mi reduced (P ⬍0.001) vaginal pH, from 5.4 ⫾ 0.4 to 4.7 ⫾ 0.6 at week 3 and to 4.6 ⫾ 0.6 at the end of the study. At week 6, vaginal pH in the Mi group was significantly lower (P ⬍0.005; T-test) in comparison with the L group (4.6 versus 5.3). Seven of 15 patients in the Mi group and 4 of 15 in the L group had a positive WT and CC at baseline. In all seven patients in the Mi group, the WT was negative both at week 3 and at week 6. In the L group, only one patient had a negative WT at the end of the study. In the Mi group, CC were observed in seven patients at baseline and in only one patient at week 6. No patients in the L group with CC at baseline (4) were negative at week 6. Conclusions: In suspected bacterial vaginosis, Mi significantly improves, in comparison with acidic vaginal douche, vaginal pH, and both physical and microbiologic signs linked to this clinical condition.
Intrainvestigator Comparison of Efficacy of Endometrial Ablation by Two Different Methods Martin Weisberg, MD Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA Objective: To compare results of endometrial ablation by rollerball and hydrothermablation among nine clinical sites to determine whether the efficacy of either technique varied from site to site and therefore from surgeon to surgeon. Methods: A blind, retrospective comparison of 276 patients, ages 30 –50 years, who underwent endometrial ablation in nine sites with either rollerball or hydrothermablation. Results were based on the analysis of 6 months of Janssen menstrual diaries completed by the subjects. Comparison of percent success (defined as eumenorrhea or better) to percent failure was calculated for each method and then compared among the nine sites. Results: The success rate of rollerball endometrial ablation appeared to vary from site to site more than the success rate of hydrothermablation, which was more consistent from site to site. Conclusions: The success of endometrial ablation by rollerball varied among surgeons, whereas the success of hydrothermablation was more consistent and therefore likely less dependent on the technique or experience of the surgeon. Obstetrics & Gynecology
Morbidity (%) Surgical
Associated
Total
6.2 3.2
4.0 0.9
10.2 4.1
Abdominal Vaginal
Conclusions: The overall morbidity associated with hysterectomy for benign disease is low. These figures have been further refined to delineate the complications of additional operative procedures performed at the time of hysterectomy. Overall, additional procedures increased morbidity by 20% in association with abdominal hysterectomy and by 46% with vaginal hysterectomy. In addition, a profile can be provided for each surgeon.
Effects of Miphil, A New Polycarbophil Vaginal Gel, in Suspected Bacterial Vaginosis: A Randomized Study Versus Vaginal Douche Massimo Milani, MD “Borella” Hospital, Milan, Italy
Bruno Molteni, MD Background: Vaginal pH is an important factor in maintaining a normal vaginal flora. Miphil (Mi) (Mipharm, Italy) is a new polycarbophil-based vaginal gel with high bioadhesivity and a long-lasting (⬎72 h) pH-lowering effect. 58S Tuesday Posters
Objective: To evaluate the effects on vaginal pH and odor of Mi in comparison with a vaginal douche (Lactacid) (L) in suspected bacterial vaginosis. Patients and methods: Thirty women (mean age 38 ⫾ 8 years) (15 per arm) with a vaginal pH ⬎4.5 plus vaginal discharge or a positive whiff test (WT) or presence of clue cells (CC) were enrolled in a randomized, 6-week trial comparison with L. Mi (2 g) or L were applied twice weekly. Vaginal pH was measured by means of a pH meter (Krison PAKOI) at baseline, at week 3, and at week 6. Results: In comparison with baseline, Mi reduced (P ⬍0.001) vaginal pH, from 5.4 ⫾ 0.4 to 4.7 ⫾ 0.6 at week 3 and to 4.6 ⫾ 0.6 at the end of the study. At week 6, vaginal pH in the Mi group was significantly lower (P ⬍0.005; T-test) in comparison with the L group (4.6 versus 5.3). Seven of 15 patients in the Mi group and 4 of 15 in the L group had a positive WT and CC at baseline. In all seven patients in the Mi group, the WT was negative both at week 3 and at week 6. In the L group, only one patient had a negative WT at the end of the study. In the Mi group, CC were observed in seven patients at baseline and in only one patient at week 6. No patients in the L group with CC at baseline (4) were negative at week 6. Conclusions: In suspected bacterial vaginosis, Mi significantly improves, in comparison with acidic vaginal douche, vaginal pH, and both physical and microbiologic signs linked to this clinical condition.
Intrainvestigator Comparison of Efficacy of Endometrial Ablation by Two Different Methods Martin Weisberg, MD Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA Objective: To compare results of endometrial ablation by rollerball and hydrothermablation among nine clinical sites to determine whether the efficacy of either technique varied from site to site and therefore from surgeon to surgeon. Methods: A blind, retrospective comparison of 276 patients, ages 30 –50 years, who underwent endometrial ablation in nine sites with either rollerball or hydrothermablation. Results were based on the analysis of 6 months of Janssen menstrual diaries completed by the subjects. Comparison of percent success (defined as eumenorrhea or better) to percent failure was calculated for each method and then compared among the nine sites. Results: The success rate of rollerball endometrial ablation appeared to vary from site to site more than the success rate of hydrothermablation, which was more consistent from site to site. Conclusions: The success of endometrial ablation by rollerball varied among surgeons, whereas the success of hydrothermablation was more consistent and therefore likely less dependent on the technique or experience of the surgeon. Obstetrics & Gynecology