Study objective To assess the safety and patient satisfaction of laparoscopic subtotal hysterectomy (LSH) using a standardised surgical technique.Design Prospective observational study.Setting Princess Royal University Hospital, Chelsfield Park Hospital and Sloane Hospital, Kent, UK.Patients and materials Four hundred consecutive women with menorrhagia underwent LSH. The procedure was performed using the Plasma Kinetic Bipolar Diathermy (Gyrus International Ltd, Berkshire, UK) for pedicle ligation and the Lap Loop system (Roberts Surgical Healthcare Ltd, Kidderminster, UK) to detach the cervix. An electromechanical morcellator (Morcellex; Ethicon Women's Health and Urology, Cincinnati, OH, USA) was used to remove the uterus from the abdominal cavity.Main outcome measures Patient satisfaction, morbidity rates and readmission rates.Results A total of 400 LSH were performed between February 2003 and November 2006. The principal clinical indication for hysterectomy was menorrhagia. The mean duration of surgery was 46.4 minutes. The mean operative blood loss was 126 ml. Concurrent surgery was performed in 141 women. Minor and major perioperative complications were encountered in 5% (n = 20) of women. The major complication rate was 1.2% (n = 5): three women (0.75%) with bladder perforation, two women (0.5%) with bowel injury and one woman (0.25%) with a vesicocervical fistula. Eight women (2%) suffered from cyclical vaginal bleeding postoperatively.Conclusions LSH is a safe and effective treatment for menorrhagia and other menstrual disorders when hysterectomy is indicated. Women appreciate the quick recovery period, reduced time off work and faster return to normal activity. Our data suggest that LSH can replace abdominal hysterectomy in selected cases.
Objective To report the case histories of two patients who presented with haematometra and haematosalpinx 18 and 24 months after endometrial ablation.
Design This is a retrospective case note analysis.
Subjects A 51‐year‐old woman, who had undergone endometrial ablation 18 months previously, presented with acute abdominal pain. She was known to be taking continuous combined hormone replacement therapy. Pelvic ultrasound scan showed a large cystic mass, and diagnostic laparoscopy revealed a right haematosalpinx. She underwent right salpingectomy and was pain‐free after the operation. A 48‐year‐old woman presented with lower abdominal pain 2 years after endometrial balloon ablation. The ultrasound scan of the pelvis showed a haematometra (4.4 × 2.6 × 3.3 cm). She underwent examination under anaesthesia (EUA), dilation and drainage of the haematometra. A few weeks later she had a recurrence and underwent hysterectomy.
Conclusion As more ablation procedures are performed, more delayed complications will arise.
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