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Objective: We investigated the effectiveness of switching cefazolin (CEZ) to cefmetazole (CMZ) for preoperative antimicrobial prophylaxis and the role of preoperative vaginal preparation using normal saline to reduce vaginal cuff infectious morbidity after total laparoscopic hysterectomy (TLH).Methods: We retrospectively investigated 1476 patients who underwent TLH at our hospital between April 2010 and December 2020. The vaginal cuff infectious morbidity and the causative bacteria were analyzed. The CEZ group included 1095 women who received a preoperative intravenous drip injection of CEZ, the CMZ group included 221 women who received a preoperative intravenous drip injection of CMZ, and the vaginal cleaning group included 160 women who received a preoperative intravenous drip injection of CMZ and additionally underwent preoperative vaginal preparation using normal saline. We analyzed post-TLH data to determine the causative bacteria associated with vaginal cuff infection.Results: Postoperative vaginal cuff infection occurred in 2.38%, 2.26%, and 1.25% of women in the CEZ, CMZ, and the vaginal cleaning groups, respectively. Intergroup comparison did not show a significant difference in vaginal cuff infectious morbidity. The causative bacteria associated with post-TLH vaginal cuff infection predominantly belonged to the Enterococcus species (10/38 cases).
Conclusion:Our study showed no significant intergroup difference in vaginal cuff infectious morbidity; however, further studies are warranted to conclusively establish the effectiveness of preoperative vaginal preparation using normal saline.
A 74-year-old woman with BMI of 40.4 visited our hospital with a complaint of vaginal bleeding. Histological examination of the endometrium revealed a grade 1 endometrial carcinoma. Pelvic contrast-enhanced MRI and contrastenhanced CT showed no obvious myometrial invasion and three cm umbilical hernia, respectively. The preoperative diagnosis was endometrial cancer, stage IA equivalent. A four cm longitudinal incision was made in the right lower abdomen and the intraperitoneal area was observed using laparoscopy. The umbilical hernia was firmly adhered to the hernial orifice and comprised only the great omentum. A five mm camera port was then placed five cm to the right of the umbilicus under laparoscopic observation, and two additional ports were placed in the mid and left lower abdomen in a typical diamond configuration. Although it was difficult to obtain a regular view with a direct laparoscope due to interference between forceps, a total laparoscopic hysterectomy with bilateral adnexectomy was completed using to a flexible laparoscope. She was discharged on the fourth postoperative day. The FIGO stage for the endometrial cancer was stage IA, pT1aNxM0, endometrial carcinoma grade one. No postoperative therapy was administered as risk for recurrence was low. There was no evidence of tumor recurrence 14 months post-surgery. In cases of laparoscopic operation complicated by umbilical hernia, the usual umbilical approach is complicated. However, by placing the camera port on the right side of the umbilicus and using a flexible laparoscopy, it may be possible to perform a laparoscopic surgery, which was equally effective.
A degenerated leiomyoma rarely ruptures during pregnancy. As the rupture of a degenerated leiomyoma can cause panperitonitis due to the leakage of fluid content into the peritoneal cavity, prompt diagnosis and surgical intervention are required.
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