Efficacy of Laparoscopic Subtotal Hysterectomy in the Management of Menorrhagia: 400 Consecutive Cases

Erian, J.; Hassan, Marwa A.; Pachydakis, Anastasios; Chandakas, S.; Wissa, I; Hill, N. C. W.

doi:10.1097/ogx.0b013e31818091b8

Cited by 10 publications

(23 citation statements)

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“…Similar to ''open'' hysterectomy, some authorities advocate for LSH and have justified this assertion with the argument that LSH is easier and faster, and associated with less blood loss, and fewer complications compared with TLH and LAVH [6][7][8]. However, these putative benefits remain unsubstantiated, and most of the recent studies compared some or all of laparoscopic approaches with the different approaches performed abdominally.…”

Section: Introductionmentioning

confidence: 90%

Comparative analysis of different laparoscopic hysterectomy procedures

Hobson

Imudia

Al-Safi

et al. 2011

Arch Gynecol Obstet

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Section: Introductionmentioning

confidence: 90%

Comparative analysis of different laparoscopic hysterectomy procedures

Hobson

Imudia

Al-Safi

et al. 2011

Arch Gynecol Obstet

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“…10 Dosing in each cohort occurred sequentially. Dose escalation proceeded once preliminary safety/tolerability (days [1][2][3][4][5][6][7][8][9][10][11][12][13][14] and PK data (days 1 and 7) had been reviewed for all subjects at the previous dose. Blood samples for safety and PK analysis were collected on days 1, 7, and 14 of the 14-day in-house treatment period.…”

Section: Multiple-day Dosing Studymentioning

confidence: 99%

“…The prevalence of adenomyosis in women undergoing hysterectomy for menorrhagia or dysmenorrhea has been reported to range from 20% to 50%. 2,7 No drug is approved for the treatment of adenomyosis. Physicians typically prescribe antiprostaglandins (nonsteroidal anti-inflammatory agents), narcotics, tranexamic acid, oral contraceptives, danazol, aromatase inhibitors, gonadotropin-releasing hormone analogues, or a levonorgestrel-releasing intrauterine device system to treat symptoms.…”

mentioning

confidence: 99%

Single‐ and Multiple‐Day Dosing Studies to Investigate High‐Dose Pharmacokinetics of Epelsiban and Its Metabolite, GSK2395448, in Healthy Female Volunteers

Mahar

Enslin

Gress

et al. 2017

Clinical Pharm in Drug Dev

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Open-label single-and double-blind repeat-dose studies in healthy female volunteers were conducted to investigate the pharmacokinetics (PK) and safety/tolerability of epelsiban total daily doses ranging from 600 to 900 mg. In 1 study (n = 12), epelsiban was dosed at 300 or 450 mg twice daily (every 12 hours) for a single day. In the repeat-dose doubleblind study, epelsiban and placebo were administered to 31 subjects as 200 mg 3 times daily, 300 mg 3 times daily (TID), or 450 mg twice daily (BID) for 14 days. After both single and 14 daily repeat doses, the PK profiles for epelsiban and its metabolite, GSK2395448, remained linear at all administered doses. The exposures at a given total daily dose were also similar between BID and TID dosing regimens. Exposure (AUC 0-τ ), based on dosing intervals, for both epelsiban and GSK2395448 was similar. However, compared with morning dosing, C max was lower after evening dosing, possibly because of a food effect. The highest accumulation of epelsiban and GSK2395448 exposures (AUC 0-τ ) was approximately 34% for each after repeat dosing, consistent with the short half-life. At total daily doses of 600 and 900 mg, epelsiban was generally well tolerated, and there were no significant safety concerns identified.

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“…Sir, I read with interest the article by Erian et al 1 on laparoscopic subtotal hysterectomy for menorrhagia.…”

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confidence: 99%

Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases

Ismail

2008

BJOG

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Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases Sir, I read with interest the article by Erian et al. 1 on laparoscopic subtotal hysterectomy for menorrhagia.There are methodological issues. While the title revolves around efficacy in dealing with menorrhagia, the abstract concentrates on safety and patient satisfaction. Similarly, the article begins by defining the primary outcome measure as patient satisfaction although there is no mention of this in the method. There is no power calculation. Four hundred might sound large enough, but with certain rare complications of subtotal hysterectomy, this might not be enough. Menorrhagia not responding to medical treatment is the same as dysfunctional uterine bleeding not responding to hormonal treatment. It is notable that pain, rather than menorrhagia, was the indication in some women. Operating time should be from induction of anaesthesia, rather than pneumoperitoneum. An early follow up or a recovery diary would have been more accurate in assessing postoperative pain and return to work.The presentation of the results needs attention. Numerical data are described using both parametric and nonparametric tests and some numbers are given without percentage. All the private cases stayed overnight and all those from the NHS went home the same day. If the technique was so comfortable, then one would have expected most private patients to go home the same day. At the end of the day, any cost saving should apply to private patients, either insured or selfpaying. Preoperative transfusion is not a complication of the operation and should not have been included in that category. Performing a large loop excision of the transformation zone (LLETZ) at the same time is interesting as the patient could have had a total hysterectomy. No information was given as to why was the LLETZ performed nor what was the histological diagnosis. The talk about future data collection should not be in the results section. The possibility of abdominal leiomyomatosis following morcellation of fibroids needs to be addressed.It is important to put the findings in perspective. Information as to the numbers of total hysterectomy (vaginal, laparoscopic and abdominal) as well as the number of mirena insertions and ablations carried out at the same time interval at the hospital would have given an indication to the proportion of cases that can benefit from the technique. This is particularly important, given the high number of women having subtotal hysterectomy included in the study. A comparison of complications would have helped even more. Certainly, the relative value of this technique would have been better demonstrated through a randomised controlled trial against another technique of laparoscopic subtotal hysterectomy. Likewise, an idea about how many women declined the technique would help appreciating patient acceptability.There is no reference to back the estimated number of hysterectomies carried out in the UK or the claim that laparoscopic su...

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Efficacy of Laparoscopic Subtotal Hysterectomy in the Management of Menorrhagia: 400 Consecutive Cases

Cited by 10 publications

References 0 publications

Comparative analysis of different laparoscopic hysterectomy procedures

Comparative analysis of different laparoscopic hysterectomy procedures

Single‐ and Multiple‐Day Dosing Studies to Investigate High‐Dose Pharmacokinetics of Epelsiban and Its Metabolite, GSK2395448, in Healthy Female Volunteers

Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases

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