Outcomes after Total versus Subtotal Abdominal Hysterectomy

Thakar, Ranee; Ayers, Susan; Clarkson, Patrick; Stanton, Stuart L.; Manyonda, Isaac

doi:10.1056/nejmoa013336

Cited by 386 publications

(344 citation statements)

References 36 publications

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“…La propuesta del establecimiento de una nueva técnica quirúrgica merece ser realizada, que independiente de la vía de acceso, desaparezca una de las complicaciones más importantes de la histerectomía, la cual es la IUE y con ello el ahorro de millones de dólares anualmente 30 .…”

Section: Análisis Y Discusiónunclassified

Eficacia de la histerectomía modificada en la prevención y tratamiento de la incontinencia urinaria de esfuerzo

Ángel¹,

Campo²

2016

rcslibre

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Como citar: Muñoz Ángel OR, Rendón Campo LF. Eficacia de la histerectomía modificada en la prevención y tratamiento de la incontinencia urinaria de esfuerzo. Rev Colomb Salud Libre, 2016; 11 (2): 127-134. ResumenIntroducción: la incontinencia urinaria de esfuerzo (IUE) es una complicación cada vez más frecuente luego de una histerectomía. Diferentes estudios reportan una incidencia entre el 30% y 70%. Se presenta por una alteración anatómica y funcional de las estructuras pélvicas y su dinámica luego del procedimiento quirúrgico tradicional. Una modificación de la técnica tradicional, desarrollada por el Dr. Muñoz, de histerectomía usada hasta el momento en la mayoría de los pacientes puede tratar IUE PREQUIRÚRGICA y evitar la incidencia postquirúrgica de esta complicación y mejorar la calidad de vida de las pacientes. Materiales y métodos: Se realizó un estudio longitudinal cuasi experimental tipo antes y después en 31 pacientes sometidas a histerectomía abdominal, con la nueva técnica, en el instituto de seguro social de Puerto Tejada (Cauca. Colombia). A cada paciente se le realizó un estudio ecográfico donde se realizaron mediciones de la longitud uretral (LA), la distancia entre el borde inferior de la sínfisis púbica y la distancia más cerca a la uretra (DU), la distancia entre borde inferior de la sínfisis púbica y el cuello vesical (DC) y el ángulo entre la línea horizontal y distancia sínfisis -cuello vesical. Todas las mediciones se realizaron antes y después del procedimiento. Resultados: Del total de pacientes evaluadas, 18 padecían incontinencia urinaria y afirmaron no padecerla posteriormente a la cirugía, el seguimiento a estas pacientes muestra los mismos resultados nueve años luego de la cirugía. Las mediciones ecográficas pre y pos quirúrgicas mostraron diferencias significativas con esta nueva técnica. A la fecha se han practicado cerca de 600 cirugías con la técnica modificada con éxito. Análisis y discusión: Una técnica quirúrgica que respete en lo posible las estructuras pélvicas y sus estructuras de soporte permiten tratar y evitar la aparición de la IUE y mejora sustancialmente la calidad de vida de las pacientes, permite ahorros en cuanto a re intervenciones y gastos millonarios en salud. AbstractIntroduction: Urinary stress incontinence (USI) is an frequent complication following a hysterectomy. Different studies report an incidence between 30% and 70%. USI presents by an anatomical and functional

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Section: Análisis Y Discusiónunclassified

Eficacia de la histerectomía modificada en la prevención y tratamiento de la incontinencia urinaria de esfuerzo

Ángel¹,

Campo²

2016

rcslibre

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“…The advantages of abdominal supracervical hysterectomy are questionable, as recent randomized trials have demonstrated no differences in sexual and urinary functions outcomes in women treated with the two procedures 86,87 (Class 1b). However, there may be less blood loss associated with supracervical hysterectomy 86 (Class 1b), a feature that may justify considering this approach in women with acute uterine bleeding. The various techniques are discussed in more detail in the SCPMG chronic abnormal uterine bleeding guidelines currently in preparation.…”

Section: Hysterectomymentioning

confidence: 99%

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

Munro

2013

TPJ

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Acute uterine bleeding unrelated to pregnancy has been defined as bleeding "sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention." The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women.

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“…Advocates of this procedure hypothesized that removing the entire cervix may diminish sexual response, urinary function and pelvic support, while increasing operative time and complications (1)(2)(3)(4)(5). Subsequent studies failed to find benefit from retention of the cervix at hysterectomy (6)(7)(8)(9). Moreover, persistent symptoms in some women, mainly pelvic pain and vaginal bleeding, force removal of the cervical stump (6,10,11).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for trachelectomy following supracervical hysterectomy

Tsafrir

Aoun

Papalekas

et al. 2017

Acta Obstet Gynecol Scand

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Introduction. We identified risk factors for trachelectomy after supracervical hysterectomy (SCH) due to persistence of symptoms. Material and methods. A retrospective case-control study in a university-affiliated hospital. Seventeen women who underwent a trachelectomy following SCH for nonmalignant indications between June 2002 and October 2014 were compared with 68 randomly selected women (controls) who underwent a SCH within the same time period. Demographics and clinical characteristics were compared between the study and control groups. Univariate analysis identified potential risk factors for trachelectomy following SCH. Univariate logistic regression models predicted which patients would have a trachelectomy following SCH. Results. The occurrence of trachelectomy following SCH during the study period was 0.9% (17/1892). The study group was younger than the control group (mean age 38 AE 6 years vs. 44 AE 5 years; p < 0.001). Patients who had a history of endometriosis [odds ratio (OR) 6.23, 95% CI 1.11-40.5, p = 0.038] had increased risk for trachelectomy. Pathology diagnosed endometriosis only among women in the study group. Preoperative diagnosis of abnormal uterine bleeding (OR 0.22, 95% CI 0.06-0.075, p = 0.016), anemia (OR 0.12, 95% CI 0.01-0.53; p = 0.003), and fibroid uterus (OR 0.24, 95% CI 0.07-0.82, p = 0.024) reduced the risk for future trachelectomy. Conclusion. Young age and endometriosis are significant risk factors for trachelectomy following SCH.

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Outcomes after Total versus Subtotal Abdominal Hysterectomy

Abstract: Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.

Cited by 386 publications

References 36 publications

Eficacia de la histerectomía modificada en la prevención y tratamiento de la incontinencia urinaria de esfuerzo

Eficacia de la histerectomía modificada en la prevención y tratamiento de la incontinencia urinaria de esfuerzo

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

Risk factors for trachelectomy following supracervical hysterectomy

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