Aqua Dissection -Ndvh - Figoo-2009

AQUA DISSECTION IN NON-DESCENT VAGINAL HYSTERECTOMY (100 CASES)

- AN OBSERVATION OF FENI PVT. HOSPITAL, BANGLADESH.

DR MOHAMMAD ABDUL QUAYYUM

F C P S

Chief Consultant (Gynae), Feni Private Hospital, Feni Bangladesh.

Hysterectomy is the major gynecological operation.

During vaginal hysterectomy operation adequate haemostasis is the important issue because it associated with significant morbidity.

INTRODUCTION

It was a retrospective study conducted at the Feni pvt. hospital in Bangladesh.

One hundred patients of non- descent uterus requiring hysterectomy were included in this study.

The patients were selected on the basis of questioner, clinical examination & counseling.

The preference of anesthesia was determined by anesthesiologist .

MATERIAL AND METHODS

Inclusion Criteria:

Patients with non-descent uterus with

- Chronic PID

- DUB

- Fibroid- up to 20wks GA.size.

- Adenomyosis.

MATERIAL AND METHODS(CONTD)

Exclusion Criteria:

- Malignancy of uterus & cx.

- Suspected dense adhesion in the pelvis.

- Complex adnexal mass including

endometriosis.

- Android pelvis.

- Uterine prolapse.

MATERIAL AND METHODS(CONTD.)

Instruments trolley

Operative technique.

MATERIAL AND METHODS(CONTD.)

150 – 200 ml normal saline with or without adrenaline was injected in the loose vaginal submucosa,anterolaterally,1-2 cm away the os. but not posteriorly and operative field becomes pale.

Operative technique.

MATERIAL AND METHODS(CONTD.)

Operative technique.

A transverse incision given below the bladder ridge & the area easily separable during dissection.

MATERIAL AND METHODS(CONTD.)

VIDEO PRESENTATION

MATERIAL AND METHODS(CONTD.)Operative technique.

Data regarding age, parity, uterine size, operative blood loss ,duration of operation, operative & post operative complications and hospital stay were analyzed & evaluated.

All patients received a course of broad spectrum antibiotics for 7days.

MATERIAL AND METHODS(CONTD.)

PARAMETER MEAN +/- SD

AGE 35.2 +/- 5.2 YERS

PARITY 4.17 +/- 1.5

PATIENTS CHARACTERISTIC

RESULTS TABLE-1

INDICATION NUMBER(n=100)

PERCENTAGE%

CHRONIC PID 53 53

DUB 20 20

FIBROID 13 13

ADENOMYOSIS 7 7

ADNEXAL MASS 5 5

CX. POLYP 2 2

INDICATION OF OPRATION

RESULTS TABLE II

SIZE OF UTERUS(WKS)

NUMBER(n=100)

PERCENTAGE%

6 GA 9 9

8 GA 31 31

10 GA 34 34

12 GA 12 12

14 GA 5 5

16 GA 5 5

18 GA 2 2

20 GA 2 2

UTERINE SIZE

RESULTS TABLE II

ANESTHESIA NUMBER(n=100)

PERCENTAGE%

G/A 17 17

SPINAL 83 83

TYPES OF ANESTHESIA

RESULTS TABLE II

NAME OF OPRATION NUMBER(n=100)

PERCENTAGE%

HYSTERECTOMY 84 84

HYSTERECTOMY WITH UNIL. SO

11 11

HYSTERECTOMY WITH BILAT. SO

5 5

TYPES OF OPRATION

RESULTS TABLE V

PARAMETARS

EASY DISSECTION 91 %

DIFFICULT DISSECTION 8 %MEAN DURATION OF OPN (min)

35.5 +/- 15.3

MEAN BLOOD LOSS (ml) 166 +/- 55MEAN HOSPITAL STAY (day) 3.1 +/- 1.1

CONVERSION IN TO LAPROTOMY 0DIGNOSTIC & OPERATIVE LAPS. 6%

SURGICAL RESULT

RESULTS TABLE V

COMPLICATION NUMBER(n=100)

PERCENTAGE%

INT.OPER. HAEMORRHAGE

1 1

BLADDER INJURY 2 2

URETER INJURY 0 0

BOWEL INJURY 0 0

POST.OP.HAEMORRHAGE 1 1

VAULT HEAMOTOMA 4 4

UNEXPLINE FEVER 6 6

VAULT ABSCESS 1 1

VAGINAL DISCHARGE 7 7

SURGICAL COMPLICATION

RESULTS TABLE VII

The aim of this study was to determined the outcome of aqua dissection in NDVH.

Normal saline with or without adrenalin compress the minute vessels and making the operative field relatively blood less & easily separable.

That is why the ultra modern concept of aqua dissection in NDVH is better than conventional technique.

DISCUSSION

ABDOMINAL HYSTERECTOMY

With stitch

AQUA DISSECTION NDVH

stitch less

SCAR ON ABDOMEN 4 to 6 inch scar No scar

DURATION OF OPN. 90-150 minutes 25 - 45 minutes

ANAESTHASIA Long duration Short duration

BLOOD LOSS Moderate to heavy Very minimum

TRANSFUSION Required Rarely required

POST OPN. PAIN Yes Very minimum

HOSPITAL STAY 7 Days 24 to 72 hours

REST 45 Days 7 days

COMPARISON

DISCUSSION (CONTD)

There are many studies with using vasopressin in the NDVH operation but it associated with infection and potential adverse cardiovascular effect.

But aqua dissection in vaginal hysterectomy associate with decreased bleeding during operation and it does not increase risk of infection and operative time.

DISCUSSION (CONTD)

Aqua dissection in NDVH is a simplification of vaginal hysterectomy.This is a innovative technique that minimized the bleeding during operation.It is safe and economically acceptable for patient compliance.The best route for hysterectomy in case of non-descent uterus is the vaginal route.

CONCLUSIONS