1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com A STUDY OF 750 CASES OF SUBTOTAL ABDOMINAL HYSTERECTOMY IN BENIGN UTERINE CONDITIONS. DR RAZIA IFTIKHAR PROFESSOR & HEAD OF THE DEPARTMENT AL- TIBRI MEDICAL COLLEGE & HOSPITAL ISRA UNIVERSITY KARACHI PAKISTAN. Objectives ResultsConclusions References 1.Jan Paul WR Roovers, Johanna G vander bom, c Huub vander vaart, et al. Hysterectomy and sexual well-being: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and abdominal hysterectomy. BMJ 2003; 327:774-9. 2. Ranee Thakar, MD, Susan Ayers, Phd, Rashmi Srivastava MD, Isaac Monyonda Phd, MRCOG. Removing the cervix at Hysterectomy- An unnecessary intervention ? Amj Obstet Gynecol 2008; 112(6): 1262-1268. 3. Ewies AAA, Olah KSJ. Subtotal abdominal hysterectomy: a surgical advance or a backward step ? BJOG 2000; 107: 1376-9. 4. Hawkins J, Hudosn CN. Abdominal hysterectomy for benign conditions (including myomata). Shaw`s text book of operative gynaecology. 4 th ed. Edinburgh: Churcbill Livingstone 1977: 146-75. 5. Gimbel H, Zobbe V, Andersen BM, Filtenborg T, Gluud C, Tabor A, et al. Randomised controlled trial of total compared with subtotal hysterectomy with one year follow-up results. BJOG 2003; 110: 1088- 98. 6. Thakar R, Ayers, Darksen P. Outcome after total versus subtotal abdominal hysterectomy. N Eng J Med 2003; 347: 856-7. TO DETERMINED THE OUTCOME OF SUBTOTAL ABDOMINAL HYSTERECTOMY IN TERMS OF INTRAOPERATIVE AND POST OPERATIVE COMPLICATIONS IN WOMEN WITH BENIGN UTERINE CONDITIONS. THE VAST MAJORITY OF HYSTERECTOMIES ALL OVER THE WORLD ARE PERFORMED FOR BENIGN INDICATION. IN TOTAL ABDOMINAL HYSTERECTOMY BOTH THE BODY OF UTERUS AND CERVIX ARE REMOVED WHERE AS IN SUBTOTAL ABDOMINAL HYSTERECTOMY THE CERVIX IS CONSERVE. HYSTERECTOMY DISRUPT THE LOCAL NERVE SUPPLY AND ANATOMICAL RELATIONS OF PELVIC ORGANS 1 THE MAIN BRANCHES OF PLEXUS PASSING BENEATH THE UTERINE ARTERIES MAY BE DAMAGED DURING DIVISION OF CARDINAL LIGAMENTS, THE VESICAL INNERVATIONS WHICH ENTERS THE BLADDER BASE MAY BE DAMAGED DURING BLUNT DISSECTION OF BLADDER FROM THE UTERUS AND CERVIX. THERE IS LOW INCIDENCE OF VESICO URETHRAL DYSFUNCTION, ALSO THE UTEROSACRAL AND CARDINAL LIGAMENTS REMAIN INTACT AND THUS THE PELVIS REMAIN WELL SUPPORTED 2. THE OPERATIVE BLOOD LOSS, POSTOPERATIVE INFECTION ARE QUIT LESS AND COMPLICATIONS LIKE VAULT GRANULOMA ARE NOT FOUND. THE LIFE TIME RISK OF CARCINOMA CERVIX IS LESS THAN 1% (0.05-1%). INJURY TO ADJACENT VICERAS IS LESS FREQUENT. THE PURPOSE IS TO STUDY THE OUTCOME OF SUBTOTAL ABDOMINAL HYSTERECTOMY IN TERMS OF INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS IN BENIGN UTERINE CONDITIONS. THE SUB TOTAL ABDOMINAL HYSTERECTOMY RESULTED IN LESS OPERATIVE TIME RAPID RECOVERY,FEVER SHORT TERM AND LONG TERM COMPLICATIONS. Methods THE MEAN AGE OF THE PATIENTS WAS 46 YEARS AND PARITY BETWEEN 3-8.PATIENTS ATTENDED CONSULTANT OPD MOSTLY BECAUSE OF EXCESSIVE MENSTRUAL LOSS AND LOWER ABDOMINAL PAIN.FIBROID UTERUS WAS FOUND IN 125(16.6% CASES), DISFUNCTINAL UTERINE BLEEDING IN 150(20%),PELVIC PAIN DUE TO SEVERE ENDOMETRIOSIS IN 120(16%),PELVIC PAIN AND MENORRHAGIA IN 125(16.6%),OVARIAN CYST WITH ADNOMYOSIS IN 130(17.3%)CASES AND REPEATED PELVIC INFECTIONS REFRACTORY TO MEDICAL TREATMENT IN 100(13.3%). THERE WAS UNAVOIDABLE INJURY TO URINARY BLADDER IN 2(.27%) OF THE CASES DURING THE PROCEDURE AND WERE REPAIRED SUCCESSFULLY WITH UN EVENTFULL RECOVERY. EARLY COMPLICATIONS LIKE TEMPERATURE WAS NOTED IN 75(10%) OF THE CASES. LATE COMPLLICATIONS LIKE CYCLICAL MENSTRUAL BLEEDING IN 15(2%), VAGINAL DISCHARGE IN 30(4%) CASES. ALL THE CASES WERE FOLLOWED UP 3MONTHLY 6MONTHLY AND YEARLY. PAP SMEAR SURVEILLANCE CONTINUED IN ALL CASES TILL NOW. DURING THIS PERIOD THE SEXUAL FUNCTIONS OF ALL THE PATIENTS REMAIN UNAFFECTED.THE BOWL FUNCTIONS WERE FOUND TO BE DISTURBED(CONSTIPATION) IN 10(1.3%) OF THE CASES WHILE THE URINARY FREQUENCY WAS NOTED IN ANOTHER 10(1.3%) CASES.THERE WAS NO MORTALITY ASSOCIATED WITH THE PROCEDURE. THE HISTOPATHOLOGY OF SPECIMEN REVEALED DISFUNCTIONAL UTERINE BLEEDING FOLLOWED BY ENDOMETRIOSIS AND FIBRIOD UTERUS TO BE THE COMMON PATHOLOGY. OPTIONAL LOGO HERE Introduction THE STUDY INCLUDED 750 WOMEN, WHO UNDERWENT SUBTOTAL ABDOMINAL HYSTERECTOMY DUE TO TECHNICAL DIFFICULTIES DURING SURGERY IN BENIGN UTERINE DISEASES.THE INCLUSION CRITERIA WERE MENORRHAGIA AND PELVIC PAIN, DYSFUNTIONAL UTERINE BLEEDING, REPEATED PELVIC INFECTIONS REFRACTORY TO MEDICAL TREATMENT,FIBROID UTERUS AND OVARIAN CYST WITH ADENOMYOSIS OF UTERUS.PATIENTS OVER 60 YEARS OF AGE, UTERINE PROLAPSE AND SUSPECTED CANCER OF CERVIX AND UTERINE MALIGNANCY WERE EXCLUDED.DETAILED HISTORY AND EXAMINATION DONE AND ROUTINE INVESTIGATION INCLUDING ULTRASOUND AND PAP SMEAR WERE CARRIED OUT.SPECIFIC INVESTIGATION WERE CARRIED OUT WHERE REQUIRED.PROCEDURE WAS PERFORMED BY CLAMP CUT AND LIGATE METHOD. ALL THE PATIENTS WERE SELECTED FROM CONSULTANT`S OPD. THE COMMON PRESENTING COMPLAINTS WAS ABNORMAL VAGINAL BLEEDING, PELVIC PRESSURE AND PAIN, FAILED CONSERVATIVE MANAGEMENT. A COMPLETE GENERAL, PHYSICAL AND PELVIC EXAMINATION WAS PERFORMED. ROUTINE INVESTIGATIONS INCLUDING ULTRASOUND WAS CARRIED OUT AND FINDINGS WERE NOTED. ALL THE PATIENTS WERE COUNSELED ABOUT THE DISEASE AND THE SURGICAL PROCEDURE THEY HAVE TO UNDERGO. THE UTERUS WAS REMOVED ABOVE THE LEVEL OF INTERNAL OS TO AVOID BOTHERSOME CYCLIC MENSTRUAL BLEEDING FROM REMNANT OF ENDOMETRIUM. ONE HEALTHY OVARY WAS LEFT IN PERIMENOPAUSAL WOMEN, ALL SPECIMENS AFTER SURGERY WERE SENT FOR HISTOPATHOLOGY. DURATION OF OPERATION WAS CALCULATED FROM THE TIME FROM INCISION OF THE SKIN TO THE CLOSURE, THE AVERAGE HOSPITAL STAY WAS 3-4DAYS. ALL THE PATIENTS WERE FOLLOWED 3 AND 6 MONTHLY AND LATER YEARLY AND ARE STILL BEING FOLLOWED. THE ANALYSIS WAS PERFORMED BY USING SPSS VERSION-14. FREQUENCY AND PERCENTAGES WERE COMPUTED FOR PRESENTATION OF ALL CATEGORICAL VARIABLES.