Closed suction pelvic drainage after radical pelvic surgical procedures

Thirty-four women had short-term, low-pressure, closed suction pelvic drainage after radical gynecologic surgical procedures. Mean collected fluid losses were significantly higher after radical hysterectomy (25.3 ml/kg) when compared with abdominal hysterectomy (10.7 ml/kg) and lymphadenectomy. There was no correlation between the volume of pelvic drainage and patient's age, patient's weight, duration of operation, or amount of blood loss. The fluid contents resembled serum and were rarely culture positive. Short-term (5-day) drainage was not associated with lymphocysts.     

Protein and electrolyte content of retroperitoneal suction drainage after radical hysterectomy with pelvic lymphadenectomy

Suction drainage of the retroperitoneal space after radical hysterectomy can be achieved with minimal protein and electrolyte losses. Losses sustained have been replaced and in no patient was there marked electrolyte or protein imbalance.     

Evaluation of the improvement of cephems on the prophylaxis of pelvic infection after radical hysterectomy.

Antibiotics, especially cephems, have been improved remarkably in the last 20 years. In order to evaluate the improvement of antibiotics used for the prophylaxis of infections after radical hysterectomy, two groups of patients (group A, 1978-1979, n = 54; group B, 1985-1987, n = 55) were examined in regard to bacteriological and clinical effects. In spite of the improvement of antibiotics, the positive rate of bacteriological analysis had increased from 44.4 to 76.4%. Obvious decrease of gram-negative bacilli and increase of gram-positive cocci (GPC), e.g. Enterococcus, were observed. In contrast, fever index and febrile morbidity of group B decreased significantly more than those of group A. These results indicate that the improvement of antibiotics has brought more effective prophylaxis in the postoperative infection in spite of the high positive rate of GPC.     

Prolapse of the vagina after hysterectomy

Twenty-two patients were operated upon for posthysterectomy vaginal prolapse. The original operation had been abdominal hysterectomy in 11 patients and vaginal hysterectomy in an additional 11 patients. All of the corrective operations were performed abdominally. Vaginal sacropexy was performed upon eight patients with our own modified method using a fascial strip taken from the rectum sheath. Dexon sutures were used in the attachment of the strip to the apex of the vagina and to the periosteum of the sacrum. The fascial strip was peritonealized. A high resection of the enterocele sac was performed. Excellent permanent vaginal support was achieved in all of these patients. Other methods of operation used included direct fixation of the vaginal apex to the presacral fascia, fixation of the vagina with round ligaments and the method according to Williams and Richardson. More than one-half of the patients had recurrences.     

Effects of closed suction drainage in reducing pain after laparoscopic-assisted vaginal hysterectomy

STUDY OBJECTIVE: To estimate whether closed suction drainage of the pelvis after laparoscopic-assisted vaginal hysterectomy (LAVH) reduces the frequency and intensity of shoulder-tip, abdominal, and back pain. DESIGN: Prospective, randomized study (Canadian Task Force classification 1). SETTING: Teaching medical center. PATIENTS: One hundred sixty-four women. INTERVENTION: LAVH. MEASUREMENTS AND MAIN RESULTS: For group 1 (80 women), closed suction (Jackson-Pratt) drains were inserted into the peritoneal cavity and cul-de-sac, whereas for group 2 (84), no drains were placed. Shoulder-tip, abdominal, and back pain were evaluated by visual analog scores (VAS) 3, 24, and 48 hours after surgery. The frequency of shoulder-tip pain was significantly lower in group 1 at 24 hours (23% vs 40%, p = 0.013) and 48 hours (9% vs 21%, p = 0.024; VAS scores at 24 hrs 2.2 +/- 1.1 vs 3.8 +/- 1.3, p = 0.010; VAS scores at 48 hours 1.5 +/- 1.0 vs 2.5 +/- 1.2, p = 0.018). At 48 hours fewer women in group 1 experienced abdominal pain (31% vs 50%, p = 0.039; VAS scores 2.0 +/- 1.1 vs 4.0 +/- 1.3, p = 0.007). No statistically significant differences in frequency and VAS scores for back pain were found at any time. The quantity of oral analgesics was greater for group 2 than for group 1 (12.4 +/- 1.6 vs 9.0 +/- 1.4, p <0.001). Economic evaluation of analgesic requirements and material costs for the two groups showed that simple analgesics were more cost-effective than closed suction drainage in the treatment of pain. CONCLUSION: Closed suction drains may reduce the frequency and intensity of shoulder-tip and abdominal pain and postoperative analgesia requirements after LAVH, but simple oral analgesics are more cost effective.     

Transvaginal evisceration of small bowel after radical hysterectomy and pelvic lymphadenectomy

Vaginal evisceration is a rare event. This case report describes a 45-year-old woman who presented 8 days following radical hysterectomy and lymph node dissection for stage 1B squamous cell carcinoma of the cervix with small bowel evisceration through the vagina. She was treated by laparotomy and resection anastamosis of a discolored part of the distal ileum.     

A comparison between peritoneal sheathing of the ureters (Ohkawa technique) and retroperitoneal pelvic suction drainage in the prevention of ureteral damage during radical abdominal hysterectomy

Sixty patients had a radical abdominal hysterectomy with or without a bilateral salpingo-oophorectomy. The Ohkawa procedure was utilized in 26 (43.3%) of the patients and retroperitoneal ureteral placement with suction drainage in 34 (56.7%) of the patients. These two operative procedures were evaluated for complications such as fistula, obstruction, and hydronephrosis by comparing preoperative and postoperative intravenous pyelograms. Five of the 60 patients (8.3%) had surgical complications within one postoperative month. A ureteral obstruction occurred in two patients, and a uretrovaginal fistula occurred in two patients. Hydronephrosis was found in both sets of patients. All of these complications occurred in an additional two patients, both of whom had an Ohkawa procedure. The study led us to conclude that retroperitoneal ureteral placement is not only quicker to perform but also leads to fewer complications than the Ohkawa technique.     

Infection after radical abdominal hysterectomy and pelvic lymphadenectomy: prevention of infection with a two-dose peri-operative antibiotic prophylaxis

Surgical site-related infections occurred in 21% of 87 consecutive patients undergoing radical hysterectomy with pelvic lymphadenectomy (RHPL) without planned peri-operative prophylaxis. A prospective, randomized double-blind, placebo-controlled study was conducted in 68 consecutive RHPL patients. In the 32 available patients with two-dose cefuroxime and metronidazole prophylaxis no surgical site-related infections developed as opposed to a rate of 14% in the 28 patients in the placebo group ( P < 0.05). In a prospective, randomized double-blind study two two-dose antibiotic prophylactic regimens were compared in 105 consecutive patients. Surgical site-related infections developed in one (2%) patient in the cefuroxime plus metronidazole group, and in six (12%) patients in the moxalactam group. This difference did not achieve statistical significance. The mean length of the postoperative hospital stay of the patients with scheduled surgical prophylaxis was significantly shorter ( P < 0.01) than that of the patients operated on without surgical prophylaxis. A two-dose antibiotic regimen is recommended, because levels of antibiotics assayed in samples collected during the course of the operation indicated a rapid clearance of the antibiotics from the operative site, most likely due to the high volume of peri-operative blood loss.     

Recurrent carcinoma of the vagina following Okabayashi's radical hysterectomy for cervical carcinoma

Between 1962 and 1976, 1847 cases of cervical cancer were treated by Okabayashi's radical hysterectomy. Of these, 42 cases developed vaginal invasive carcinoma and 5 developed vaginal intraepithelial carcinoma thereafter, giving a recurrence rate of 2.5%. The vaginal recurrence rate declined annually during the period 1962-1976, and was thought to be due to the efficacy of routinization of postoperative vaginal cuff irradiation. Of the 47 recurrent cases 33 were discovered within 2 years following the operation. Seventy-two percent of the recurrent cases were asymptomatic. The importance of close follow-up of the patients during the first 2 postoperative years was denoted. The incidence of developing a secondary vaginal cancer in the cases of cervical adenocarcinoma was 10.0%, higher than the 2.2% for squamous cell carcinoma. All the recurrent cases were treated with vaginal cuff irradiation, either alone or with external irradiation and/or chemotherapy. The 3-year survival rate of the patients who had vaginal recurrence alone was 40.0%, better than that of the cases accompanied with recurrence at the other sites.     

根治性子宫切除术中系统保留盆腔自主神经的临床研究

目的 观察根治性子宫切除术中系统保留盆腔自主神经(PAN)的临床效果.方法 对2007年6月至2008年4月南方医科大学南方医院等5家医院收治的40例子宫颈癌及子宫内膜癌患者实施根治性子宫切除术中保留PAN的手术,观察手术的成功率,手术前后膀胱功能、肛门和(或)直肠功能变化.结果 (1)33例成功保留双侧PAN,成功率82.5%(A组);7例失败,占17.5%(B组),失败的原因为肥胖、术中出血多及盆腔粘连等.(2)A、B两组的手术切除范围无差异,均达Ⅲ型子宫切除术标准.(3)手术平均时间:A组:(200.3±64.8)min,B组:(190.4±50.9)min,P0.05;术中出血量:A组:(714.6±387.6)mL,B组:(614.3±11.6)mL,P0.05;平均留置尿管时间:A组:(8.6±2.0)d,B组:(17.7±4.9)d,P<0.01;术后排气时间:A组:(58.5±20.3)h,B组:(81.3±6.2)h,P<0.05;术后排便时间:A组:(90.6±29.0)h,B组:(115.4±46.4)h,P<0.05.结论 根治性子宫切除术中系统保留PAN有助于尽快恢复膀胱功能以及肛门和(或)直肠功能.     

Intraoperative electrical stimulation of the pelvic splanchnic nerves during nerve-sparing radical hysterectomy

OBJECTIVES: This study sought to determine whether intraoperative electrical stimulation (IES) of pelvic splanchnic nerves (PSNs) while monitoring bladder contraction was useful to predict postoperative bladder function during conventional nerve-sparing radical hysterectomy. METHODS: Seventeen patients with stage Ib or IIa cervical cancer underwent conventional radical hysterectomy. IES was performed in all cases, stimulating the roots of PSN, the posterior sheath of the vesicouterine ligament (PVL) and the dorsal area of the ligament. After resection of the uterus, the PSN roots were stimulated again. Bladder function was evaluated by urodynamic study (UDS) preoperatively and 3 months after surgery. RESULTS: The results of IES were consistent with bladder function evaluated by postoperative UDS. In 13 of 17 cases, an increased intravesical pressure was observed with IES of the PSN roots after uterus resection. Nine of 13 cases showed marked detrusor contraction with UDS 3 months after surgery and were able to void without using abdominal pressure except in one case. In the remaining 4 of 17 cases, no response could be detected to IES on either side. Three cases voided using abdominal pressure and one used clean intermittent self-catheterization without spontaneous voiding. CONCLUSIONS: IES while monitoring intravesical pressure during radical hysterectomy represents a technically simple and useful procedure for the prediction of postoperative bladder function.