Nondescent vaginal hysterectomy: a constantly improving surgical art

Objective

This study was undertaken to check the feasibility of the vaginal route as the primary route for all hysterectomies, in the absence of uterine prolapse, for benign conditions.

Methods

During 2005 to 2007 an effort was made to perform as many hysterectomies vaginally with or without oophorectomy in women with benign or premalignant conditions in the absence of prolapse. Severe endometriosis, immobility of the uterus, uterine size more than 18 weeks and malignancy were excluded. Patients were classified into two groups — Group I — uterine size up to 12 weeks, with no risk factors and Group II — uterine size 12–18 weeks or with confounding factors like, mild to moderate endometriosis, nulliparity or LSCS in the past. The outcome was compared between the two groups and abdominal hysterectomies done for benign conditions. Statistical analysis was done by SE(d) between mean and proportion.

Results

A total of 164 cases nondescent vaginal hysterectomies were done. Of these, 92 (56.1%) were in group I and 72 (43.9%) in group II. The operation time in Group II was significantly more than in group I (81.3 minutes with SD of 31.4 s. 62.6 minutes SE(d) between 2 means-7.49). Debulking techniques were required in 58.7% of the cases in group II compared to 2.1% in group I. Both the groups had one conversion each. The peroperative blood loss, pain score, hospital stay and return to normal activity, was comparable in both the groups of vaginal hysterectomy (VH) and significantly superior to those undergoing abdominal hysterectomies for benign conditions.

Conclusion

The vaginal approach is possible in most benign conditions requiring hysterectomy and is superior to the abdominal route with respect to recovery and complication rates.     

High-dose versus low-dose CMFP regimen in advanced breast cancer

Fifty cases of advanced breast cancer (stages III and IV) were treated by combination chemotherapy. The study compares the two different dose schedules and toxicities of a combination of cyclophosphamide, methotrexate, 5-flurouracil, and prednisone. Results are better with high-dose regimen, though the incidence of toxicity is much as compared to low-dose schedules, but, considering the beneficial response, the high-dose schedule is recommended.     

A case of postpartum chronic subdural hematoma

Headache is a common presentation during postpartum period. Anesthesiologist, obstetrician, and neurosurgeon should be aware of the possibility of subdural hematoma in patient complaining of headache following spinal anesthesia.