General surgery
Lobat Jafarzadeh; Shirin Alsadat Mousavi; Fatemeh Deris
Articles in Press, Accepted Manuscript, Available Online from 09 September 2023
Abstract
Background and Goal: Bleeding is a serious complication during and after hysterectomy. This study aimed to compare the short-term outcomes of ChitoHem and Surgicel use in posterior bladder bleeding during hysterectomy.Methods: In the present clinical trial, 46 patients who were candidates for abdominal ...
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Background and Goal: Bleeding is a serious complication during and after hysterectomy. This study aimed to compare the short-term outcomes of ChitoHem and Surgicel use in posterior bladder bleeding during hysterectomy.Methods: In the present clinical trial, 46 patients who were candidates for abdominal hysterectomy in Hajar Hospital in Shahrekord, Iran, were randomly divided into two groups. In group A, superficial (cauter and Surgicel) and in group B (superficial cauterand ChitoHem) were used to control bleeding. Hematocrit and hemoglobin levels were determined before, 6 and 12 hours after surgery. Drain discharge volume, time to stop bleeding and bleeding volume were also determined. The pain was determined by the VAS scale. Data were analyzed by SPSS statistical software.Results: Based on repeated-measures test, the mean of hemoglobin and hematocrit in the studied times showed a significant difference, so that in 6 and 12 hours after surgery they were significantly less than the ones before surgery, but their mean was not significantly different between the two groups. The mean pain score 1 month after surgery in group B was significantly lower than group A (P <0.001). The mean volume of drainage and clotting time in group B were significantly lower than group A (P <0.01). The mean volume of intraoperative bleeding, the frequency of vaginal bleeding and cuff-related complications was not significantly different in the two groups.Conclusion: The results of the present study indicate a better efficacy of ChitoHem on bleeding during hysterectomy surgery.
Obstetrics and Gynecology
Fariba Almassinokiani; Mahzad Alimian; Parinaz Hamednasimi
Volume 8, Issue 3 , May and June 2023, , Pages 210-216
Abstract
Background & Objective: Hysterectomy is the most common gynecological surgery. Every year, numerous women around the world undergo this type of surgery for various reasons. Regardless of the type of surgery, bleeding during surgery and after surgery is the most common consequence? Tranexamic ...
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Background & Objective: Hysterectomy is the most common gynecological surgery. Every year, numerous women around the world undergo this type of surgery for various reasons. Regardless of the type of surgery, bleeding during surgery and after surgery is the most common consequence? Tranexamic acid is a cheap, available and low-complication drug that has been considered in recent years to control bleeding. The present study investigated the effectiveness of Tranexamic acid on the bleeding during laparotomy hysterectomy in women aged 35 to 55 years.Materials & Methods: This study was a randomized, double-blind clinical trial performed on 80 patients undergoing laparotomy hysterectomy. Using a random number table, patients were divided into two groups A (receiving Transid) and the other group receiving drug B (not receiving Transid), both of which received 100 ml of normal saline prepared to reduce bias in the prepared syringe.Results: Mean age of the patients was 46.24 ± 5.21 years. Based on the results of mean hemoglobin before surgery, the rate of infection, infusion and induction in the control and intervention groups were not statistically different (P > 0.05). Also, the mean hemoglobin variables before and after hemorrhage were estimated by the surgeon and hemorrhage estimated according to Hernandez formula were not statistically different in the two groups (P > 0.05).Conclusion: Tranexamic acid administration has no effect on the amount of bleeding during hysterectomy laparotomy.
Obstetrics and Gynecology
Minoo Gharouni; Abolfazl Mehdizadeh Kashi; Shahla Chaichian; Zahra Azizian; Kobra Tahermanesh; Samaneh Rokhgireh
Volume 8, Issue 1 , January and February 2023, , Pages 57-62
Abstract
Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic ...
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Background & Objective: Fast-track surgery (FTS) consists of different pathways to decrease surgical complications and improve outcomes and patient satisfaction. FTS in an elective gynecologic laparoscopic surgery has not been well assessed. No consensus guidelines have been developed for gynecologic laparoscopic surgeries. The purpose of this study is to evaluate enhanced recovery after surgery (ERAS) for total laparoscopic hysterectomy.Materials & Methods: 260 patients underwent for laparoscopic hysterectomy surgery. All patients were divided into two groups as follows: one group received traditional laparoscopic hysterectomy surgery and the intervention group was treated under ERAS protocol. ERAS protocol includes not receiving preoperative mechanical bowel preparation and laxatives as well as fasting 6 h and not drinking liquids 2h before surgery. The patients were allowed to resume the ordinary diet 6h post-operation. Ondansetron 4 mg were prescribed after surgery for nausea and vomiting, pain was controlled with non-narcotic analgesics diclofenac suppository 100 mg/q12 h and paracetamol 1000 mg/q6 h until discharge. Urinary catheter was removed whenever possible and early ambulation occurred 6h after the surgery.Results: A total of 260 patients were studied. Regarding the length of hospitalization, significant differences were shown between the groups (P<0.001). Return to daily functions was occurred earlier in the fast-track surgery group than another group. Complications and VAS pain scores showed no significant differences between the groups.Conclusion: Our results show that ERAS surgery has fewer side effects and better outcomes which make it more suitable for patients undergoing laparoscopic hysterectomy.
Obstetrics and Gynecology
Fariba Yarandi; Sara Ramhormozian; Behzad Asanjarani; Elham Shirali
Volume 7, Issue 5 , July and August 2022, , Pages 458-462
Abstract
GTN (Gestational trophoblastic neoplasm) complications such as uterine rupture or massive bleeding can be life-threatening and usually need a hysterectomy. In young patients who want to preserve fertility, hysterectomy is not suitable. Under specific circumstances, some physicians choose conservative ...
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GTN (Gestational trophoblastic neoplasm) complications such as uterine rupture or massive bleeding can be life-threatening and usually need a hysterectomy. In young patients who want to preserve fertility, hysterectomy is not suitable. Under specific circumstances, some physicians choose conservative management. Uterine preservation after complicated GTN is rare by itself. In conclusion, conservative management of GTN patients who develop high-risk complications and desire for future pregnancies must be considered an option. In published case reports, outcomes of conservative surgical management have been very good if managed properly.
Obstetrics and Gynecology
Khadijeh Elmizadeh; Misa Naghdipour; Fatemeh Lalooha; Seyedeh Masoomeh Hosseini Valmi; Ali Massoudifar; Marzieh Sarafraz
Volume 7, Issue 3 , January and February 2022, , Pages 158-164
Abstract
Background & Objective: Hysterectomy is one of the major gynecologic operations. This procedure can be performed by different methods including abdominal, vaginal, and laparoscopic hysterectomy. In fast-track hysterectomy (FTH), patients do not receive opioids during surgery and there is no ...
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Background & Objective: Hysterectomy is one of the major gynecologic operations. This procedure can be performed by different methods including abdominal, vaginal, and laparoscopic hysterectomy. In fast-track hysterectomy (FTH), patients do not receive opioids during surgery and there is no need for a 12-hour pre-surgery hospitalization. Patients are encouraged to eat and move at most 6 hours after operation. This study was performed to compare the outcomes of FTH with those of routine abdominal hysterectomy (RAH).Materials & Methods: This case-control pilot study was carried out on 82 candidates for hysterectomy at Kowsar Training Hospital in Qazvin, Iran, during 2016. Patients were divided into two randomized groups of FTH and RAH. Parameters such as pain visual analogue scale (VAS) after 3, 6, 12, and 24 hours, diet tolerance, analgesic dose, postoperative nausea and vomiting, hospital stay, postoperative adverse effects, gas passing time, and readmission were investigated and compared between two groups.Results: Analgesic use, gas passing time, and hospital stay were significantly lower in the FTH group (P < /em>=0.0001). While postoperative nausea and vomiting, adverse effects, food tolerance, and readmission rate were the same in both groups (P < /em>>0.05). Moreover, diet tolerance was observed in all patients. In general, pain VAS was lower in FTH with significant difference at 3rd (P < /em>=0.002) and 12th (P < /em>=0.001) hours, and at suture removal time (P < /em>=0.026).Conclusion: It can be concluded that FTH may result in reduced pain, analgesic use, gas passing time, and hospital stay in comparison with RAH.
Mohammad Ranaei; Emad Kohsari; Mina Galeshi; Shahla Yazdani
Volume 4, Issue 3 , September and October 2019, , Pages 99-104
Abstract
Background & Objective: Adenomyosis is a prevalent gynecological disorder among women with no specified causes. It is characterized by nonspecific symptoms, and can present itself as abnormal uterine bleeding, abdominal pain, menstrual disorders, and the like. Its diagnosis is made based on the pathologic ...
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Background & Objective: Adenomyosis is a prevalent gynecological disorder among women with no specified causes. It is characterized by nonspecific symptoms, and can present itself as abnormal uterine bleeding, abdominal pain, menstrual disorders, and the like. Its diagnosis is made based on the pathologic histological examination of hysterectomized samples. This study aimed to evaluate the correlation of adenomyosis with other benign endometrial disorders in hysterectomized samples.
Materials & Methods: In this paper a total of 413 patients who referred to Rouhani Hospital of Babol, form 2012 to 2017, and underwent a hysterectomy surgery with pathological reports confirming the diagnosis of adenomyosis, were studied. After reviewing the medical records, the patients’ data, including their age, weight, number of deliveries, place of residence, and main complaints at the time of referral as well as benign endometrial pathologies correlated with adenomyosis, were examined. Finally, the obtained data were analyzed using statistical tests.
Results: The prevalence of adenomyosis in this study was 21.7%. The patients’ most common complaints were abnormal uterine bleeding (86.4%), dysmenorrhea (39.2%), abdominal pain (31.2%), dyspareunia (21.1%), mass outflow (15%), and pelvic pain (9.4%). In the current study, the benign pathologies correlated with adenomyosis were leiomyoma (52.5%), uterine polyp (11.9%), adenomyoma (5.1%), and hyperplasia (0.5%).
Conclusion: In the present study, the prevalence of adenomyosis was high and abnormal uterine bleeding was the patients’ most prevalent complaint. Moreover, leiomyoma had the highest correlation with adenomyosis.
Shayesteh Parashi; Vahideh Astaraei; Mansoureh Vahdat; Parisa Dini; Mahdis Mohammadianamiri
Volume 3, Issue 4 , November and December 2018, , Pages 143-147
Abstract
Background & Objective: Postoperative hemorrhage is one of the most frequently cited complications of total abdominal hysterectomy (TAH). This study aimed to investigate the effect of a single preoperative dose of sublingual misoprostol on reducing blood loss during total abdominal hysterectomies.
Materials ...
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Background & Objective: Postoperative hemorrhage is one of the most frequently cited complications of total abdominal hysterectomy (TAH). This study aimed to investigate the effect of a single preoperative dose of sublingual misoprostol on reducing blood loss during total abdominal hysterectomies.
Materials & Methods: This study was a single-blind randomized controlled trial (RCT). The statistical population included all women who were candidates of hysterectomy in 2017 and 2018. A total of 132 patients were randomly selected and classified into two groups of misoprostol (N=66) and placebo (N=66). Examining intraoperative blood loss was considered a primary outcome. Moreover, levels of hemoglobin before and 24 hours after the surgery, the need for a blood transfusion, febrile morbidity, and the duration of hospitalization were regarded as secondary outcomes. The means of bleeding in the two groups were compared using a t-test.
Results: There were no significant differences between the two groups in the baseline characteristics (P < /em><0.05). After the surgery, the mean of hemoglobin values was lower in the placebo group compared to the misoprostol one, and this difference was statistically significant (P < /em><0.001). There was a significant difference in intraoperative blood loss between the two groups, and it was significantly higher in the placebo group (P < /em><0.001).
Conclusion: Taking a single preoperative dose of sublingual misoprostol is effective in reducing intraoperative blood loss after total abdominal hysterectomies. Additionally, this intervention led to a decline in hemoglobin.
Forough Javanmanesh; Maryam Kashanian; Vajihe Zamani; Narges Sheikhansari
Volume 3, Issue 3 , September and October 2018, , Pages 99-103
Abstract
Aims: Pain is the main concern after surgery. Gabapentin was recently suggested as a pain killer to be used after various surgeries. The purpose of the present study was to evaluate the effects of gabapentin on pain relief and need for opiates after total abdominal hysterectomy.
Materials & Methods: This ...
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Aims: Pain is the main concern after surgery. Gabapentin was recently suggested as a pain killer to be used after various surgeries. The purpose of the present study was to evaluate the effects of gabapentin on pain relief and need for opiates after total abdominal hysterectomy.
Materials & Methods: This randomized double-blind placebo-controlled clinical trial was performed on 85 women who underwent total abdominal hysterectomy from March 2014 to March 2016 in Akbarabadi teaching hospital and Firoozgar teaching hospital in Tehran, Iran. Samples were selected using consecutive sampling method and were randomly assigned into the 2 groups. In case group (n=44) gabapentin (800mg) was orally administered one hour before surgery and in the placebo group (n=41) placebo which was similar to gabapentin administered. The pain score was assessed in 2, 6, 12 and 24 hours after surgery. Nausea and vomiting were also compared between the 2 groups. Data were analyzed by SPSS 19 software using statistical tests.
Findings: The two groups did not have significant differences according to pain score in the recovery room (point 0). Mean score of pain was lower in the case group in 2, 6, 12 and 24 hours after surgery (p=0.005). Meperidine (pethidine) use was less in the case group (p=0.003). There was no difference between the 2 groups for nausea and vomiting.
Conclusion: Using gabapentin before surgery can lower the pain after surgery and reduces the need for opiates. However, it doesn’t have an effect on nausea and vomiting.
Babak Hosseinzadeh Zorofchi; Elahe Jahan; Setare Nassiri; Atosa Najmodin; Elham Saffarieh
Volume 3, Issue 2 , May and June 2018, , Pages 73-77
Abstract
Aims: Owing to the effects of anesthesia on pain after hysterectomy as well as different advantages and disadvantages of spinal anesthesia (SA) and general anesthesia (GA), giving priority to one of these techniques over the other still seems controversial. The aim of the present study was to compare ...
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Aims: Owing to the effects of anesthesia on pain after hysterectomy as well as different advantages and disadvantages of spinal anesthesia (SA) and general anesthesia (GA), giving priority to one of these techniques over the other still seems controversial. The aim of the present study was to compare SA with GA in terms of pain intensity, the frequency of nausea and vomiting and morphine requirements after abdominal hysterectomy.
Instruments and Methods: This double-blind clinical trial was conducted on 40 abdominal hysterectomy candidates with American Society of Anesthesiologists I and II presenting to Kowsar Hospital, Semnan, Iran, in 2015. All the patients were briefed on the pain assessment scale the day before the surgery, randomly divided into two groups of GA and SA and underwent abdominal hysterectomy using the same technique. Postoperative pain was then recorded upon admission to post-anesthesia care unit and 6 and 12h later. Furthermore, frequency of nausea and vomiting as well as intravenous morphine requirements was recorded within the first 12h after the surgery. Data were analyzed using independent t-test and Chi-square by SPSS 16 software.
Findings: Postoperative pain was found to be significantly lower upon entering PACU and 6 and 12h later in the SA group compared to that in the GA group, as was the case for the frequency of nausea and vomiting as well as the dose of intramuscular morphine (p<0.05).
Conclusion: Generally, postoperative pain in SA is lower than in GA, although different postoperative complications such as nausea and vomiting are observed.
