NDVH -ACOG Presentation

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NON DECENT VAGINAL HYSTERECTOMY BANGLADESH

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AQUA DISSECTION IN NON-DESCENT VAGINAL HYSTERECTOMY (500 CASES) - AN OBSERVATION OF FENI PVT. HOSPITAL, BANGLADESH: 

AQUA DISSECTION IN NON-DESCENT VAGINAL HYSTERECTOMY (500 CASES) - AN OBSERVATION OF FENI PVT. HOSPITAL , BANGLADESH Dr . Mohammad Abdul Quayyum MBBS , FCPS Consultant (Gynae) Gynaecologcal Endoscopic and MIS Feni Pvt Hospital Bangladesh

INTRODUCTION: 

INTRODUCTION Hysterectomy is a major gynecological operation. It can be done by abdominally or vaginally or laparoscopically. Vaginal hysterectomy associated with reduced morbidity and lower costs compared to laparoscopic hysterectomy. During vaginal hysterectomy operation adequate haemostasis is an important issue because it association with significant morbidity.

Recommendation of the AAGL:- Most Hysterectomies Should be Performed Vaginally/Laparoscopically for benign uterine disease : 

Recommendation of the AAGL:- Most Hysterectomies Should be Performed Vaginally/Laparoscopically for benign uterine disease

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The aim of the present study is to report the personal experience and feasibility in performing aqua dissection in NDVH for benign gynecological indications. A retrospective study at the Feni Pvt. hospital Bangladesh. Five hundreds patients of non-descent uterus requiring hysterectomy were included in this study. The patients were selected on the basis of questionnaires, clinical examination, investication & counseling. The preference of anesthesia determined by Anesthesiologist. MATERIAL AND METHODS

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Inclusion Criteria : Patients with non-descent uterus with adequate vaginal access with good uterine mobility . - Chronic PID - DUB - Fibroid- up to 20wks GA Size. - Adenomyosis . - Intrauterine / cervical polyps MATERIAL AND METHODS(CONTD.)

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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.)

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Operative technique. Instruments trolley MATERIAL AND METHODS(CONTD.)

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After cleaning and draping, cervix was held with volsellum. 150 – 200 ml normal saline was injected in the loose vaginal submucosa,1-2 cm away the os and operative field becomes pale. Operative technique. MATERIAL AND METHODS(CONTD.)

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First open the posterior pouches by sharp scissor. Then open the anterior pouch by a transverse incision given below the bladder ridge. The area easily separable after dissection and cutting the pubo-vesico-cervical ligaments and bladder mobilized upwards. I n the case of bigger sized uterus different types morcellation techniques were performed . Operative technique:- MATERIAL AND METHODS(CONTD.)

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VIDEO PRESENTATION :- All pedicle were clamped, cut and ligated bilaterally . In bigger sized uterus morcellation techniques like uterine bisection, debulking, myomectomy or combinations of these were performed and vaginal vault closed by interrupted stich with small drainage opening. Catheterization with foley's catheter done for 24hours MATERIAL AND METHODS(CONTD.) Operative technique:-

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ANTERIOR FIBROID 18 WKS FIBROID UTERUS OVARIAN CYST VIDEO PRESENTATION MATERIAL AND METHODS(CONTD.) Operative technique :-

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Data regarding age, parity, indication of operation, uterine size, types of anesthesia, types of operation, 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 5 days . MATERIAL AND METHODS(CONTD.)

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PARAMETER MEAN +/- SD AGE 35.2 +/- 5.2 YERS PARITY 3.17 +/- 1.5 PATIENTS CHARACTERISTIC RESULTS (TABLE-1)

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INDICATION NUMBER (N=500) PERCENTAGE (%) CHRONIC PID 265 53 DUB 100 20 FIBROID 65 13 ADENOMYOSIS 35 7 ADNEXAL MASS 25 5 CX. POLYP 10 2 INDICATION OF OPRATION RESULTS (TABLE – II)

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SIZE OF UTERUS (WKS) NUMBER (N=500) PERCENTAGE (%) 6 GA 45 9 8 GA 155 31 10 GA 170 34 12 GA 60 12 14 GA 25 5 16 GA 25 5 18 GA 10 2 20 GA 10 2 UTERINE SIZE RESULTS (TABLE -III)

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ANESTHESIA NUMBER (N=500) PERCENTAGE (%) G/A 85 17 SPINAL 415 83 TYPES OF ANESTHESIA RESULTS (TABLE -IV)

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NAME OF OPERATION NUMBER (N=500) PERCENTAGE (%) HYSTERECTOMY 420 84 HYSTERECTOMY WITH UNIL. SO 55 11 HYSTERECTOMY WITH BILAT. SO 25 5 TYPES OF OPERATION RESULTS (TABLE – V)

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TECHNIQUE USED NUMBER (N=70) PERCENTAGE (%) BISECTION 25 35.7 MYOMECTOMY 25 35.7 WEDGE DEBULKING 20 28.6 Morcellation Techniques RESULTS (TABLE – VI)

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PARAMETARS EASY DISSECTION 91 % DIFFICULT DISSECTION 8 % MEAN DURATION OF OPERATION (min) 35.5 +/- 15.3 MEAN BLOOD LOSS (ml) 166 +/- 55 MEAN HOSPITAL STAY (day) 3.1 +/- 1.1 CONVERSION IN TO LAPAROTOMY 0.02% DIGNOSTIC & OPERATIVE LAPAROSCOPY. 6% SURGICAL RESULT RESULTS (TABLE –VII)

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COMPLICATION NUMBER (N=500) PERCENTAGE (%) INTRA.OPER. HAEMORRHAGE 2 0.4 BLADDER INJURY 2 0.4 URETER INJURY 0 0 BOWEL INJURY 0 0 POST.OPER.HAEMORRHAGE 10 2 VAULT HEAMOTOMA 3 0.6 UNEXPLINE FEVER 3 0.6 VAULT ABSSES 1 0.2 VAGINAL DISCHARGE 8 1.6 SURGICAL COMPLICATION RESULTS ( TABLE – VIII)

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Normal saline compress the minute vessels and making the operative field relatively blood less & easily separable. There are many studies with using vasopressin and adrenaline 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

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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 15 - 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 42 Days 7 days COMPARISONS DISCUSSION (CONTD)

AQUA DISSECTION IN NON-DESCENT VAGINAL HYSTERECTOMY (500 CASES) – DAY CARE HYSTERECTOMY ? : 

AQUA DISSECTION IN NON-DESCENT VAGINAL HYSTERECTOMY (500 CASES) – DAY CARE HYSTERECTOMY ? Man learns where he lives and Experience is the greatest teacher in the world .

CONCLUSION: 

Thank You E-mail : quayyum1959@gmail.com 24 CONCLUSION At the end we can say The simplified innovative technique of NDVH is simple, safe & very fast , relatively blood less and least invasive method of hysterectomy carried out successfully with a high success rate and very low morbidity .