Long Term Complications
Long Term Complications
Long Term Complications
COMPLICATIONS
OF
HYSTERECTOMY
INTRODUCTION
DEFINTION
20% will have procedure by 55yrs
Reasons –Uterine fibroid and menstrual abnormalities
Developing Countries-
-28% of all major gynecological operations in UCH
-Life threatening conditions
Perception of the procedure
- freedom for the patient in developed country
Developing country Ist hysterectomy was
performed – Charles
procedure aversion clay –patient died
-sexual rejection 1843
-Loss of feminity -A year later- did
another patient died
-Preference for
15 days after (fell
perpetual while changing linen
menstrual flow from the hands of the
-Reincarnation potters )
theory Ist successful total
was done by
-Outlet of bad blood Richardson- 1929
Types of hysterectomy
Based on route
– Abdominal
– Vaginal
– Laparoscopic assisted vaginal hysterectomy
– Laparoscopic supravaginal hysterectomy
– CASH procedure(Semm)
-classical abdominal semm( serrrated edge macro-
morcellated) hysterectomy
- laparoscopic supracervical hysterectomy
-coring out of the cervical canal by serrated
resection device
-Laparoscopic Doderlin hysterectomy
- detachment of the adnexae by laparoscope
- anterior colpotomy/completion per vagina
Based on portion removed
Subtotal
Total
Panhysterectomy – misnomer
Radical hysterectomy
-Type 1 simple extrafascial hysterectomy with out dissection of the ureters
from its canal
Type 11 modified radical hysterectomy (Telinde’s)
- uterine ligated medial to the ureter
-cardinal ligaments resected from the medial halve
-Pelvic lymph node dissection
-Upper vaginoplasty
Type III Wertheim meig’s operation
- cardinal ligament divided at the pelvic side wall
-uterosacrals –side of the rectum full dissection of ureter except for
attachment to bladder and lateral over the lower 2 cm
Type IV
Upper ¾ of vagina removed, resection of internal iliac
Type V
Excision of inflitrated bladder, ureter, rectum or bowels
complications
Disruption of the ultimate anatomical
relationships of the uterus, bowel ,bladder
and vagina to one another
Subsequent alteration of functions above
organs
Beneficial /detrimental effect
Detrimental effects on long term
- Psychological
Long term detrimental effects cont.
Anatomical considerations:
Changes in bowel, sexual and urinary
functions
- Disruption of the pelvic plexus of nerves
Level of disruptions
Main branches passing beneath the uterine
arteries- Damaged during division of the
cardinal ligament
Blunt dissection of the bladder off the uterus
and cervix- vesical innervations
Paravaginal vaginal disruption of the pelvic
neurons
Plexuses around the cervix
Urinary system
-urinary incontinence –bladder neck
-increased vesical sensitivity lasting up to 6months
-There may be a degree of vesicourethral dysfxn b/4
surgery
-conflicting results
Gastrointestinal
-surgeons increased constipation
irritable bowel syndrome
-Draw back of supportive studies –retrospective and
tasking of patient memory
-Manometric studies showed no change in sphincter
function
-Proctometrograms- increased rectal compliance
volume
COMPLICATIONS CONT.