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Laparascopic Hysterectomy

For patients undergoing laparoscopic hysterectomy (major surgery, defined as >30 minutes duration) there is a risk for venous blood clots. So these patients require medications to prevent blood clots in the legs. Laparascopic hysterectomy is when small holes are made in the abdomen instead of a big incision and surgery is guided with the help of a camera placed inside.

2.7 to 3.9 per cent of patients require opening up of the abdomen because of unforeseen causes after having been signed up for laparascopic hysterectomy.

Other complications could include bleeding, injury to the urinary tract, and drying up of the vaginal tissue adjoining the removed uterus and injury to the intestines. The risk of injury to urinary tract and vaginal tissue trying is higher than that for the open hysterectomy.

Approximately 0.3 to 0.7 percent of abdominal hysterectomies(AH) require revisits due to unintentional complications such as injury to organs.

Some studies:

- There was a study done in the United Kingdom which enrolled 37,000 hysterectomies (1994 to 1995); over 24,000 of the procedures were performed abdominally. The rates for complications for AH were 3.6 percent. The risk of severe complications was lower in abdominal versus laparoscopic procedures (four versus six percent).

The complications were death, blood clotting, myocardial infarction, stroke, renal failure, severe infection, secondary bleeding, fistula (abnormal opening onto the skin through any hollow organs), ureteral obstruction, and visceral (organ) damage.

- In one trial, 292 women were assigned to AH and 584 women were assigned to laparoscopic hysterectomy; the number of patients with at least one major complication was significantly less in abdominal than laparoscopic hysterectomy (six versus 11 percent). The major complications of AH were hemorrhage (two percent), bladder injury (one percent), and bowel injury (one percent).

- 61,000 abdominal hysterectomies were studied in England. 5.7 percent of women underwent emergency readmissions within 30 days of discharge. This was done looking retrospective records of the women.

Infection

11 percent of women who don't receive antibiotics before the procedure, develop fever or infection. If there is a fever of 100 degrees F after the operation, the doctor needs to think of all the possible causes of fever and investigate accordingly. Common infections are urinary tract infection, wound infection, unknown site infection, and vaginal or intraabdominal infection.

Bowel Injury

Bowel injuries are seen in 0.2 to one percent of cases. These injuries occur when the surgeon is trying to separate the adhesions between the bowel and the uterus .

Ileus

This is, to put it simply, paralysis of the moving function of the bowel to propel the food downwards. This can cause vomiting and constipation. This can result after surgery.

Bowel Obstruction

The risk is approximately 13.6/1000. This usually if there is scar tissue formations causing adhesions outside the bowel wall causing obstructions.

Blood Clots

Without taking anti-blood clot medications, the risk of blood clots in patients after gynecologic surgery is 15 to 30 percent.

If the patient develops swelling and pain in the calves or there is unexplained fast breathing, then blood clots have to be suspected.

Bladder injury

This is seen in 0.02 to one percent of hysterectomies.

Ureteral injury

Ureters are a pair of tubes bringing urine from the kidneys to the bladder. 13.9 out of 1000 for laparascopic and 0.4 out of 1000 for abdominal hysterectomy.

Abdominal Hysterectomy

For abdominal hysterectomy (open), injury to urethra could present as pain in the sides or the groin, fever, a mass in the abdomen or slowing down of the intestinal emptying (what is known as ileus). Postoperative serum creatinine concentration rises >=0.3 mg/dL above preoperative values support this diagnosis.

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