SURGICAL MANAGEMENT

OF DYSFUNCTIONAL
UTERINE BLEEDING

K.KABILAN
SURGICAL MANAGEMENT OF DUB
• DUB is usually controlled by medical line of
management
• The need for surgical management arises
when there is a failure in medical line of
management
 An overview of Management of
Menorrhagia
Menorrhagia

Young women Older women

Rule out uterine pathology and cancer

Pregnancy desired Pregnancy not desired
•Progestogens •COC Normal uterus Uterine pathology
•Ethamsylate •Progestogens (DUB)
•NSAID •Mirena
•GnRH 3-4 months •Medical theraphy
•COC contraindicated
over 40 years

Effective Fails No response

•MIS
Continue for 6-9
•Hysterectomy Hysterectomy with
months and oopherectomy after
follow up with conservation Surgery
of ovaries 50 years (No MIS)
 SURGICAL MODALITY
Hysterectomy
Abdominal
Vaginal
Laproscopic
Laproscopic assisted vaginal hysterectomy
Ovaries must be preserved in patients age
below 50yrs
 Indications
• Failure of medical line of management and
MIS.
• Family history of uterine malignancy.
• Premalignant endometrial pathologies.
 ABDOMINAL HYSTERACTOMY
Abdominal hysterectomy is preferred when
extensive adhesions are anticipated
Advantages:
• Good access and better visualisation.
• Technically easy.
• Less time consuming.
• No need of advanced instrumentation as in
laproscopic procedure
• P.Op bleeding and bladder injury are less in
compare to vaginal hysterectomy
• Anatomical relations not altered.
Disadvantages:
• Patient recovery prolonged.
• Prolonged hospitalisation.
• Incisional pain.
• P.Op wound infection.
• Uretral injury.
• Risk of developing hernia.
 VAGINAL HYSTERECTOMY
“ Gynaecologist route”

This approach preffered

when extensive
adhesions are not
anticipated.
Pre-requesties:
• Uterus size <12 cms.
• Mobile uterus without
adhesions;vallsellum traction
test positive.
• No adnexal tumour or
pathology
Advantages:
• Faster recovery
• Reduced hospital stay
• No risk of developing hernia
• Peritoneum minimally opened, no bowel
handling hence less post operative illness
• Bowel function returns soon
• Quick ambulation
• Less post-operative infection
• Least invasive route
Disadvantages:
• Pelvic infection
• Vesical injury, fistula
• Vaginal shortening and stenosis
• Recurrent cystocele, rectocele, entrocele
• Vault prolapse
• P.Op bleeding Haemorrhagic shock
LAPROSCOPIC HYSTERECTOMY
&
LAVH
Advantages:
• Faster patient recovery
• Reduced hospital stay
• Less post operative pain
• Less wound infection
• Provides better visualization and access to
abdomen and pelvis
Disadvantages:
• Time consuming
• Expensive
• Require better surgical skills
 OU
K Y
AN
TH