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AQUA DISSECTION IN NON-DESCENT VAGINAL

HYSTERECTOMY (100 CASES)
- AN OBSERVATION OF FENI PVT. HOSPITAL,
BANGLADESH.

Dr. Mohammad Abdul Quayyum
consultant (OBS & GYN)
Feni pvt. Hospital.
Bangladesh.
AIMS & OBJECTIVES

To study the outcome of performing
the aqua dissection in case of non-
descent vaginal hysterectomy.
Introduction

Hysterectomy is the major gynecological operation.
The best route for hysterectomy in case of non-
descent uterus is the vaginal route.
Minimizing blood loss during vaginal
hysterectomy is important because of the
associated morbidity.
Introduction - cont

The aqua dissection with or without adrenaline is the
best technique in NDVH
that minimized bleeding,operative time and morbidity.
Material and Methods
It was a retrospective study conducted
at the Feni pvt. Hospital in
Bangladesh.
One hundred patients of non- descent
uterus requiring hysterectomy were
included in this study.
The patients were selected on the
basis of questioner, clinical
examination & counseling.
The preference of anesthesia was
determined by anesthesiologist .
Material & Methods (contd.)

Inclusion Criteria:
Patients with non-descent uterus with
- Chronic PID
- DUB
- Adenomyosis.
- Fibroid- up to 20wks GA.
Material & Methods (contd.)

Exclusion Criteria:
- Malignancy of uterus & cx.
- Suspected dense adhesion in the pelvis.
- Complex adnexal mass including
endometriosis.
- Android pelvis.
Material & Methods (contd.)
Operative technique.

Instruments trolly
Material & Methods (contd.)
Operative technique.

150 – 200 ml normal saline with or without adrenaline was
injected in the loose vaginal submucosa,1-2 cm away the
os.both anteriorly & lateraraly but not posteriorly and
operative field becomes pale.
Material & Methods (contd.)
Operative technique.

A transverse incision given below the
bladder ridge & the area easily separable
during dissection
Material & Methods (contd.)

Data regarding age, parity, uterine size, peri-
operative blood loss ,duration of operation,
operative & post operative complication and
hospital stay were analyzed & evaluated.
All patients received a course of broad
spectrum antibiotics for 7days.
RESULTS
TABLE-1
PATIENTS CHARACTERISTIC

PARAMETER MEAN +/- SD

AGE 35.2 +/- 5.2 YERS

PARITY 4.17 +/- 1.5
TABLE II
INDICATION OF OPRATION
INDICATION NUMBER PERCENTAGE
(N=100)
CHRONIC PID 53 53
DUB 20 20
FIBROID 13 13
ADENOMYOSIS 7 7

ADNEXAL 5 5
MASS
CX. POLYP 2 2
TABLE III
UTERINE SIZE
SIZE OF UTERUS NUMBER PERCENTAGE
(WKS) (N=100)

6 GA 9 9
8 GA 31 31
10 GA 34 34
12 GA 12 12
14 GA 5 5
16 GA 5 5
18 GA 2 2
20 GA 2 2
TABLE IV
TYPES OF ANESTHESIA

ANESTHESIA Number Percentage
(N=100) %

G/A 17 17

SPINAL 83 83
TABLE IV
TYPES OF OPRATION
NAME OF OPRATION NUMBER PERCENTAGE
(N=100)

HYSTERECTOMY 84 84

HYSTERECTOMY 11 11
WITH UNIL. SO

HYSTERECTOMY 5 5
WITH BILAT. SO
TABLE IV
SURGICAL RESULT
PARAMETARS
EASY DISSECTION 91 %
DIFFICULT DISSECTION 8%
MEAN DURATION OF OPN (min) 35.5 +/- 15.3

MEAN BLOOD LOSS (ml) 166 +/- 55
MEAN HOSPITAL STAY (day) 3.1 +/- 1.1

CONVERSION IN TO LAPROTOMY 0
DIGNOSTIC & OPERATIVE LAP. 6%
TABLE IV
SURGICAL COMPLICATION
COMPLICATION NUMBER PERCENTAGE
(N=100)
INT.OP.HAEMORRHAGE 1 1
BLADDER INJURY 2 2
URETER INJURY 0 0
BOWEL INJURY 0 0
POST.OP.HAEMORRHAGE 1 1
VAULT HEAMOTOMA 4 4
UNEXPLINE FEVER 6 6
VAULT ABSSES 1 1
VAGINAL DISCHARGE 7 7
TABLE V
CONCOMITANT SURGICAL OPERATION

NAME OF OPN. NUMBER PERCENTAGE

ANT.-POST.COLPO. 6 6

POST.COLPO. 5 5

TVT 5 5
Discussion
Main problems in NDVH :
Inadequate vaginal access .
Enlarged uterus.
Inadequate access to overies.
Discussion (contd.)

The aim of this study was determined the
outcome of acceptability of aqua dissection in
NDVH.
Normal saline with or without adrenalin
compress the minute vessels and making the
operative field blood less. & easily separable.
That is why the ultra modern concept of aqua
dissection in NDVH is better than conventional
technique.
COMPRISONS

ABDOMINAL HYSTERECTOMY AQUA DISSECTION NDVH
With stitch stitch less

SCAR ON ABDOMEN 4 to 6 inch scar No scar
DURATION OF OPN. 90-150 minutes 25 - 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 45 Days 7 days
Discussion (contd.)
There are many studies with using
vasopressin in the NDVH operation but it
associate with infection and potential
adverse cardiovascular effect.
But aqua dissection in vaginal
hysterectomyis associated with
decreased blood loss, does not
increase risk of infection, and
decrease operative time.
Conclusions
-Aqua dissection in NDVH is a
simplication of vaginal
hysterectomy .
-This is a inovative technique that
minimized the bleeding during
operation
-It is safe and economically
acceptable for patient compliance