hysterectomy for the massive leiomyomatous uterus
DESCRIPTION
obgynTRANSCRIPT
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Oleh : Nesatelge Ginting
HYSTERECTOMY FOR THE MASSIVE LEIOMYOMATOUS UTERUS
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INTRODUCTION
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•Benign smooth muscle neoplasm in the uterine organ
What is uterine leiomyomatous?
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Epidemiology Often found in women of reproductive age (20-25%).
The prevalence increased by more than 70% after pathologic anatomy of the uterus done.
Turned into a malignancy about (<1%).
Figures on the incidence above 35 years of age about 40%
In Indonesia myoma uteri 2,39%-11,87% of all ginecological patients who were treated.
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RISK FACTOR
AGE AT MENARCHE
PARITY
RACE
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WHERE DO UTERINE FIBROIDS GROW?
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COMMON SYMPTOMS
Bleeding between periods,
pelvic pain or “fullness,”
infertility
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THE MANAGEMENT OF UTERINE LEIOMYOMAS
Medical management
Surgical management
Conservative Surgical Therapies
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•From Greek, hystera "womb" and ektomia "a cutting out of“.
•The surgical removal of the uterus
What is hysterectomy?
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HOW IS A HYSTERECTOMY PERFORMED ?
Abdominal hysterectomy. Vaginal hysterectomy
Laparoscopic hysterectomy
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TYPE OF HYSTERECTOMY
Subtotal hysterectomy
Total hysterectomy
Total hysterectomy and bilateral or unilateral salpingo-oophorectomy
Radical or Wertheim’s hysterectomy
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INDICATION
BENIGN DISEASE
PRE-INVASIVE NEOPLASTIC DISEASES
INVASIVE DISEASE
ACUTE CONDITIONS
OTHER INDICATIONS
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To determine if the complication rate of abdominal hysterectomy is increased in
women with greatly enlarges myomatous uteri
Objective
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THREE GROUP OF WOMAN UNDERGOING ABDOMINAL HYSTERECTOMY
Group 1• 208 women• Weight of uteri less than 500 gr
Group 2• 63 women• Uterine weights of 500 – 999 gr
Group 3• 47 women• Uteri weight at least 1000 gr
Material
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METHODS
• Used to compare the group for : know the RISK for having at least one major operative complication
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The complication rate from hysterectomy increases with increasing
uterine weight, due mainly to an increased blood loss associated with
surgery for larger uteri.
CONCLUTION
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REFERENCE
• 1. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, MorrowB,KiekeBA,etal.Hysterectomysurveillance—United States, 1980-1993. Morb Mortal Wkly Rep CDC Surveill Summ 1997;46(SS-4):1–16.
• 2. Friedman AJ, Haas ST. Should uterine size be an indication for surgical intervention in women with myomas? Am J Obstet Gynecol 1993;168:751–5.
• 3. Reiter RC, Wagner PL, Gambone JC. Routine hysterectomyforlargeasymptomaticuterineleiomyomata:Areappraisal. Obstet Gynecol 1992;79:481–4.
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• 4. Hillis SD, Marchbanks PA, Peterson HB. Uterine size and risk of complications among women undergoing abdominal hysterectomy for leiomyomas. Obstet Gynecol 1996; 87:539–43.
• 5. Flickinger L, D’Ablaing G, Mishell DR. Size and weight determinations of nongravid enlarged uteri. Obstet Gynecol 1986;68:855–8.
• 6. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM.Uterineleiomyomas:Racialdifferencesinseverity,symptoms, and age at diagnosis. J Reprod Med 1996;41:483–90. 1274 Unger et al