Which Body Cavity Would Be Open To Perform A Hysterectomy - T-Tees - Your Answers Await, Life's Questions Unraveled

Complications

We can categorize the most common complications of hysterectomy into infectious causes, venous thromboembolic disease, injury to the genitourinary and gastrointestinal tracts, bleeding, nerve injury, and vaginal cuff dehiscence.[24] Additional potential complications after an abdominal hysterectomy include pelvic organ prolapse, pelvic organ fistula, urinary incontinence, and intestinal ileus. As with any surgery requiring general anesthesia, there is also the risk of adverse reactions to anesthetics. Abdominal hysterectomy has been determined to have higher odds of postoperative complications within 30 days of surgery and an overall higher risk of complications when compared to other minimally invasive techniques of hysterectomy such as laparoscopy.[25] The most common complications of abdominal hysterectomy are described below:

You may be interested

Infection

You are viewing: Which Body Cavity Would Be Open To Perform A Hysterectomy

The most common infections identified after a hysterectomy include vaginal cuff cellulitis, pelvic abscess or infected hematoma, wound infection, and urinary tract infection. The risk of infection increases with operative times that exceed 3 hours, lack of preoperative antibiotics, and patient factors such as comorbid medical conditions, compromised immune status, obesity, and poor nutrition.[24] Vaginal cuff cellulitis presents late in the hospital course or soon after discharge. Patients can be asymptomatic with spontaneous resolution of the inflammation or can present with fever, purulent vaginal discharge, pelvic pain, and exam findings of tenderness or induration at the vaginal cuff.[26] These findings can be differentiated from those of infected pelvic hematoma or abscess, which tend to present later after discharge from the hospital, with symptoms of pelvic pain, fever, and rectal pressure, and exam findings of a fluctuant, tender mass, or purulent discharge at the vaginal cuff.[24]

Refer to more articles: Which Action Is The Best Example Of A Civic Responsibility

Venous Thromboembolism (VTE)

Patients undergoing major gynecological surgery have a significant risk of developing deep venous thrombosis (DVT) and pulmonary embolism (PE) when no thromboprophylaxis is given. The incidence of DVT after gynecologic surgery has been found in some studies to be higher in open procedures and in patients with malignant conditions.[27] The exact incidence of VTE after hysterectomy is difficult to approximate, as many cases go unrecognized. The risks of thromboembolic events must be balanced against the potential risk of major perioperative bleeding. Thromboprophylaxis is only recommended for patients undergoing gynecological surgery who are considered to be at increased risk of VTE.[28]

Genitourinary and Gastrointestinal Tract Injuries

Injury to the genitourinary tract during pelvic surgery, while rare, can lead to a high risk of patient morbidity. Studies have indicated radical hysterectomy as the most common type of pelvic surgery associated with urologic complications.[29] The bladder is injured more frequently than the ureters. A review of urinary tract injuries during benign gynecologic surgery found lower rates of bladder injury after abdominal hysterectomy than after laparoscopic and vaginal approaches, consistent with other studies within the literature.[30] Injury to the bladder occurs most commonly during dissection within the vesicovaginal plane, whereas injury to the ureter is most common to occur during dissection along the pelvic sidewall, particularly when encountering the infundibulopelvic ligaments where the ovarian vessels are ligated, but also during ligation of the uterine vessels and at the bladder base.[24] While injuries to the bladder and ureter may be noted during surgery, injury to the serosal layer of the bladder may go unnoticed during surgery if the defect in the bladder wall is not full-thickness, and delayed presentation of vesicovaginal fistula can occur.[31] GI tract injuries during an abdominal hysterectomy can occur via thermal injury, direct mechanical damage, and indirectly through interruption of vascular supply.

Refer to more articles: Which Dove Deodorant Smells The Best

Bleeding

Abdominal hysterectomy is associated with more bleeding than the other routes of hysterectomy, with an average blood loss of 400mL. Studies have shown that estimated blood loss above this caliber is associated with increased risks of major postoperative complications and increased hospital stay.[32]

Nerve Injury

Damage of the femoral nerve is the most common cause of neuropathy described after pelvic surgery, and the most common site of injury is at the anterior surface of the psoas muscle from direct compression by a self-retained retractor and at the inguinal canal from indirect stretch injury while the patient is in the prolonged dorsal lithotomy position.[33] Other nerve injuries include the iliohypogastric and ilioinguinal nerves at the level of the anterior abdominal wall during laparotomy or excessive stretching of the fascia, the obturator nerve from an inadvertent crush injury by clamps or excessive stretching, and rarely, the peroneal nerve due to positioning of the legs in the stirrups.

Vaginal Cuff Dehiscence

Cuff separation can occur within days of surgery or years later. The separation may be along the entire length or localized to a portion of the vaginal incision and can be of partial- or full-thickness. The most feared complication associated with vaginal cuff dehiscence is the evisceration of intraperitoneal contents through tissue separation. Total abdominal hysterectomy has been associated with a lower risk of vaginal cuff dehiscence compared to laparoscopic procedures.[34]

Source: https://t-tees.com
Category: WHICH