Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study of 30 cases

Background: Non-Descent Vaginal Hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. Objective of present study was to assess safety, feasibility of NDVH in patients with previous cesarean section.Methods: Retrospective study was conducted in department of Obstetrics and Gynecology of Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences, Dharwad, India from April 2008 to June 2016. Effort was made to perform hysterectomies vaginally in women with benign conditions with history of one, two or three caesarean sections. Information regarding age, parity, number of previous LSCS, uterine size, blood loss, duration of operation, difficulties in separating bladder, intra -operative, post-operative complications were recorded.Results: Total thirty cases were selected for NDVH with history of one, two and three cesarean sections. All successfully underwent NDVH, except one in which bladder injury occurred which was repaired at same time vaginally. Thirteen patients had previous one Lower Segment Cesarean Section (LSCS), sixteen had two LSCS and one had three LSCS. Commonest indication was abnormal uterine bleeding followed by leiomyoma of uterus. Mean duration of surgery was 97 min. Mean blood loss was 150 ml. Post-operative complications were minimal. Patient mobility, resumption of daily activities was fast. Mean hospital stay was 4-5 days.Conclusions: Vaginal hysterectomy is safe, cost effective method of hysterectomy in women with previous cesarean section scar requiring hysterectomy for benign conditions with fewer complications, shorter hospital stay and less morbidity

Modified purandare’s cervicopexy-a conservative surgery for genital prolapse: a retrospective study

Background: Purandare described a technique for the surgical treatment of genital prolapse in young women in 1965. This technique of cervicopexy is easy to perform and provides dynamic support to the uterus. The objective of study is to evaluate the role of modified Purandare’s cervicopexy in the treatment of genital prolapse in reproductive age group and to study the pregnancy outcome and fertility in patients who have undergone modified Purandare’s sling surgery.Methods: Between January 2007 and December 2015, 20 women in the reproductive age (mean age 30.5 years, range 24 to 37 years) underwent modified Purandare’s cervicopexy at Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences, Dharwad, India. Of these, 2 (10%) patients were nulligravida, 7 (35%) were primipara and 11 (55%) were multigravida. Four (20%) women had associated infertility. Additional surgeries like tubectomy were performed in 4 (20%) women, tubal patency test in 3 (15%), ovarian drilling in 2 (10%) and myomectomy in 2 (22.2%) women, and cystocele repair was done in 4 women (20%).Results: All 20 patients were analysed for intraoperative and postoperative complications. All were followed up for mean duration of 12 months. There were no reported intra or post-operative complications. Out of 4 infertile women, 2 conceived spontaneously 6 months after the surgery. Of these, one delivered successfully at term by lower segment caesarean section and other by normal vaginal delivery. One woman conceived 8 months after the surgery spontaneously, antenatally followed for 3 months and then later was lost to follow-up. There was no recurrence of prolapse.Conclusions: Nulliparous prolapse can be treated by various surgical procedures, each having their own merits and de-merits. Our modification of Purandare’s cervicopexy is simple, effective and is less technically demanding

Sacrospinous ligament fixation for prevention and treatment of vaginal vault prolapse: a retrospective study of 45 cases

Background: To assess intraoperative and postoperative complications and to evaluate recurrence of vault prolapse in women who have undergone unilateral (left) Sacrospinous ligament fixation.Methods: Between January 2007 and January 2015, 45 women (mean age 56.5 years, range 35 to 78 years) underwent vaginal unilateral (left) Sacrospinous ligament fixation at Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences, Dharwad, India. 15 patients had prior hysterectomy. Concomitant hysterectomy and Sacrospinous ligament fixation was performed in 30 patients. Sacrospinous ligament fixation was combined with additional procedures like Trans-Obturator tape (TOT) insertion in 2 (4.6%) patients.Results: All patients were analyzed for intraoperative and postoperative complications. 1 patient had Urinary tract infection (n=1, 2.2%), 1 patient had haemorrhage requiring blood transfusion (n=1, 2.2%). The mean follow up was for 15 months (range 6 months to 24 months). 1 patient (2.2%) had asymptomatic recurrent cystocele and 1 patient (2.2%) had dyspareunia. No recurrence of vault prolapse was noted.Conclusions: Sacrospinous ligament fixation is a simple, effective and safe procedure for treatment and prevention of vault prolapse with least complications and recurrence rates.

Surgical management of chronic fourth degree perineal tear: a single center experience

Background: The aim of this article is to present the ridge about the recognition, preoperative management, surgical technique and long term follow up of patients with chronic fourth degree perineal tear.Methods: Authors conducted a prospective study in the department of obstetrics and gynecology in SDM hospital of medical sciences from 2008 January to 2016 December. Data on age, parity, incontinence to flatus, solid or liquids stools, duration of symptoms, history of previous repair, duration of repair, post-operative stay, complications and recovery were collected and analyzed. A total of thirty cases of chronic perineal tear were studied.Results: A total of 30 patients underwent CPT repair. Average duration of surgery was 90 minutes. 27 out of 30 patients were discharged on post-operative day 10. Three patients were non-compliant to treatment. Of the total 30 patients, two patients were lost for follow up. Overall success rate was 93% including patients who underwent re-surgery for failed repair.Conclusions: The significant finding of the present study was that a secondary repair of an anal sphincter injury was not associated with an unfavorable subjective outcome in relation to symptoms of anal incontinence. A good insight of perineal and anal sphincter anatomy and adherence to the sound principles is essential. The success rate in this study is 93.3% highlighting that a diligently performed operation by a surgeon of adequate expertise likely results in satisfactory outcome

Sacrospinous ligament fixation for prevention and treatment of vaginal vault prolapse: a retrospective study of 45 cases

Background: To assess intraoperative and postoperative complications and to evaluate recurrence of vault prolapse in women who have undergone unilateral (left) Sacrospinous ligament fixation.Methods: Between January 2007 and January 2015, 45 women (mean age 56.5 years, range 35 to 78 years) underwent vaginal unilateral (left) Sacrospinous ligament fixation at Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences, Dharwad, India. 15 patients had prior hysterectomy. Concomitant hysterectomy and Sacrospinous ligament fixation was performed in 30 patients. Sacrospinous ligament fixation was combined with additional procedures like Trans-Obturator tape (TOT) insertion in 2 (4.6%) patients.Results: All patients were analyzed for intraoperative and postoperative complications. 1 patient had Urinary tract infection (n=1, 2.2%), 1 patient had haemorrhage requiring blood transfusion (n=1, 2.2%). The mean follow up was for 15 months (range 6 months to 24 months). 1 patient (2.2%) had asymptomatic recurrent cystocele and 1 patient (2.2%) had dyspareunia. No recurrence of vault prolapse was noted.Conclusions: Sacrospinous ligament fixation is a simple, effective and safe procedure for treatment and prevention of vault prolapse with least complications and recurrence rates.

Prevalence of metabolic syndrome in pre as well as postmenopausal women in a tertiary care center: A hospital based observational study

Background: Metabolic syndrome is a constellation of metabolic abnormalities and a complex  pre-disease  state that predicts future development of type 2 diabetes mellitus and cardiovascular diseases. Epidemiologically it is observed that incidence of metabolic syndrome increases with age and more so in women once they attain menopause. Objectives: To study the prevalence of metabolic syndrome in pre as well as post-menopausal women and to study the various components of metabolic syndrome. Materials and Methods: We performed an observational study in a tertiary care teaching institute. Women attending general health checkup were selected for the study A total of 484 women were selected. 267 were in the postmenopausal group and 217 in premenopausal group. After a detailed collection of demographic data, medical, surgical, obstetrical and gynecological history, general physical and systemic examination was done. Height, weight, waist circumference were measured. BMI was calculated. Venous blood sample sent for fasting blood glucose, HDL, Triglycerides. Metabolic syndrome was diagnosed when three out of five parameters were found abnormal. Results: Metabolic syndrome was seen in 158 women (32.6%). Among these women, 118 (44.19%) were postmenopausal women and 40 (18.4%) were premenopausal. Postmenopausal women are at twice the risk of developing metabolic syndrome

Solid pseudopapillary tumor of the pancreas

Solid pseudopapillary tumor of the pancreas is considered to be a rare pancreatic tumor. These tumors are typically present in women in their third decade of life. The tumors have a low malignant potential. We report a case of 22-year-old female who presented with intermittent abdominal pain of 3 years duration. Distal pancreatectomy with splenectomy was done as a definitive treatment. The importance of accurate diagnosis and treatment is emphasized

Clinical analysis of ectopic pregnancies in a tertiary care centre

Background: An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus.Almost all ectopic pregnancies more than 90% occur in a fallopian tube.As the pregnancy grows, it can cause the tube to rupture. A rupture can cause major internal bleeding. Objectives: to determine the incidence, clinical features, risk factors, treatment and outcomes associated with ectopic pregnancy in a tertiary level teaching hospital. Methods: The data was collected from the medical records section of the hospital. There were 162 cases of ectopic pregnancy diagnosed and treated in the hospital in the study period. Results: 40 patients with history of previous miscarriage had ectopic pregnancies (24.69%). Past history of undergoing lower segment caesarean section was observed in 35 patients (21.60%). Eight (4.9%) out of 162 patients had prior history of ectopic pregnancy. Prior history of tubectomy was seen in 21 (12.9%) patients. The triad of symptoms i.e. amenorrhoea, pain abdomen and per vaginal bleeding was found in only 53 patients (32.7%). The most common site of ectopic pregnancy was ampullary 110 (67.9%) followed by isthmic in 33 (20.3). Other rare sites of ectopic pregnancy noted in our study were 3 (1.8%) cases of caesarean scar pregnancy, one (0.6%) case of cervical pregnancy and 3 (1.8%) cases of ovarian pregnancies. 142 patients (87.65%) were primarily treated with various surgical procedures. Of these, 80 patients (49.38%) were treated with various open procedures, and 62 patients (38.2%) were treated with laparoscopic procedures. Of the 20 patients (12.34%) treated medically, 10 patients (6.17%) failed to respond to the treatment and had to undergo surgical procedure later. Anaemia was the most common complication and was seen in 57 patients (35.1%). Conclusion: Prevention of ectopic pregnancy is difficult because only few of the risk factors are modifiable. Tubal pathology carries the highest risks and pelvic inflammatory diseases plays a major role in tubal adhesions and obstruction. Physicians and patients awareness about the possibility and risk of extra and intra uterine gestation following all methods of sterilization is necessary

Prevalence of Metabolic Syndrome in Pre as Well as Postmenopausal Women in A Tertiary Care CENTER: A Hospital Based Observational Study

Background: Metabolic syndrome is a constellation of metabolic abnormalities and a complex  pre-disease  state that predicts future development of type 2 diabetes mellitus and cardiovascular diseases. Epidemiologically it is observed that incidence of metabolic syndrome increases with age and more so in women once they attain menopause. Objectives: To study the prevalence of metabolic syndrome in pre as well as post-menopausal women and to study the various components of metabolic syndrome. Materials and Methods: We performed an observational study in a tertiary care teaching institute. Women attending general health checkup were selected for the study A total of 484 women were selected. 267 were in the postmenopausal group and 217 in premenopausal group. After a detailed collection of demographic data, medical, surgical, obstetrical and gynecological history, general physical and systemic examination was done. Height, weight, waist circumference were measured. BMI was calculated. Venous blood sample sent for Fasting blood glucose, HDL, Triglycerides. Metabolic syndrome was diagnosed when three out of five parameters were found abnormal. Results: Metabolic syndrome was seen in 158 women (32.6%). Among these women, 118 (44.19%) were postmenopausal women and 40 (18.4%) were premenopausal. Postmenopausal women are at twice the risk of developing metabolic syndrome