LAVH or TAH – choosing it wise and making it safe

Background: Hysterectomy is the most commonly performed surgery in our gynaecological practice, abdominal route being the most common. Here we compare the various features and outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH).Methods: The study design is a retrospective observational study. Outcome measures were indication, duration, complications of surgery, post op recovery and cost following TAH and LAVH.Results: A total of 116 cases underwent hysterectomy. Of these 98 underwent TAH and 18 underwent LAVH. Commonest indication for TAH in our study was fibroid followed by abnormal uterine bleeding (AUB); whereas in LAVH it was AUB followed by fibroid. Mean operating time in TAH was 118 minutes whereas in LAVH it was 166 minutes. One patient who underwent LAVH had ureteric injury and another had vault abscess. There were no major complications among TAH cases. A few patients had minor complications like fever, wound infection and urinary tract infection following TAH whereas fever was the only minor complication seen in a minority of the LAVH patients. Mean fall in haemoglobin in TAH was 1.05 gm% whereas in LAVH it was 0.95 gm%. None of the patients required postoperative blood transfusion. A few patients following TAH required additional analgesics apart from routine whereas in LAVH none required it. Mean duration of hospital stay following TAH was 6.84 days where as in LAVH it was 3.1 days. Mean hospital expenses in TAH were INR 28480, while for LAVH it was 44360.Conclusions: Undoubtedly expertise is the decisive factor behind the success of hysterectomy. LAVH though advantageous in many aspects like less post operative pain and cosmetic benefits, it could be technically demanding with availability only in well-equipped centres and cost factors. Surgeons need to be trained in all modalities of hysterectomy

Comparison Between Pap Smear and Via As Screening For Cervical Lesions

Introduction: An important reason for higher cervical cancer incidence in developing countries is lack of effective screening programs like pap smear, aimed at detecting precancerous conditions before they progress to invasive cancer. The potential difficulties in implementing cervical cytology based screening in low-resource settings have prompted the investigation of accuracy of alternative low technology tests such as Visual inspection with acetic acid application [VIA], Visual inspection with acetic acid application with magnification [VIAM], visual inspection on Lugol’s Iodine application [VILI] in early detection of cervical neoplasia .In our study we compared pap smear with VIA to study the accurarcy of VIA as it is simpler and easier technique to be used as screening in low resource settings. Aim: This is a hospital based descriptive, prospective study to evaluate validity of pap smear and VIA techniques as screening tests in identifying cervical lesions. Materials And Methods: After general and systemic examination as a routine,visual local pelvic examination including visualisation of cervix and vagina per speculum and the findings are documented in the proforma .Then VIA and pap smear are done in that order, if any of these tests are positive then cervical biopsy will be taken and further advise to the subject is given. Results: A total of 313 women were involved in the study. The sensitivity of pap smear is 54.5% specificity is 98.9% while that of VIA 95.4% and 97.9%respectively. We found that VIA accuracy was comparatively more than that of pap smear. Conclusion: In low resource settings, usefulness of VIA is more than that of pap smear. We suggest to perform VIA in all the women inspite of having pap smear facility to improve detection rate of cervical lesions and provide better patient councelling and treatment