Vaginal hysterectomy. Study of early discharge and implications 

Authors: S. N. M. Youssif; R. S. Ledward  

Affiliation: South-East Kent Health District,

Published in: Journal of Obstetrics and Gynaecology, Volume 13, Issue 5 September 1993 , pages 355 - 357 

Subject: Obstetrics, Gynecology & Women's Health 

Abstract:  Early postoperative discharge (48-72 hours) was planned for 20 patients in whom vaginal hysterectomy was performed for indications other than utero-vaginal prolapse. All were thought to be fit for early discharge from hospital to their homes under family doctor and district nurse care. One patient was readmitted 10 days after the operation with deep venous thrombosis, treated with heparin and then warfarin, and discharged seven days later. Another patient was readmitted 14 days after the operation with vaginal cuff infection, treated with antibiotics, and discharged three days later.   We believe early discharge (48-72 hours) after vaginal hysterectomy is safe and economical. Implications are discussed. 

 

Sacrospinous colpopexy as prophylactic and therapeutic treatment of vaginal vault prolapse after hysterectomy 

Authors: S. N. M. Youssif, Jamila Shahid                                                                                                                                                           

Affiliation: Obstetrics and Gynaecology Department, Norfolk and Norwich Hospital, Norwich

Published in: Journal of Obstetrics and Gynaecology , Volume 15, Issue 5 September 1995 , pages 311 - 315 

Subject: Obstetrics, Gynecology & Women's Health 

Abstract To evaluate the effectiveness of fixing the vaginal vault to the strong and immobile sacrospinous ligament when combined with traditional repairs of procidentia and vaginal vault prolapse, 20 patients with genital prolapse who needed vaginal hysterectomy and repair, or repair of vault prolapse, were studied.   Intra-operative and postoperative complications were minimal. Vaginal axis and depth were restored. Vaginal function was maintained. Discomfort was relieved. Dyspareunia did not occur. Incidence of recurrent prolapse or vaginal laxity was low when assessed after one year. All patients were satisfied.   Sacrospinous colpopexy should be added to traditional repairs to treat procidentia and with vault prolapse repairs to prevent recurrent vaginal vault prolapse. 

 

Outpatient endometrial biopsy: the pipelle

Author: Youssif SN , McMillan DL 

Affiliation: Department of Obstetrics and Gynaecology, Whipps Cross Hospital, London.

Published in: British journal of hospital medicine 1995 Sep 6-19

Subject: Obstetrics, Gynecology & Women's Health

Abstract: The pipelle endometrial biopsy (EB) is accurate, safe, economical and acceptable to patients, clinicians and pathologists. Transvaginal sonography can reduce the number of EBs needed, and when both techniques are used together the sensitivity and specificity in the diagnosis of endometrial adenocarcinoma reach 100%. Hysteroscopy and dilatation and curettage are indicated in the minority of patients under the age of 40 years.

 

Early discharge after hysterectomy for benign diseases by mini-laparotomy 

Author: S. N. M. Youssif  

Affiliation: Obstetrics and Gynaecology Departments, The Ipswich Hospital, Ipswich; and The County Hospital, Hereford

Published in: Journal of Obstetrics and Gynaecology, Volume 15, Issue 6  November 1995 , pages 401 - 405 

Subject: Obstetrics, Gynecology & Women's Health 

Abstract: To determine the safety and feasibility of total abdominal hysterectomy for benign diseases through a mini-laparotomy (40-75 mm) incision and discharge 48 hours after operation a prospective study of 60 patients with benign uterine conditions for whom surgical treatment was indicated was planned. Main outcome measures included intra-operative complications, duration of operation, postoperative complications, postoperative hospital stay, amount of analgesia needed, hospital readmission, scar length, patient satisfaction and ability for early return to work. Forty-two patients (70 per cent) were discharged home 48 hours postoperatively; eight patients (13%) at 60 hours, eight patients (13%) at 72 hours and two patients (3%) at 84 hours postoperatively. There were no intra-operative complications and post-operative complications were minimal. No patient required hospital readmission. On a simple four item questionnaire, nearly all patients were happy regarding the entire experience particularly the home visit by a nurse after 6 days, the small scar and early discharge. 

 

Outpatient Endometrial Biopsy

Author: Botros Rizk, Johan Smitz, Serag N. M. Youssif, , Afifa Halim Kirolos, , Magdy Ragheb, Samy Saleeb

Published in: Middle East Fertility Sterility Journal: Volume 2, No 2, 1997

Subject: Obstetrics, Gynecology & Women's Health

Objective: Our first objective is to review and critically analyze the published data comparing the different modalities of endometrial biopsies. Our second objective is to integrate the sonographic findings in the clinical management to rationalize the use of endometrial biopsy.

Study design: The study was designed to review endometrial biopsy from the gynecologist, patient and pathologist perspectives. Major studies comparing the Novak, Vabra and Pipelle endometrial biopsies were analyzed. Studies addressing the use of transvaginal sonography in the evaluation of the pre- and postmenopausal patients were incorporated. 

Conclusions: The results are reported in three different groups of patients. In patients undergoing endometrial biopsy for endometrial dating, large studies comparing the Novak curette with the Pipelle suction curette showed comparable efficacy in terms of tissue adequacy. However, the pain experienced was significantly less with the Pipelle. In patients with abnormal uterine bleeding, larger samples of patients were analyzed. In comparison to Vabra curettage, Pipelle had a higher rating according to the gynecologists, pathologists and patients satisfaction. In comparison of the percentage of endometrial surface evaluated, the Vabra aspirator had a significantly higher success than the Pipelle. The Pipelle was equally effective to the Novak curette and to the Tiss U-Trap. In patients diagnosed with or suspected to have gynecological cancer, transvaginal sonography should be performed before any procedure. The cut-off limit for endometrial abnormality is positively related to the positive predictive value of the ultrasound testing. Most authors would agree that a cut-off limit of 5 mm is satisfactory. In patients with known endometrial cancer, the Pipelle had 97.5% sensitivity. Hysteroscopy, dilatation and curettage should be performed if the endometrial cavity could not be negotiated. 

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