8surgical management of dysfunctional uterine bleeding- kabilan
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8/9/2019 8surgical Management of Dysfunctional Uterine Bleeding- Kabilan
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SURGICAL MANAGEMENT OF
DYSFUNCTIONAL UTERINE
BLEEDING
K.KABILAN
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SURGICAL MANAGEMENT OF DUB
DUB is usually controlled by medical line of
management
The need for surgical management ariseswhen there is a failure in medical line of
management
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An overview o Management o
Menorrhagia
Menorrhagia
Young women Older women
Pregnancy desired Pregnancy not desiredRule out uterine pathology and cancer
Progestogens
EthamsylateNSAIDGnRH 3-4 months
COC
Progestogens
Mirena
Effective Fails
Continue for 6-9
months and
follow up
MIS
Hysterectomy
with conservation
of ovaries
Normal uterus(DUB)
Uterine pathology
Surgery
Medical theraphy
COC contraindicated
over 40 years
No response
Hysterectomy with
oopherectomy after
50 years (No MIS)
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SURGICAL MODALITY
Hysterectomy
Abdominal
VaginalLaproscopic
Laproscopic assisted vaginal hysterectomy
Ovaries must be preserved in patients agebelow 50yrs
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Indications
Failure of medical line of management and
MIS.
Family history of uterine malignancy. Premalignant endometrial pathologies.
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ABDOMINAL HYSTERACTOMY
Abdominal hysterectomy is preferred when
extensive adhesions are anticipated
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Advantages:
Good access and better visualisation.
Technically easy.
Less time consuming.
No need of advanced instrumentation as in
laproscopic procedure
P.Op bleeding and bladder injury are less in
compare to vaginal hysterectomy
Anatomical relations not altered.
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Disadvantages:
Patient recovery prolonged.
Prolonged hospitalisation. Incisional pain.
P.Op wound infection.
Uretral injury. Risk of developing hernia.
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VAGINAL HYSTERECTOMY
This approach prefferedwhen extensiveadhesions are not
anticipated.
Pre-requesties: Uterus size
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Advantages:
Faster recovery Reduced hospital stay
No risk of developing hernia
Peritoneum minimally opened, no bowelhandling hence less post operative illness
Bowel function returns soon
Quick ambulation
Less post-operative infection
Least invasive route
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Disadvantages:
Pelvic infection
Vesical injury, fistula Vaginal shortening and stenosis
Recurrent cystocele, rectocele, entrocele
Vault prolapse P.Op bleeding Haemorrhagic shock
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LAPROSCOPIC HYSTERECTOMY
&
LAVH
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Advantages:
Faster patient recovery
Reduced hospital stay
Less post operative pain
Less wound infection
Provides better visualization and access to
abdomen and pelvis
Disadvantages:
Time consuming
Expensive
Require better surgical skills
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