AQUA DISSECTION IN NON-DESCENT VAGINAL

HYSTERECTOMY (100 CASES)

- AN OBSERVATION OF FENI PVT. HOSPITAL,

BANGLADESH.

DR MOHAMMAD ABDUL QUAYYUM

FCPS

Chief Consultant (Gynae),

Feni Private Hospital, Feni
Bangladesh.
 INTRODUCTION

Hysterectomy is the major gynecological operation.

During vaginal hysterectomy operation adequate

haemostasis is the important issue because it
associated with significant morbidity.
 MATERIAL AND METHODS

It was a retrospective study conducted

at the Feni pvt. hospital in Bangladesh.
One hundred patients of non- descent
uterus requiring hysterectomy were
included in this study.
The patients were selected on the
basis of questioner, clinical
examination & counseling.
The preference of anesthesia was
determined by anesthesiologist .
MATERIAL AND METHODS(CONTD)

Inclusion Criteria:
Patients with non-descent uterus with
- Chronic PID
- DUB
- Fibroid- up to 20wks GA.size.
- Adenomyosis.
 MATERIAL AND METHODS(CONTD.)

Exclusion Criteria:
- Malignancy of uterus & cx.
- Suspected dense adhesion in the pelvis.
- Complex adnexal mass including
endometriosis.
- Android pelvis.
- Uterine prolapse.
MATERIAL AND METHODS(CONTD.)

Operative technique.

Instruments trolley
 MATERIAL AND METHODS(CONTD.)
Operative technique.

150 – 200 ml normal saline with or without adrenaline was

injected in the loose vaginal submucosa,anterolaterally,1-2 cm
away the os. but not posteriorly and operative field becomes
pale.
MATERIAL AND METHODS(CONTD.)
Operative technique.

A transverse incision given below the

bladder ridge & the area easily separable
during dissection.
MATERIAL AND METHODS(CONTD.)
Operative technique.

VIDEO PRESENTATION
MATERIAL AND METHODS(CONTD.)

Data regarding age, parity, uterine size,

operative blood loss ,duration of
operation, operative & post operative
complications and hospital stay were
analyzed & evaluated.
All patients received a course of broad
spectrum antibiotics for 7days.
 RESULTS
TABLE-1
PATIENTS CHARACTERISTIC

PARAMETER MEAN +/- SD

AGE 35.2 +/- 5.2 YERS

PARITY 4.17 +/- 1.5

 RESULTS
TABLE II
INDICATION OF OPRATION

INDICATION NUMBER PERCENTAGE

(n=100) %
CHRONIC PID 53 53
DUB 20 20
FIBROID 13 13
ADENOMYOSIS 7 7
ADNEXAL MASS 5 5
CX. POLYP 2 2
 RESULTS
TABLE II
UTERINE SIZE
SIZE OF UTERUS NUMBER PERCENTAGE
(WKS) (n=100) %
6 GA 9 9

8 GA 31 31
10 GA 34 34
12 GA 12 12
14 GA 5 5
16 GA 5 5
18 GA 2 2
20 GA 2 2
 RESULTS
TABLE II
TYPES OF ANESTHESIA

ANESTHESIA NUMBER PERCENTAGE

(n=100) %

G/A 17 17

SPINAL 83 83
 RESULTS
TABLE V

TYPES OF OPRATION

NAME OF OPRATION NUMBER PERCENTAGE

(n=100) %
HYSTERECTOMY 84 84

HYSTERECTOMY WITH 11 11
UNIL. SO

HYSTERECTOMY 5 5
WITH BILAT. SO
 RESULTS
TABLE V

SURGICAL RESULT

PARAMETARS
EASY DISSECTION 91 %
DIFFICULT DISSECTION 8%
MEAN DURATION OF OPN (min) 35.5 +/- 15.3

MEAN BLOOD LOSS (ml) 166 +/- 55

MEAN HOSPITAL STAY (day) 3.1 +/- 1.1

CONVERSION IN TO LAPROTOMY 0
DIGNOSTIC & OPERATIVE LAPS. 6%
 RESULTS
TABLE VII

SURGICAL COMPLICATION
COMPLICATION NUMBER PERCENTAGE
(n=100) %
INT.OPER. HAEMORRHAGE 1 1

BLADDER INJURY 2 2
URETER INJURY 0 0
BOWEL INJURY 0 0
POST.OP.HAEMORRHAGE 1 1
VAULT HEAMOTOMA 4 4
UNEXPLINE FEVER 6 6
VAULT ABSCESS 1 1
VAGINAL DISCHARGE 7 7
 DISCUSSION

The aim of this study was to determined the

outcome of aqua dissection in NDVH.
Normal saline with or without adrenalin
compress the minute vessels and making the
operative field relatively blood less & easily
separable.
That is why the ultra modern concept of aqua
dissection in NDVH is better than conventional
technique.
 DISCUSSION (CONTD)
COMPARISON

ABDOMINAL HYSTERECTOMY AQUA DISSECTION NDVH

With stitch stitch less
SCAR ON ABDOMEN 4 to 6 inch scar No scar
DURATION OF OPN. 90-150 minutes 25 - 45 minutes
ANAESTHASIA Long duration Short duration
BLOOD LOSS Moderate to heavy Very minimum
TRANSFUSION Required Rarely required
POST OPN. PAIN Yes Very minimum
HOSPITAL STAY 7 Days 24 to 72 hours
REST 45 Days 7 days
DISCUSSION (CONTD)
There are many studies with using
vasopressin in the NDVH operation
but it associated with infection and
potential adverse cardiovascular
effect.
But aqua dissection in vaginal
hysterectomy associate with
decreased bleeding during operation
and it does not increase risk of
infection and operative time.
 CONCLUSIONS
Aqua dissection in NDVH is a
simplification of vaginal hysterectomy.
This is a innovative technique that minimized the
bleeding during operation.
It is safe and economically acceptable for patient
compliance.
The best route for hysterectomy in case of non-
descent uterus is the vaginal route.