Tariq Miskry

Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse.

Background. To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse.

Mass closure: a new technique for closure of the vaginal vault at vaginal hysterectomy

A variety of methods of management of the vaginal vault have been described, all of which maintain certain principles. In techniques that advocate closure of the vault, the peritoneum and vaginal epithelium are treated with separate sutures. This leaves a potential space above the vaginal closure. We describe a simple technique of mass closure which obliterates this space and incorporates the pedicles to provide support for the vault. This method may hold potential advantages in terms of haemostasis, risk of vault haematoma, and post‐operative vaginal cuff infections.

Sonographic Comparison of Pelvic Collections After Abdominal, Vaginal, and Laparoscopic Hysterectomy

The objective was to compare the relative incidence of early pelvic vault collections using transvaginal ultrasound after abdominal, vaginal, and laparoscopic hysterectomy, in a prospective comparative study. A transvaginal pelvic ultrasound was performed on the second and third postoperative days to determine the presence and volume of fluid collections at the vaginal vault, and febrile morbidity noted. Fifty women were studied: 15 after abdominal hysterectomy, 23 after vaginal hysterectomy, and 12 after laparoscopically assisted vaginal hysterectomy. Seven vault collections were identified (14%). No statistically significant association was identified between the presence or size of pelvic collections and the type of hysterectomy, concurrent oophorectomy, operative time, or estimated blood loss. Two of the seven women with vault collections had postoperative pyrexia (p = 0.02). Vaginal vault collections were relatively uncommon, often asymptomatic, and similar between the three routes of hysterectomy.

Incisional hernia involving a fallopian tube and mimicking scar endometriosis

A 38-year-old gravida 2, para 2, presented 9 months after cesarean with a tender swelling at one end of the Pfannenstiel incision, associated with cyclical abdominal wall bruising every 4 weeks. Her obstetric history included a primary cesarean for fetal distress in 1996, with delivery of a 3000-g male infant in good condition. Postpartum hemorrhage was treated by curettage 15 days postcesarean with subsequent development of secondary amenorrhea due to dense intrauterine adhesions. Hysteroscopic lysis of adhesions was done. Postoperatively, the woman was prescribed 30 mg of oral, cyclical estrogen 21 of 28 days for 2 months. Despite continuing amenorrhea, she conceived spontaneously 3 months later, but at 26 weeks’ gestation, antepartum hemorrhage occurred, and a 616-g male with Apgar scores of 4 and 4 at 1 and 5 minutes, respectively, was delivered by emergency lowsegment cesarean through a Pfannenstiel incision. The infant died 10 days postpartum. At cesarean, the uterine cavity was free of adhesions, ovaries and tubes were in a normal position and condition, and the parietal peritoneum was not sutured. There were no postoperative complications, but she presented 9 months later with an incisional mass and secondary amenorrhea. On examination, there was a 2-cm, fixed, tender, soft mass below the right end of the abdominal scar surrounded by a 12-cm area of bruising. The differential diagnoses included scar endometriosis and incisional hernia. At surgery, cervical stenosis was noted and, after dilatation, some old blood was released from the uterine cavity. Hysteroscopy showed a normal cavity other than complete obliteration of the left tubal ostium, which was not treated. Laparoscopy to evaluate tubal patency found an 8-cm hematosalpinx of the right fallopian tube with the distal end herniated through a fascial defect in the prior abdominal wall incision. A 4-cm abdominal incision was made over the mass, and the tube was dissected free, dropped back into the pelvis, and the hernia in the rectus sheath was repaired. After that, chromopertubation confirmed a patent right fallopian tube and a proximal block on the left side. There were no postoperative complications. Four months after surgery, the woman was having normal, cyclic menses and was trying to conceive.