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Discussion in 'All Categories' started by Akismet - Feb 19th, 2012 10:48 pm.
I hope you can help me. I have two questions.
1. I know there is laproscopy and advanced laproscopy. Please see my problem and what would work for the case.
2. is there anyone in South Africa that you can recommend for this operation

My mother aged 62, diabetic, hypertensive heart disease patient, high cholestrol, high blood pressure of which she is on chronic medication for all.

My mother has had 2 abnormal pap smears with ASCUS as a result over a year with 1 normal pap smear in the middle.

She has had fibroids in the Uterus lining for many years now. After menopause she was on hormone replacement therapy and the fibroids grew in size so she stopped the hormones and for many years the fibroids the largest measuring about 6cm have not increased in size. The largest located close to the liver aorta.

She also has a mild sagging uterus and a more sagging bladder that can be felt if a hand is placed by the vagina opening but is not hanging outside the vagina, it has not caused urine incontinence yet urine drips only if the bladder is full and she coughs or does excercise but if bladder is relieved, she is fine.

She has had infections for 2 years now on a regular basis and been on anti-biotics at least once every 6-8 weeks. There was blood in urine but after last cycle of antibiotics that stopped. Her urologist took a biopsy of the bladder a year ago and that was negative. But the bladder retains some urine that leads to infections.

We have been to many specialists of which some are professors. The specialists in gynecology and oncology have determined a probability of cancer to get a pap smear like this at this age. Since the uterus and bladder are sagging and blocking the cervix and uterus opening no tissue sampling was possible. I has suggested a hysterectomy pelvic repair while another suggested a biopsy to determine the need of a hysterectomy and the type of hysterectomy and a bladder repair if required seeing the bladder as the main problem after ruling out cancer

Specialists in obstetrics and gynecology and gynecology and endoscopy have indicated a need for a vaginal hysterectomy due to the prolapse in uterus that they believe is the main problem they dont think its cancer and that the bladder being a consequence of the enlarged uterus sagging. And whether to have a pelvic organ restructure is debatable. Some suggesting not to have an operation but rather monitor pap smears.

They have put her on osteregen vaginal cream to thicken the lining to prepare her operation.

The result of all the above is confusing. Since my mother is a high risk patient and her case complex it seems that more than one answer can be right. However we would like the best answer for her case. I have done research and found this new method used lift laperoscopy. It seems good as she is diabetic and this will help with healing. Do you carry this out At this stage we are looking at options for going abroad but if its for a better option for her.

Also with a normally normal sized uterus but large due to the fibroids can it be done this way Or do you suggest something else. Is it wrong to have the operation without a biopsy she does not want to go to theatre twice as in case it is cancer she will need to remove lymph nodes

I really hope you can help and advise what option would work for her. I know its difficult with out having seen the patient and that is why I have tried to provide as much information as I could. If this type of operation is possible please let me know side effects and how soon can she do it We dont know the urgency of the situation so the sooner the better.

My mum is a very active woman woman who is still sexually active.
Thanks or your help
re: Hysterectomy by Dr M K Gupta - Feb 25th, 2012 9:35 pm
Dr M K Gupta
Dr M K Gupta
Dear Akismet

Your mother need radical hysterectomy with lymphadenectomy. Radical hysterectomy involves surgical removal of the uterus, the supporting ligaments and the upper vagina, together with removal of the pelvic lymph nodes and sometimes the para-aortic lymph nodes. A standard radical hysterectomy is performed through an incision in the abdomen. Laparoscopic radical hysterectomy is a minimally invasive procedure that aims to achieve the same excision via a laparoscopic approach.

We don't have any idea about the surgeon in Africa who can perform this surgery.

With regards
M.K. Gupta
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