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Laparoscopic Hysterectomy could increase conplication to patient
Thu - November 3, 2016 5:02 am  |  Article Hits:1547  |  A+ | a-
A study that analysed 32,000 operations in three countries, found that one in 67 - 1.5 per cent - vaginal and laparoscopic ‘keyhole’ hysterectomies had to be ‘converted’ to open surgery during operations, increasing the risk of ill health afterwards. Meghana Pandit, a consultant gynaecologist, Chief Medical Officer and Deputy Chief Executive of University Hospitals Coventry and Warwickshire NHS Trust, said women undergoing surgery needed to be aware of the risks associated with the different methods of performing a hysterectomy, which could leave them needing further operations or with longer-term health problems. The research - the largest ever international study of its kind – looked at hospital data from England, the USA and Australia collected by the healthcare data informatics company Dr Foster. Around 60,000 women undergo a hysterectomy each year in the UK. By the age of 60, one in five women in the UK and one in three in the USA are likely to have had a hysterectomy. All forms of hysterectomy are generally very safe, and death from surgery is extremely rare. But until now, no major international study has set benchmarks for the risk of ill-heath following an operation, of the three main types of procedure – abdominal, vaginal and laparoscopic hysterectomy. While a majority of hysterectomies - 53 per cent - continue to be performed abdominally by open surgery, the trend in recent years has been for more vaginal and laparoscopic procedures, which are less invasive and typically have a much shorter length of stay in hospital and faster recovery times. Younger women aged 30 to 60 are more likely to undergo these types of hysterectomy. Analysing over 32,000 cases of hysterectomy for benign diseases, the researchers examined the risk of ‘conversion’ – the need to switch to open surgery midway through an operation in the event of complications during vaginal or laparoscopic hysterectomy, such as major internal bleeding. They found that traditional abdominal hysterectomies carry the highest risk of bleeding and readmission to hospital within seven days, as well as having the longest average stay in hospital. But the study also identified that vaginal and laparoscopic hysterectomies had a 1.5 per cent incidence of conversion to open surgery during the operation (483 of the 32,181 cases studied), equivalent to 1 in every 67 operations. Conversion cases, moreover, carried by far the highest risk of bleeding. In turn, this can leave women needing further surgery or a blood transfusion, or with longer-term health problems, including wound infections and damage to surrounding organs such as the bowel or bladder. It can also leave them more prone to deep vein thrombosis or pulmonary embolism (a clot in the vein or lung). And the cost to the NHS of performing hysterectomy with complications can be as high as £12,278, which does not include costs from extra time in hospital. Professor Pandit said: “Most women choosing a hysterectomy do so because they want to improve their quality of life. “They may have suffered years of heavy periods, pelvic pain or prolapse and many are still relatively young and fit. So it’s very important that when a clinician is discussing hysterectomy options with their patient they tell them about morbidity risks associated with the different methods of hysterectomy. Patients should be clearly advised that conversion during surgery is associated with higher rates of problems afterwards. “We need to keep a close eye on conversion rates to ensure that it is a rare complication of surgery when needed, and not a common occurrence. If these conversions become frequent, it may indicate that the preoperative assessment was inadequate, case selection was incorrect or that there’s a training issue. “We suggest that all gynaecologists performing hysterectomy record their surgical morbidity outcomes using this study as a benchmark and use it to counsel women undergoing hysterectomy." David Rose, Chief Executive of Dr Foster, said: “This is an incredibly important piece of international research made possible through detailed analysis of data from leading hospitals around the world.” The research was published in the International Journal of Gynaecology and Obstetrics.
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