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Be Selective in Hysterectomy Performed for Menometrorrhagia


 

SAN DIEGO — Identify and treat abdominal pelvic pain or dyspareunia originating from bladder problems before performing supracervical hysterectomy for menometrorrhagia, Maurice K. Chung, M.D., advised at an international congress of the Society of Laparoendoscopic Surgeons.

By selecting only patients who are free of pain and dyspareunia and by transecting the uterus and part of the upper cervix, he said, postoperative spotting or bleeding can be avoided.

Patients who still have abdominal pelvic pain or dyspareunia after management of bladder problems should not be candidates for supracervical hysterectomy because of the risk that pain symptoms will persist after the procedure, leading to a second surgery to remove the cervix, said Dr. Chung, who has a private practice in Toledo, Ohio.

He reported on 42 laparoscopic supracervical hysterectomies he performed for menometrorrhagia from 2002 to 2004. Of the 42 women, 13 also presented with abdominal pelvic pain and dyspareunia underwent potassium sensitivity tests, which were positive in 12 patients, pointing to bladder problems as the cause of the pain. He treated all 13 medically for bladder problems until they were pain free before proceeding to laparoscopic supracervical hysterectomy.

Thirteen of the 42 patients had adenomyosis, and 6 of those had symptoms of abdominal pelvic pain or dyspareunia, in addition to menometrorrhagia. Five of the six had positive potassium-sensitivity tests, and medical treatment resolved their pain before proceeding to surgery.

The laparoscopic supracervical hysterectomies included endoscopic suturing of the bilateral ascending uterine arteries at the mid-cervix. Patients were followed for 6 months to 2 years.

In general, about 10% of women who undergo laparoscopic supracervical hysterectomy report postoperative spotting or bleeding. Twelve women in the current study underwent concomitant bilateral salpingo-oophorectomy. No bleeding or spotting would be expected after this surgery unless the patient started hormone therapy.

None of the 42 patients reported any postoperative bleeding or spotting, which Dr. Chung said was most likely due to a careful selection of patients. Selecting patients for surgery who have only menometrorrhagia will increase the rate of amenorrhea, he said.

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