viernes, 18 de enero de 2019

Hysterectomy Complications

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By Liji Thomas, MDReviewed by Yolanda Smith, B.Pharm.

A hysterectomy is largely a low-risk surgical procedure. The most common complications of hysterectomy may be classified as follows:

Infections

These are the most common, and vary with the type of hysterectomy. Thus a vaginal hysterectomy is followed by some kind of infectious complication in up to 13 percent of patients, but only 9 percent after a keyhole surgery.

Venous thromboembolism

Though laboratory tests show that up to 12 percent of patients have a clotting episode, clinical symptoms occur in only 1 percent. Early ambulation and prophylactic anticoagulants are associated with a lowering of the risk for such events.

Injury to the genitourinary (GU) and gastrointestinal (GI) tract

This may be estimated to occur in 0.5-0.6 percent of patients following a hysterectomy. The injury may occur to the ureter (1 percent), the bladder, or the rectum, and is usually repaired during the same procedure. Temporary colostomies or urinary catheters may have to be used in a few such cases to drain the orifice adequately during the period of healing. Difficulties would include incontinence, urgency of urination, or frequent infections.

Hemorrhage

This occurs rarely after such procedures, with transfusions being required more often after laparoscopic hysterectomy as compared to vaginal surgery. Median blood loss is less than 660, 287 and 568 mL in abdominal, vaginal and laparoscopic hysterectomy respectively.

Nerve injury

This is a significantly debilitating condition but fortunately rare, occurring in 0.2 to 2 percent of patients after a hysterectomy or other major pelvic surgery.

Vaginal cuff dehiscence

This occurs in less than 4 out of 100 patients, but more commonly following a total laparoscopic hysterectomy as compared to a laparoscopic-assisted procedure. The lowest rate is found in vaginal hysterectomy (0.08 percent).

Anesthetic complications

These are very rare, with serious complications occurring in only 1 of 10 000 cases of general anesthesia. These include the risk of neuropathy, allergy and death, the latter occurring in 1 in 100 000 patients. Generally fit patients have a very low risk of complications following anesthesia. Smoking, obesity and heart/lung infections carry the highest risk of anesthetic complications.

Ovarian failure

Within five years of the procedure, one or both ovaries may fail because of interruption to their blood supply following removal of the uterus. This may precipitate the symptoms of menopause. This may also lead to osteoporosis and ischemic heart disease in later life.

Low libido

All women do not respond the same way to the removal of the uterus. Some complain of less sexual enjoyment, perhaps due to the loss of uterine contractions or the sensation of pressure against the cervix. The removal of the ovaries may precipitate vaginal dryness and lack of sexual desire. Many patients regain full sexual pleasure once the couple adjusts to the new situation.

Depression

Some women complain of feeling depressed, either because of the loss of reproductive capacity or the feeling that they have lost an important part of their feminine personalities. Counseling with a professional or a group often helps, if the couple cannot handle it on their own.

Mortality

The mortality rate following a hysterectomy ranges from 0.6 to 1.6 per 1000 procedures.

Which procedure?

Vaginal hysterectomies are associated with fewer complications than the abdominal procedure, probably due to the use of prophylactic antibiotics. However, the risk of unplanned major surgery, as for hemorrhage and repair of injuries to other organs is higher with vaginal hysterectomy (39 percent increase), especially following laparoscopically-assisted procedures (64 percent higher), as compared to abdominal procedures. Overall, it is likely to cause less fever, hemorrhage, hospitalization and convalescence.

The risk of complications, especially of post-operative hemorrhage which is the major one, decreases with age, and is 46 percent higher in the presence of fibroids. However, the risk of excessive bleeding was not less with age in patients undergoing hysterectomy for dysfunctional uterine bleeding.

The risk of complications doubles with laparoscopic procedures. However, patient selection and surgeon experience may affect this risk. Post-operative complications were most common in those who had operative problems, in those who were being operated upon for fibroids, women with serious illnesses and multiparous women.