HYSTERECTOMY FOR THE MASSIVE LEIOMYOMATOUS UTERUS

Oleh : Nesatelge Ginting

INTRODUCTION

What is uterine leiomyomatous?

Benign smooth muscle neoplasm in the uterine organ

Epidemiology

Often found in women of reproductive age (20-25%).

The prevalence increased by more than 70% after pathologic anatomy of the uterus done. Turned into a malignancy about (<1%). Figures on the incidence above 35 years of age about 40% In Indonesia myoma uteri 2,39%-11,87% of all ginecological patients who were treated.

RISK FACTOR

AGE AT MENARCHE PARITY

RACE

WHERE DO UTERINE FIBROIDS GROW?

COMMON SYMPTOMS

Bleeding between periods, pelvic pain or fullness, infertility

THE MANAGEMENT OF UTERINE LEIOMYOMAS

Medical management Surgical management Conservative Surgical Therapies

What is hysterectomy?

From Greek, hystera "womb" and ektomia "a cutting out of. The surgical removal of the uterus

HOW IS A HYSTERECTOMY PERFORMED ?

Abdominal hysterectomy.

Vaginal hysterectomy

Laparoscopic hysterectomy

TYPE OF HYSTERECTOMY

Subtotal hysterectomy

Total hysterectomy

Total hysterectomy and bilateral or unilateral salpingooophorectomy

Radical or Wertheims hysterectomy

INDICATION

BENIGN DISEASE
PRE-INVASIVE NEOPLASTIC DISEASES

INVASIVE DISEASE
ACUTE CONDITIONS OTHER INDICATIONS

Objective

To determine if the complication rate of abdominal hysterectomy is increased in women with greatly enlarges myomatous uteri

Material

THREE GROUP OF WOMAN UNDERGOING ABDOMINAL HYSTERECTOMY

Group 1
208 women Weight of uteri less than 500 gr

Group 2
63 women Uterine weights of 500 999 gr

Group 3
47 women Uteri weight at least 1000 gr

METHODS
Used to compare the group for : know the RISK for having at least one major operative complication

CONCLUTION

The complication rate from hysterectomy increases with increasing uterine weight, due mainly to an increased blood loss associated with surgery for larger uteri.

REFERENCE
1. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, MorrowB,KiekeBA,etal.Hysterectomysurveillance United States, 1980-1993. Morb Mortal Wkly Rep CDC Surveill Summ 1997;46(SS-4):116. 2. Friedman AJ, Haas ST. Should uterine size be an indication for surgical intervention in women with myomas? Am J Obstet Gynecol 1993;168:751 5. 3. Reiter RC, Wagner PL, Gambone JC. Routine hysterectomyforlargeasymptomaticuterineleiomyomata:Areappr aisal. Obstet Gynecol 1992;79:481 4.

 4. Hillis SD, Marchbanks PA, Peterson HB. Uterine size and risk of complications among women undergoing abdominal hysterectomy for leiomyomas. Obstet Gynecol 1996; 87:53943. 5. Flickinger L, DAblaing G, Mishell DR. Size and weight determinations of nongravid enlarged uteri. Obstet Gynecol 1986;68:8558. 6. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM.Uterineleiomyomas:Racialdifferencesinseverity,symptoms, and age at diagnosis. J Reprod Med 1996;41:48390. 1274 Unger et al