RESUMO
OBJECTIVE: To evaluate the viability of the vaginal route as an alternative to laparoscopy for patients seeking permanent surgical contraception. METHODS: We conducted a retrospective cohort study in 2021, dividing patients into two groups based on their preference: vaginal and laparoscopic salpingectomy. The statistical analysis was conducted using STATA, employing standard statistical methods based on the distribution of variables. RESULTS: The study included 64 patients, with 34 undergoing the vaginal approach and 30 the laparoscopic route. No statistically significant differences were observed in baseline characteristics or complications between the two groups. Both surgical methods were found to be feasible. The vaginal route demonstrated a significantly shorter mean surgical time (P < 0.001). The laparoscopic route exhibited significantly less intraoperative blood loss (P < 0.001) and fewer hospitalization hours (P = 0.008). Postoperative satisfaction and pain levels did not show statistically significant differences. CONCLUSION: Vaginal salpingectomy is a feasible technique with low complication rates, making it a potential option for gynecologists to offer their patients. We propose vaginal route inclusion in the training curriculum for gynecologic surgeons during the residency program, without any subspecialty requirements.
Assuntos
Laparoscopia , Salpingectomia , Vagina , Humanos , Feminino , Estudos Retrospectivos , Salpingectomia/métodos , Adulto , Laparoscopia/métodos , Vagina/cirurgia , Duração da Cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Dor Pós-Operatória/prevenção & controleRESUMO
SUMMARY OBJECTIVE: The aim of this study was to observe the feasibility of the tubal/adnexal approach using vaginal natural orifice transluminal endoscopic surgery and compare its contribution with surgeon ergonomics and postoperative patient comfort with that of conventional laparoscopy. METHODS: We completed this study retrospectively with 47 patients. Patients were followed at their postoperative first month. We analyzed the usability of the vaginal natural orifice transluminal endoscopic surgery method over conventional laparoscopy by comparing the demographics, surgical data, and postoperative findings collected between the two groups. RESULTS: Patients in the conventional laparoscopy group were older (39.1±3.3 years) than those in the vaginal natural orifice transluminal endoscopic surgery patient group (p=0.005). Pain intensity 24 h after surgery was lower in the vaginal natural orifice transluminal endoscopic surgery group (p=0.003), while sexual function and dyspareunia did not differ between the two groups in the first month. Patients in the vaginal natural orifice transluminal endoscopic surgery group were more relieved about painlessness and the comfort it brought than the conventional laparoscopy group (p=0.027, χ2=12.56). CONCLUSION: Patients subjected to the vaginal natural orifice transluminal endoscopic surgery procedure showed higher levels of satisfaction, less postoperative pain, and greater comfort than those subjected to conventional laparoscopy.
RESUMO
Resumen OBJETIVO: Describir las características epidemiológicas, clínicas, de laboratorio, de tratamiento médico-quirúrgico y patología, en una serie de 14 pacientes con carcinoma seroso de ovario atendidas en un hospital de alta complejidad y revisión de la bibliografía con el fin de actualizar los conceptos. MATERIALES Y MÉTODOS: Estudio de serie de casos retrospectivo y descriptivo de pacientes con cáncer de ovario seroso confirmado por patología. Las pacientes se estudiaron en un hospital general de alta complejidad entre 2013 y 2016. Variables de estudio: epidemiológicas, clínicas, de laboratorio, del tratamiento médico quirúrgico, comorbilidades y patología. Revisión narrativa de la bibliografía correspondiente a la información relacionada con las variables evaluadas. RESULTADOS: Se diagnosticaron 14 mujeres, de 50 a 80 años; 3 casos con antecedente de histerectomía y 1 de salpingoclasia. Diagnóstico histológico: 10 con tumor seroso de alto grado, 2 moderadamente diferenciado, 1 seroso de bajo grado y otro no clasificado. Procedimientos quirúrgicos: histerectomía, salpingooforectomía bilateral, linfadenectomía, omentectomía en 8 casos. Clasificación en estadios: IV en 6, 3 IIIB, 2 IC, 1 IIIC y una 1 IB. Tratamiento: 10 mujeres con carboplatino y paclitaxel. Revisión de 2227 artículos encontrados, 41 seleccionados. CONCLUSIONES: El carcinoma seroso de ovario se clasifica, actualmente, en bajo y alto grado (más frecuente y agresivo). Este tipo fue el más frecuente, los factores de riesgo encontrados, por el número reducido de pacientes, no permiten emitir conclusiones.
Abstract OBJECTIVE: To describe the epidemiological, clinical, laboratory, surgical medical management and pathology characteristics in a series of 14 patients with serous ovarian carcinoma in a highly complex hospital and review of the literature in order to update the concepts. MATERIALS AND METHODS: Retrospective and descriptive case series study of a patient with serous ovarian cancer confirmed by pathology. The patients were studied in a highly complex general hospital between 2013 and 2016. Study variables: Epidemiological, clinical, laboratory surgical medical treatment, comorbidities, and pathology. Narrative review of the bibliography corresponding to information related to the evaluated variables. RESULTS: Fourteen women between the ages of 50 and 80 were diagnosed, 3 with a history of hysterectomy and 1 with tubal ligation. Histological diagnosis: 10 with high-grade serous tumor, 2 moderately differentiated, 1 low-grade serous and one not classified. Surgical procedures: hysterectomy, bilateral salpinges-oophorectomy, lymphadenectomy, omentectomy in 8 cases. They classified into states: IV in 6, 3 IIIB, 2 IC, 1 IIIC and 1 IB. Treatment 10 women with carboplatin and paclitaxel. Review 2227 articles were found, 41 sectioned. CONCLUSIONS: Serous ovarian carcinoma is currently classified as low and high grade (more frequent and aggressive). This type was the most frequent, the risk factors found by the reduced number do not allow conclusions to be drawn.
RESUMO
Abstract Objective To determine which mode and potency of electrocoagulation, using a modern electrosurgical generator, yields the smallest unobstructed area of the Fallopian tubes. Methods In an experimental study, tubes from 48 hysterectomies or tubal ligation were evaluated. Tubes were randomly allocated to one of the following groups: group A) 25 W x 5 seconds (n = 17); group B) 30 W x 5 seconds (n = 17); group C) 35 W x 5 seconds (n = 18), group D) 40 W x 5 seconds (n = 20); group E) 40 W x 5 seconds with visual inspection (blanch, swells, collapse) (n = 16); group F) 50 W x 5 seconds (n = 8). Bipolar electrocoagulation was performed in groups A to E, and monopolar electrocoagulation was performed in group F. Coagulation mode was used in all groups. Digital photomicrography of the transversal histological sections of the isthmic segment of the Fallopian tube were taken, and themedian percentage of unobstructed luminal area (mm2) was measured with ImageJ software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The Kruskal-Wallis test or analysis of variance (ANOVA) was used for statistical analysis. Results Ninety-six Fallopian tube sections were analyzed. The smallest median occluded area (%; range) of the Fallopian tube was obtained in the group with 40 W with visual inspection (8.3%; 0.9-40%), followed by the groups 25 W (9.1%; 0-35.9%), 40 W (14.2; 0.9-43.2%), 30 W (14.2; 0.9-49.7%), 35 W (15.1; 3-46.4%) and 50 W (38.2; 3.1-51%). No statistically significant difference was found among groups (p = 0.09, Kruskal-Wallis test). Conclusion The smallest unobstructed area was obtained with power setting at 40 W with visual inspection using a modern electrosurgical generator. However, no statistically significant difference in the unobstructed area was observed among the groups using these different modes and potencies.
Resumo Objetivo Determinar em qual modo e potência, usando unidades geradoras modernas de eletrocoagulação, produz a menor área de não-obstrução das tubas de Falópio. Métodos Num estudo experimental, tubas uterinas derivadas de 48 histerectomias ou ligadura tubária foram avaliadas. As tubas foram alocadas aleatoriamente para um dos seguintes grupos: grupo A) 25 W x 5 segundos (n = 17); grupo B) 30 W x 5 segundos (n = 17); grupo C) 35 Wx 5 segundos (n = 18), grupo D) 40 W, 5 segundos (n = 20); grupo E) 40 W x 5 segundos inspeção visual (branqueia, incha e colapsa) (n = 16); grupo F) 50 Wx 5 segundos (n = 8). A eletrocoagulação bipolar foi usada nos grupos de A a E, e a eletrocoagulação monopolar, no grupo F. O modo de coagulação foi utilizado em todos os grupos. Cortes histológicos transversais do segmento ístmico das tubas de Falópio foram corados e fotografados digitalmente, e a percentagem da área luminal (mm2) não-obstruída foi medida com o software ImageJ (ImageJ, National Institutes of Health, Bethesda, MD, USA). O teste de Kruskal-Wallis ou ANOVA foram usados para a análise estatística. Resultados Noventa e seis cortes histológicos de tubas de Falópio foram analisados. A mediana da menor área não-obstruída (%; amplitude) da tuba de Falópio foi obtida no grupo 40 W com inspeção visual (8,3%; 0,9-40%), seguido do grupo 25 W (9,1%; 0- 35,9%), 40W(14,2; 0,9-43,2%), 30 W(14.2; 0,9-49,7%), 35 W(15,1; 3-46,4%) e 50 W (38,2; 3.1-51%). Não houve diferença significativa entre os grupos (p = 0,09, teste de Kruskal-Wallis). Conclusão A menor área não-obstruída foi obtida com a potência de 40 W com inspeção visual usando um gerador moderno de eletrocirurgia. Contudo, nenhuma diferença significativa na área não-obstruída foi observada entre os grupos usando esses modos e potências.
Assuntos
Humanos , Feminino , Adulto , Esterilização Tubária/métodos , Eletrocoagulação/métodos , Tubas Uterinas/cirurgia , Técnicas In Vitro , Distribuição Aleatória , Tubas Uterinas/anatomia & histologiaRESUMO
Abstract Objective To evaluate the trends in definitive contraception in a ten-year interval comprising the years 2002 and 2012. Method Retrospective analysis of the tubal sterilization performed in our service in 2002 and2012,analyzingthedemographiccharacteristics,personalhistory,previouscontraceptive method, definite contraception technique, effectiveness and complications. Results Definitive contraception was performed in 112 women in 2002 (group 1) and in 60 women in 2012 (group 2). The groups were homogeneous regarding age, parity, educational level and personal history. The number of women older than 40 years choosing a definitive method was more frequent in group 1, 49.1% (n = 55); for group 2, the rate was 34.8% (n = 23) (p = 0.04). The time between the last delivery and the procedure was 11.6±6.2 and 7.9±6.4 years (p = 0.014) in 2002 against 2012 respectively. In 2002, all patients performed tubal ligation by laparoscopic inpatient regime. In 2012, the bilateral placement of the Essure (Bayer Corporation, Whippany, NJ, US) device was suggested to 56.1% (n = 37) of the patients, while laparoscopy was suggested to 43.9% (n = 29) of them. All women who underwent laparoscopic sterilization had the procedure successfully completed using silastic rings. The overall bilateral device placement rate for the Essure was 91.6%, with only one complication reported. All Essure procedures were performed in an outpatient setting; for the laparoscopy, this rate was 79% (n = 15). No intentional pregnancies occurred until this date. Conclusions There is a trend in the decrease in definitive contraception over the years in our institution, maybe as a result of the development of long-acting reversible contraceptives. The hysteroscopic procedure has become a frequent option, as it is performed in an office setting without anesthesia, being a well-tolerated, minimal invasive method.
Resumo Objetivo Avaliar as tendências da contracepção definitiva feminina num intervalo de 10 anos, 2002 e 2012. Métodos Análise retrospectiva das mulheres submetidas a esterilização em 2002 e 2012 no Serviço de Ginecologia de um hospital em Portugal, atendendo às caraterísticas demográficas, antecedentes pessoais, método contraceptivo prévio, técnica de contracepção efetuada, eficácia e complicações ocorridas. Resultados Foram submetidas a contracepção definitiva 112 mulheres em 2002 (grupo 1), e 66 em 2012 (grupo 2). Os grupos eram semelhantes na idade, paridade, nível educacional e antecedentes pessoais. O número de mulheres com mais de 40 anos que optou por um método definitivo foi superior no grupo 1, 49,1% (n = 55), versus 34,8% (n = 23) no grupo 2 (p = 0,04). O tempo decorrido entre o último parto e o procedimento foi de 11.6±6.2 anos e 7.9±6.4 anos (p = 0.014) em 2002 versus 2012, respetivamente. Em 2002, todas as mulheres foram submetidas a laqueação tubária em regime de internamento. Em 2012, a colocação bilateral do Essure (Bayer Corporation, Whippany, NJ, EUA) foi proposta para 56,1% (n = 37) das pacientes, enquanto a laparoscopia foi proposta para 43,9% (n = 29) delas. A laqueação por laparoscopia foi realizada com sucesso em todos os casos com anéis de silastic. A taxa de colocação bilateral do Essure foi de 91,6%, tendo sido registrada uma complicação. Todos os procedimentos com Essure foram realizados em regime de ambulatório, enquanto que tal se verificou em 79% (n = 15) daquelas pacientes submetidas a laparoscopia. Não ocorreram gravidezes não intencionais. Conclusão Parece haver uma tendência para a diminuição da esterilização como opção contraceptiva, provavelmente devido à disponibilidade de diversos métodos contraceptivos de longa duração aliada aos benefícios não contraceptivos. A opção pelo dispositivo Essure, mais recentemente, é justificada pela sua realização em contexto de consultório, sem anestesia, sendo um método minimamente invasivo e bem tolerado.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Esterilização Reprodutiva/tendências , Esterilização Reprodutiva/estatística & dados numéricos , Fatores de Tempo , Estudos Retrospectivos , Pessoa de Meia-IdadeRESUMO
Objetivo: Evaluar las ventajas de la técnica de esterilización tubaria por vía vaginal en pacientes que acudieron al servicio de Ginecología del Hospital Universitario de Caracas y Ambulatorio del IVSS Patrocino Peñuela Ruíz, de enero a noviembre de 2014. Métodos: Investigación tipo ensayo clínico multicéntrico, en 49 mujeres no puérperas en edad fértil que solicitaron la esterilización quirúrgica. Se realizó la técnica de colpotomía posterior para localizar las trompas y realizar la esterilización. Resultados: La edad promedio fue de 32,5 años. El 80 % tenía de 1 a 3 partos. El 12,2 % tenía una cesárea previa y dos el 16, 3 %. El tiempo promedio de intervención fue de 22,8 minutos y de pérdida sanguínea de 32,5 cm³, sin necesidad de hemoderivados. Las complicaciones intraoperatorias se presentaron en 6 % de los casos, ameritando laparotomía 2 casos. Se pudo demostrar que las adherencias retrasan el tiempo quirúrgico. Según la escala visual análoga (EVA), 53,1 % de las pacientes a las seis horas no tenía dolor y a las 12 horas había disminuido notoriamente en el 85,7 %. Conclusión: La esterilización quirúrgica por colpotomía es beneficiosa porque el tiempo quirúrgico es corto, el sangrado escaso, el dolor leve y las complicaciones bajas.
Objective: To evaluate the advantages of tubal ligation by colpotomy incision in patients who assisted to the Gynecology Unit of University Hospital of Caracas and Patrocino Peñuela Ruíz Hospital form January to November 2014. Methods: Multicentric clinical assay, performed in 49 patients of reproductive age who demanded tubal ligation. Posterior colpotomy was performed to access the Fallopian tubes. Results: Mean age was 32,5 years. Eighty percent had 1 to 3 vaginal deliveries. One previous C section was reported in 12 %, and 2 in 16, 3 %. Mean surgery time was 22,8 minutes, and the mean blood loss 32,5 cc; blood transfusión was not required. Intraoperatory complications were present in 6 % of cases, 2 of them required laparotomy. The presence of adherences was related to longer surgical time. According to the Visual Analogue Scale (VAS), 53,1 % of the patients had no pain 6 hours after the surgery, and pain decreased significantly in 85. 7 % of the patients 12 hours after the procedure. Conclusion: Tubal ligation by colpotomy is highly recommended due to the short surgical time and low rate of complications, blood loss and pain.
RESUMO
A Lei n. 9.263, de 1996, findou uma omissão histórica do Estado brasileiro no âmbito do planejamento familiar, além de legislar a provisão de esterilização cirúrgica no sistema público de saúde. Já as portarias do Ministério da Saúde n. 144, de 1997, e n. 48, de 1999, contêm critérios potencialmente restritivos à obtenção da laqueadura tubária e à sua obtenção nos termos regulatórios. Se a não aderência à regulamentação relaciona-se ao período de aconselhamento de 60 dias e à proibição da laqueadura até o 42º dia após o parto, parte das recusas dos profissionais envolvidos na provisão da laqueadura é consequência das percepções e posturas destes sobre critérios tais como idade e número de filhos e sobre as eventuais implicações da esterilização para a requisitante. As recusas explícitas ou implícitas nesta filtragem resultam em uma demanda frustrada. Esta lógica aplica-se ao nível municipal da gestão da saúde, refletindo-se na inexistência de serviços credenciados na maioria dos municípios brasileiros com capacidade hospitalar para oferecer o procedimento. Empregando os dados da PNDS 2006 e as Autorizações de Internação Hospitalar, este artigo analisa, primeiramente, a aderência à regulamentação das laqueaduras tubárias realizadas no SUS no período 2000-2006 e a dimensão da rede de municípios com serviços credenciados em 2006 e 2013. A demanda frustrada é estudada a partir das informações da PNDS 2006 sobre as tentativas malogradas devido à recusa do serviço procurado, à não obtenção sem especificação do motivo e à não concordância do cônjuge.
Brazilian Act 9263, of 1996, ended a historic omission by the Brazilian State regarding family planning policies. Among other provisions, the law legalized surgical sterilization in the public health system. In contrast, Ministry of Health ordinances No. 144, of 1997, and No. 48, of 1999, set down potentially restrictive criteria for obtaining tubal ligation in compliance with law. If non-compliance with the regulation is related to the mandatory 60-day counselling period and to the prohibition of tubal ligation until the 42nd day postpartum, some refusals by professionals involved in providing ligation result from these individuals' personal perceptions and attitudes regarding criteria such as age and number of children, and regarding the possible implications of the sterilization for the petitioner. Explicit and implicit refusals result in frustrated demand. The same logic applies to the municipal level of health management and is reflected in the non-existence of accredited services in most municipalities with hospital capacity to offer the procedure. Employing data from the 2006 PNDS and hospitalization authorization records, this paper first examines compliance with the regulation on tubal sterilizations performed in the Federal Public Health System (SUS) between 2000-2006 as well as the number of municipalities, even with accredited hospitals in 2006 and 2013. The frustrated demand is examined on the basis of information from the PNDS (DHS) 2006 regarding failed attempts due to refusals of the service sought, failure to provide motives, and non-consent by spouses.
La Ley Nº 9.263, de 1996, puso fin a una omisión histórica del Estado brasileño en el ámbito de la planificación familiar, además de legislar sobre la prestación de la esterilización quirúrgica en el sistema público de salud. Sin embargo, las ordenanzas del Ministerio de Salud Nº 144, de 1997, y Nº 47, de 1999, contienen criterios potencialmente restrictivos para la obtención de la ligadura de trompas de conformidad con las reglamentaciones. En tanto que la no adhesión a la reglamentación se relaciona con el período de consejería obligatorio de 60 días y la prohibición de la esterilización hasta los 42 días después del parto, parte de las negaciones de los profesionales involucrados en la prestación del procedimiento resultan de sus percepciones y posturas sobre criterios como la edad y el número de hijos y sobre las posibles consecuencias para la solicitante. Los rechazos explícitos o implícitos producen una demanda frustrada. Esta lógica se aplica al nivel municipal de la gestión de salud y se refleja en la falta de servicios acreditados en la mayoría de los municipios con capacidad hospitalaria para ofrecer el procedimiento. Empleando datos de la Pesquisa Nacional de Demografia e Saúde (PNDS) de 2006 y de las autorizaciones de internación hospitalaria, este artículo examina la adhesión a la regulación de las esterilizaciones quirúrgicas femeninas realizadas en el Sistema Único de Saúde (SUS) en el período 2000-2006 y la extensión de la red de municipios con servicios acreditados en 2006 y 2013. La demanda frustrada se analiza a partir de la información provista por la PNDS de 2006 sobre los intentos fallidos de obtención del servicio debidos a su negación, los casos de no obtención cuyo motivo no está especificado y la negativa del cónyuge.
Assuntos
Humanos , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Anticoncepção/métodos , Esterilização Tubária/estatística & dados numéricos , Legislação como Assunto , Saúde Reprodutiva , Serviços de Planejamento Familiar/legislação & jurisprudência , Brasil , Necessidades e Demandas de Serviços de Saúde , Sistema Único de SaúdeRESUMO
Es necesario revisar la intervención de la cirugía reproductiva desde la perspectiva de un tratamiento preparatorio para el de fecundación in vitro (FIV). Si hay hidrosálpinx, es necesaria una salpingectomia laparoscópica antes de ingresar a un programa de FIV, considerando que la cirugía no compromete la estimulación ovárica ni las tasas de embarazo con respecto a las pacientes con las trompas sanas. No se ha demostrado alteraciones en los índices de implantación ni de embarazo por efecto de la endometriosis; por tanto, no vale la pena llevar a la paciente a los riesgos de una cirugía. Frente a una ligadura de trompas, los mejores resultados se logran si se llevó a cabo por aplicación de clips en el parte media del istmo, y los peores cuando el procedimiento se realizó distalmente con la eliminación del extremo fimbrial. Las pacientes con miomas subserosos o intramurales menores a 4 cm, que no afectan la cavidad uterina, tienen resultados de FIV/ICSI similares a las que no los tienen; ellas no requieren una miomectomía. En los casos de pérdida recurrente del embarazo, útero septado y polipectomía (>9 mm), los resultados reproductivos de la resectoscopia (histeroscopia quirúrgica) muestran beneficios significativos. El futuro de la cirugía reproductiva, debe considerar preservar la capacidad de tener hijos antes de pensar en eliminar la patología. Todos los ensayos futuros deberán abordar los posibles efectos a largo plazo en detrimento de la fertilidad femenina.
It is necessary to review reproductive surgery from the perspective of in vitro fertilization (IVF) preparatory treatment. When hydrosalpinx is present, laparoscopic salpingectomy is required before entering to an IVF program, considering that surgery does not compromise ovarian stimulation or pregnancy rates with respect to patients with healthy fallopian tubes. As rates of implantation and pregnancy are not altered by endometriosis, carrying the patient to surgery risks is not worth. Faced with tubal ligation, best results are achieved when clips were applied in the middle of the isthmus and worst results when the procedure removed the distal end of the fimbria. Patients with less than 4 cm subserosal or intramural fibroids that do not alter the uterine cavity have IVF / ICSI results similar to those that do not have them, and do not require myomectomy. In cases of recurrent pregnancy loss, uterine septum and polypectomy (>9 mm), resectoscopy (by hysteroscopy) shows significant reproductive benefits. The future of reproductive surgery should consider preserving the ability to have children before considering eliminating pathology. All future trials should address the potential female fertility detrimental long-term effects.
RESUMO
Objetivo. Describir si existe o no relación entre la velocidad de aplicación del anestésico en anestesia subaracnoidea y la presentación de hipotensión y efectos colaterales en las pacientes programadas para cesárea y Pomeroy postparto. Métodos. Estudio observacional de serie de casos, en el Instituto Materno Infantil-Hospital La Victoria. Se incluyó a 60 pacientes intervenidas por cesárea o Pomeroy postparto, y en quienes se midieron dos variables: la velocidad de aplicación de la anestesia subaracnoidea (menor o mayor a 60 segundos) y los efectos de dos mezclas anestésicas (bupivacaína hiperbárica al 0,5 % 7,5 mg, más morfina 100 mcg, y bupivacaína hiperbárica al 0,5 % 12 mg, más fentanil 20 mcg). Se registraron las cifras de presión arterial media y los efectos colaterales al aplicar el anestésico, en los minutos 1, 5, 10 y 15, y al final de la cirugía. Resultados. La evidencia obtenida sugiere que no hay diferencias entre los efectos hemodinámicos de las mezclas o entre las técnicas anestésicas, así como tampoco las hay en cuanto a la presentación de efectos secundarios.
Objective. To identify any potential relationship between the rate of administration of the anesthetic agent in the subarachnoid space and thedevelopment of hypotension and side effects in patients scheduled for C-section and postpartumPomeroy. Methods. Observational case series study at the Instituto Materno Infantil-Hospital La Victoria. 60patients who underwent a C-section procedure or a postpartum Pomeroy were included and two variables were measured: the rate of administrationof the anesthetic agent in the subarachnoid space (<60 or >60 seconds) and the effects of two anesthetics combined (0.5 % hyperbaricbupivacaine 7.5 mg, plus morphine 100 mcg, and 0.5 % hyperbaric bupivacaine 12 mg, plus fentanyl 20 mcg). The mean blood pressure values were recorded, together with any side effectsfollowing the administration of the anesthetic agent at 1, 5, 10 and 15 minutes and at the end of surgery.Results. The evidence obtained suggests that there are no differences in the hemodynamic effects of the combination or the anesthetic technique used, nor with regards to the occurrence of side effects.
Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Anestesia , Anestesia Local , Cesárea , Esterilização Tubária , Anestésicos Locais , Esterilização , Esterilização TubáriaRESUMO
Antecedentes: La analgesia preventiva continúa siendo fuente de discusión y desacuerdo entre los especialistas que manejan el dolor. Hay resultados contradictorios, incluidos algunos metaanálisis, sobre la efectividad de la analgesia preventiva con ketamina. Objetivo: Evaluar la eficacia de la ketamina preventiva en la cirugía ambulatoria de mujeres programadas para esterilización definitiva con electrofulguración por laparoscopia, en la disminución del dolor postoperatorio, comparada contra ketamina administrada de manera no preventiva. materiales y métodos: Entre diciembre de 2007 y enero de 2008 se incluyeron 130 mujeres de la Clínica Piloto de Profamilia, en Bogotá (Colombia), que deseaban planificar mediante ligadura de trompas. Fueron asignadas de manera aleatoria simple a dos grupos: a 71 pacientes se les administró ketamina antes de la incisión quirúrgica (0.25 mg/kg) y a 59 pacientes se les administró ketamina a la misma dosis al fnal del procedimiento. La administración de ketamina y la evaluación de los desenlaces se realizaron de manera enmascarada. Resultados: El nivel de dolor medido mediante la Escala Visual Análoga (EVA) fue similar para ambos grupos, aunque hubo una mayor proporción de pacientes con dolor al minuto 15 en el grupo de ketamina preventiva (19.7% vs. 6.8%, p=0.03). El grupo de ketamina no preventiva presentó más náusea (15% vs 10%) y mareo (46% vs. 37%), aunque esto no fue significativo (p>0,05) Conclusión: La eficacia de la ketamina preventiva para el alivio del dolor postoperatorio no fue diferenre a la de la ketamina no preventiva .
Background: The pre-emptive analgesia keeps being a source of discussion and discord between the spe-cialists in the pain management. There are contradictory results, even in meta-analysis, about effectiveness of preemptive analgesia with ketamine. Objective: To evaluate effectiveness of ketamine as preemptive analgesia in women under laparoscopic electrofulguration of Falopio tubes, in control of postoperative pain, compared with ketamine administered in a non preemptive way. material and methods: 130 women who wanted a defnitive contraceptive method as laparoscopic tubal ligation were included with the diagnosis of satisfed parity, from the Clínica Piloto de Profamilia, in Bogotá (Colombia), between december 2007 and january o2008. They were randomly assigned in two groups: 71 received preemptive ketamine (before initiating the surgical procedure, dose of 0,25 mg/kg) and the other 59 patients received ketamine, the same doses, at the end of the procedure. Both, administration of ketamine and evaluation of patients outcomes, were made in blinded form. Results: Patients were similar at the start of the study. The level of pain measured with a visual analog scale (VAS) was similar for both groups, there was a higher proportion of patients with pain in the preemp-tive ketamine group to the minute 15 (29.7% vs 6.8%) Ketamine non preemptive group, felt more nauseous (25% vs. 10% and seasickness (46% vs 37%), this was not signifcative (p>0.05)). Conclusions: The preemptive ketamine wasn't different in effectiveness to ketamine administered in non preemptive way for the relief of postoperative pain .
Assuntos
HumanosRESUMO
Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.
PIP: This paper presents the case of a 32-year-old woman who developed a tubo-ovarian abscess 7 years following tubal ligation via minilaparotomy. Symptoms experienced included pain, which was exacerbated by walking, and mild deep dyspareunia. Abdominal and pelvic examinations revealed pain in the left iliac fossa, cervical excitation tenderness, and an ill-defined left adnexal mass. Sonographic evaluation of the pelvis showed an irregularly shaped, cystic mass (8.0 x 4.5 x 5.3 cm) with thickened internal septations and solid parts. A left tubo-ovarian multilobulated complex mass adherent to the omentum and the pelvic side was found upon laparotomy. There was pus in the Pouch of Douglas, and the uterus was 10 weeks in size with symmetrical enlargement. The previously ligated right fallopian tube and the ovary were unremarkable. Management includes left adnexectomy, omental biopsy, and 5-day course of antibiotics against Staphylococcus aureus, which was cultured from the purulent material in the Pouch of Douglas. Tubo-ovarian abscess should be considered in diagnosing patients presenting symptoms of pelvic inflammatory disease.
Assuntos
Abscesso/etiologia , Doenças Ovarianas/etiologia , Infecções Estafilocócicas/etiologia , Esterilização Tubária/efeitos adversos , Abscesso/diagnóstico , Adulto , Feminino , Humanos , Laparotomia , Doenças Ovarianas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Close of skin with cyanocrilate in surgical wounds after tubary sterilization. The objective was to determine the use of cyanocrillate in surgical wounds coalescence, to decrease the time employed when closing the skin, as well as to aid the healing process. This is an observation, prospective, length, comparison, study. Since March, 1995, the Gyneceum-Obstetrics "Luis Castelazo Ayala" Hospital has carried out this research, forming two groups as follows. Group A: Tubary sterilization (OBT) was practiced to 36 patients applying a superficial coat of cyanocrilate. Group B included 31 patients whose skin was sutured with catgut 00. In Group A. the average time for skin closure is 14.5 seconds, in wounds with a length of 2 to 6 cm. In Group B the average time is 3.9 minutes, in wounds with a length of 1 to 4 cm. 4 cases of group A reported pain for the first 12 hours (11.1%), pruritus in wound in 3 cases (8.3%), partial dehiscence of wound, 1 case (2.7%). While in Group B the result are: Pain in 10 cases (32.2%), pruritus in 3 cases (9.6%), partial dehiscence of wound in 3 cases (9.6%), 1 case with poor edges coaptation (3.2%), and reaction to suture in 2 cases (6.4%). Not even an infection condition occurred. Cyanocrilate used in selected cases is an inexpensive, fast, easy to use efficient method, with little morbidity and likely to improve the aesthetic of surgical scar.
PIP: 100 women undergoing bilateral tubal sterilization at a hospital in Mexico City between March and September 1995 participated in a prospective study of the use of the contact adhesive cyanoacrylate for closure of the surgical wound. Cyanoacrylate was used for the patients in group A, while in group B the skin was sutured with catgut 00. The remainder of the procedure was similar in both groups. The 36 patients in group A and 31 in group B who attended follow-ups at 12 hours, 7 days, and 40 days were included in the study. Patients in group A ranged in age from 20 to 36 and averaged 31.7 years, while those group B ranged from 18 to 35 and averaged 27.5 years. Group A patients had 2.8 and group B 3.1 children on average. The wounds in group A ranged from 2 to 6 cm and averaged 3.1 cm, while those in group B ranged from 1 to 4 cm and averaged 2.5 cm in length. The time for wound closure ranged from 4 to 30 seconds and averaged 14.5 seconds in group A, and from 1 to 7 minutes with an average of 3.9 minutes in group B. 4 patients in group A had pain (11.1%), 3 had pruritus (8.3%), and 1 each had (2.7%) poorly joined borders, partial dehiscence of the wound, and bleeding. 10 patients in group B had pain (32.2%), 3 each (9.6%) had pruritus and partial dehiscence of the wound, 1 had poorly joined borders (3.2%), and 2 had reactions at the site of the sutures (6.4%). It was concluded that, in appropriately selected cases, cyanoacrylate is inexpensive, rapid, easy to use, and efficient, with few side effects.
Assuntos
Cianoacrilatos , Esterilização Tubária/métodos , Suturas , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , CicatrizaçãoRESUMO
Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.
PIP: 27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.
Assuntos
Seleção de Pacientes , Esterilização Tubária , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Humanos , Masculino , ParidadeRESUMO
One hundred three patients underwent abdominoplasty combined with other intraabdominal procedures including 67 tubal ligations, 34 total abdominal hysterectomies and 2 cholecystectomies, from January 1983 to July 1991. The patients were divided into two groups, those undergoing the standard or total abdominoplasty and those undergoing limited abdominoplasty with or without liposuction in delimited areas. In this series of 103 patients, we found only two minor complications and only three patients were transfused with autologous units of blood. When performed by well-schooled surgical teams, abdominoplasty may be combined with intraabdominal procedures with gratifying results.
PIP: Between January 1983 and July 1991, well trained surgical teams performed either standard abdominoplasty or miniabdominoplasty on 103 patients who also underwent tubal ligation, total abdominal hysterectomy, or cholecystectomy to determine whether surgeons can effectively combine abdominoplasty with other intraabdominal procedures. Prescribed preoperative procedures included respiratory exercises. Physicians advised patients to stop smoking 2 weeks before surgery. Physicians also instructed them not to take any aspirin or other drugs with anticoagulant effects 2 weeks before surgery. Tubal ligation patients who also underwent standard abdominoplasty were in the operating room for 3 hours and for 2 hours if they underwent miniabdominoplasty. Total abdominal hysterectomy patients were in the operating room for either 3-4 hours (standard abdominoplasty) or 2.5-3 hours (miniabdominoplasty). Surgeons performed cholecystectomy in those patients who only underwent standard abdominoplasty. They were in the operating room for 4-5 hours. The combination of intraabdominal procedure and standard abdominoplasty increased the time in the operating room by 40-90 minutes. Number of days in the hospital for standard abdominoplasty patients included 2-3 for tubal ligation, 5 for total abdominal hysterectomy, an 5-7 for cholecystectomy. Miniabdominoplasty patients were in the hospital 1-2 days for tubal ligation and 5 days for total abdominal hysterectomy. Only 2 minor complications occurred: a seroma and a minor skin slough. 3 patients required transfusion of autologous units of blood and non of them lost more than 500 ml of blood. The physicians encouraged all patients to become ambulatory soon after the operation and to wear elastic stockings to prevent thromboembolic events. As a result, none of the patients suffered a pulmonary embolism. In conclusion, good surgical teams can safely and effectively combine abdominoplasty with intraabdominal procedures.
Assuntos
Músculos Abdominais/cirurgia , Colecistectomia , Histerectomia , Lipectomia/métodos , Esterilização Tubária , Perda Sanguínea Cirúrgica , Feminino , Seguimentos , Humanos , Tempo de Internação , Complicações Pós-Operatórias/etiologia , Técnicas de SuturaRESUMO
PIP: Even though Brazil's BEMFAM program stopped providing sterilization services over a year ago, many sources hostile to BEMFAM in the Brazilian government are still accusing it of misconduct. BEMFAM is sponsored by the International Federation of PLANNED Parenthood and was investigated and cleared of any wrong doing by the Brazilian government. In Brazil it is against the law to perform sterilization for the purposes of birth control, yet it is estimated that there are between 6-20 million such operations each year. Over 65% of the births in Brazil are by Caesarian section and it is common for women to ask their doctors to perform a tubal ligation at the same time. Abortion is illegal in Brazil, but there are an estimated 1.4-2.4 million abortions each year. 56% of Brazilian women use contraceptives, with 90% using either the pill or illegal sterilization. 90% of those who use the pill obtain it over the counter at pharmacies with inadequate knowledge on how to use it. 80% of the people receive their health care from the Brazilian government.^ieng
Assuntos
Aborto Criminoso , Aborto Induzido , Cesárea , Anticoncepção , Agências Internacionais , Organizações , Esterilização Reprodutiva , Esterilização Tubária , América , Brasil , Comportamento Contraceptivo , Países em Desenvolvimento , Serviços de Planejamento Familiar , Cirurgia Geral , América Latina , Procedimentos Cirúrgicos Obstétricos , América do Sul , TerapêuticaRESUMO
PIP: The National School of Public Health aided by WHO conducted a survey between 1984 and 1985 in 7 communities of Rio de Janeiro, Brazil, enlisting 1900 women aged 15-49 from 2019 households selected. 1783 were interviewed, yielding a response rate of 92%. 538 (30%) women were single, 7.2% of who had no sexual experience. 4.5% of the sample were widowed, divorced, or separated. Their familiarity with contraceptives was as follows: oral contraceptives, (OCs) 99.7%; female sterilization and the condom, 90%; coitus interruptus and vasectomy; 33%; the diaphragm, 27%; and natural methods; 22%. 83% of the women used OCs; less than 20% used the condom, coitus interruptus, or spermicides; and 5% had used the IUD. 8% of those 40 decided on tubal sterilization. 67% of the women in sexual unions used contraceptives vs. 35% of single women with sexual activity. Nonuse increased after age 35, while more than 50% of women 20 did not use contraceptives. Half of the sterilized women underwent the procedure before age 30 when they had 4 children. 66% of ligations were done during birth, and accompanied 63% Cesarean section. Only 28 of sterilizations were done by laparoscopy on another occasion. Misinformation about sterilization was rife, as 15% of sterilized women states that they wanted to bear a child in the future, and 11% thought that they could get pregnant. 42% of women aged 35 and over were sterilized by laparoscopy. In hospitals and clinics the average sterilized woman was 29.4 years old and had 3.5 children. Contraceptive prevalence was higher than the national average, it was comparable to the level in countries that have traditionally low fertility. The fact that OCs, the pill, and tubal ligation made up the predominant pattern of contraceptive use is the result of the inability of the health care system to provide an integrated family planning program with education about and provision of contraceptives.^ieng
Assuntos
Fatores Etários , Comunicação , Comportamento Contraceptivo , Anticoncepção , Acessibilidade aos Serviços de Saúde , Conhecimento , Estado Civil , Estudos de Amostragem , Esterilização Tubária , População Urbana , América , Brasil , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , Casamento , População , Características da População , Pesquisa , América do Sul , Esterilização ReprodutivaRESUMO
From January 1, 1987 January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope), were carried out. Morbidity and main risk factors, were analyzed. More frequent surgical complications were: mesosalpinx rupture, and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema, three cases (0.8%), uterine perforation, two cases (0.5%); other pelvic structures lesions, three cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of an uterine mobilizer in a puerperal uterus, and practice of tubal occlusion during the luteal phase of cycle, due to possibility of luteal phase pregnancy; therefore, if a risk factor is present, it is advisable to use other contraceptive technique.
PIP: Between January 1, 1987-January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope) were undertaken. Morbidity and major risk factors were analyzed. The most frequent surgical complications were: mesosalpinx rupture and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema in 3 cases (0.8%); uterine perforation in 2 cases (0.5%); other pelvic structure lesions in 3 cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of a uterine mobilizer in a puerperal uterus, and the practice of tubal occlusion during the luteal hase of the cycle due to the possibility of a luteal phase pregnancy. Therefore, if a risk factor is present, it is advisable to use another contraceptive method. (author's modified)
Assuntos
Tubas Uterinas/lesões , Esterilização Tubária/efeitos adversos , Adolescente , Adulto , Criança , Contraindicações , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Ligamentos/lesões , Pessoa de Meia-Idade , Gravidez , Fatores de Risco , Esterilização Tubária/métodos , Enfisema Subcutâneo/etiologia , Perfuração Uterina/etiologiaRESUMO
Brazil has one of the highest rates of caesarean section in the world. Patterns of caesarean sections were studied in a cohort of 5960 mothers followed from 1982 to 1986 in southern Brazil. Overall, 27.9% were delivered by caesarean section in 1982, this proportion being 30% for nulliparae, 80% for second deliveries when the first was by caesarean, and over 99% for third births when the first two were by caesarean. Socioeconomic status and requests for sterilisation by tubal ligation were important underlying factors. 9.4% of the women were sterilised during a caesarean section (3.7% in the lowest income group and 20.2% in the highest). 31% of women who had had their first child by a caesarean section and who were having a second operative delivery were sterilised. The high rates of caesarean sections and accompanying sterilisations reflect the lack of appropriate reproductive and contraceptive policies in the country.
Assuntos
Cesárea/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Brasil/epidemiologia , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Renda , Gravidez , Reoperação , Fatores de Risco , Esterilização Tubária/estatística & dados numéricosRESUMO
PIP: Voluntary sterilization is the chosen family planning method of more couples worldwide than any other, evidence of its acceptability and lack of serious shortcomings. This work offers observations on training, counseling, supervision, cost-effectiveness, and acceptability of voluntary sterilization programs, and presents some results of Profamilia's program. Training of qualified medical personnel in the available techniques is a relatively simple. Profamilia has trained almost 1000 medical professionals, nearly half of whom were from other countries, but a legal technicality has forced Profamilia to curtail training of foreign professionals. It is much more difficult to train personnel to identify and inform potential clients about sterilization, promote the procedure, and provide follow-up, yet these program activities are crucial to a successful sterilization program. Counseling of couples is necessary and should include discussion of the greater convenience of vasectomy compared to tubal ligation. Sterilization should be presented as a permanent method. This permanence, often viewed as a disadvantage, has a positive side in freeing couples of the need for further consideration of family size or contraception and in protecting them against family and social pressures to have more children. Raising marriage age or family size requirements in the hope of avoiding regret does not appear justified. Assuring that sterilization is truly voluntary is a preoccupation of donors, but has not been a problem in Profamilia programs. All clients are required to make some payment and to sign a detailed consent form. Profamilia has been persuaded to discourage mental defectives from undergoing sterilization because of possible legal problems. Periodic, unannounced visits to clinics are recommended for quality control and supervision. Profamilia employs salaried medical personnel for sterilization when careful supervision is available to ensure that they do not unjustifiably reject applicants, and pays on a per-case basis otherwise. It is estimated that each Profamilia sterilization provides 12.5 couple-years of protection. Each sterilization costs US $ 33.20 on average, 60% of it for personnel costs. Profamilia offer highly subsidized services for its lower middle class clients and almost free services for its poorest 40% of clients. The financial strain is considerable for Profamilia, which carries out some 70,000 sterilizations each year at a cost of US $ 2.25 million, only 1/7 of it directly paid for by clients. Since 1973, Profamilia has performed over 700,000 tubal ligations. There have been 19 deaths, 9 attributed to surgical and 5 to anesthetic problems. There are minor complications in about 1% of cases. 26,401 vasectomies were performed through 1990, with 2 cases requiring hospitalization.^ieng
Assuntos
Análise Custo-Benefício , Aconselhamento , Educação , Emoções , Planejamento em Saúde , Administração de Serviços de Saúde , Consentimento Livre e Esclarecido , Organização e Administração , Aceitação pelo Paciente de Cuidados de Saúde , Gestão de Recursos Humanos , Avaliação de Programas e Projetos de Saúde , Esterilização Reprodutiva , Esterilização Tubária , Ensino , Vasectomia , Instituições de Assistência Ambulatorial , América , Comportamento , Colômbia , Anticoncepção , Comportamento Contraceptivo , Países em Desenvolvimento , Estudos de Avaliação como Assunto , Serviços de Planejamento Familiar , América Latina , Psicologia , América do SulRESUMO
This study was undertaken to assess the effects of different tubal occlusion procedures on ovarian function. Three groups of subjects randomized to tubal occlusion by laparoscopy and Yoon ring (24 subjects), minilaparotomy and Yoon ring (19 subjects) and minilaparotomy and Pomeroy (22 subjects), and one separate control group of 26 healthy subjects not using any form of contraception were studied in a prospective design. The characteristics of the menstrual patterns were studied for one year after sterilization. Determination of the circulating progesterone levels were made on days 15, 20 and 25 of menstrual cycles initiated 1, 3, 6 and 12 months following the tubal ligation. In the analysis of the bleeding pattern there was a statistically significant difference in the mean segment length and in the longest bleeding-free interval in the subjects who had been sterilized by minilaparotomy with Yoon ring, when compared to the other two study groups and to the control group. However, the magnitude of this difference in number of days was not considered clinically significant. There was no statistically significant difference in the percentage of ovulatory cycles within the study and the control groups, or when the results of the study groups were compared with each other or to the control group.
PIP: This study was undertake to assess the effects of different tubal occlusion procedures on ovarian function. 3 groups of subjects randomized to tubal occlusion by laparoscopy and Yoon ring (24 subjects), minilaparotomy and Yoon ring (19 subjects) and minilaparotomy and Pomeroy (22 subjects), and 1 separate control group of 26 healthy subjects not using any form of contraception were studied in a prospective design. The characteristics of the menstrual patterns were studied for 1 year after sterilization. Determination of the circulating progesterone levels were made on days 15, 20, and 25 of menstrual cycles initiated 1,3,6 and 12 months following the tubal ligation. In the analysis of the bleeding pattern there was a statistically significant difference in the mean segment length and in the longest bleeding-free interval in the subjects who had been sterilized by minilaparotomy with Yoon ring, when compared to the other 2 study groups and to the control group. However, the magnitude of this difference in number of days was not considered clinically significant. There was no statistically significant difference in the % of ovulatory cycles within the study and the control groups, or when the results of the study groups were compared with each other or to the control group. (Author's).