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Oleh : Nesatelge Ginting
HYSTERECTOMY FOR THE MASSIVE LEIOMYOMATOUS UTERUS
INTRODUCTION
•Benign smooth muscle neoplasm in the uterine organ
What is uterine leiomyomatous?
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
•From Greek, hystera "womb" and ektomia "a cutting out of“.
•The surgical removal of the uterus
What is hysterectomy?
HOW IS A HYSTERECTOMY PERFORMED ?
Abdominal hysterectomy. Vaginal hysterectomy
Laparoscopic hysterectomy
TYPE OF HYSTERECTOMY
Subtotal hysterectomy
Total hysterectomy
Total hysterectomy and bilateral or unilateral salpingo-oophorectomy
Radical or Wertheim’s hysterectomy
INDICATION
BENIGN DISEASE
PRE-INVASIVE NEOPLASTIC DISEASES
INVASIVE DISEASE
ACUTE CONDITIONS
OTHER INDICATIONS
To determine if the complication rate of abdominal hysterectomy is increased in
women with greatly enlarges myomatous uteri
Objective
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
Material
METHODS
• Used to compare the group for : know the RISK for having at least one major operative complication
The complication rate from hysterectomy increases with increasing
uterine weight, due mainly to an increased blood loss associated with
surgery for larger uteri.
CONCLUTION
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):1–16.
• 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:Areappraisal. 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; 87:539–43.
• 5. Flickinger L, D’Ablaing G, Mishell DR. Size and weight determinations of nongravid enlarged uteri. Obstet Gynecol 1986;68:855–8.
• 6. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM.Uterineleiomyomas:Racialdifferencesinseverity,symptoms, and age at diagnosis. J Reprod Med 1996;41:483–90. 1274 Unger et al