Browsing by Author "Silva, MC"
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- Laparoscopic Assisted Vaginal Hysterectomy Versus Vaginal HysterectomyPublication . Condeço, R; Barreto, S; Leitão, C; Silva, MC; Mira, RIntroduction: Hysterectomy is the commonest gynecologic operation, performed for malignant and benign conditions. There are many approaches to hysterectomy for benign disease. Studies comparing the techniques have showed that vaginal hysterectomy has benefits in terms of reduced hospital stay, faster recovery and less operating time. Objective: The purpose of this study is to compare the surgical and immediate postoperative outcomes of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) with those of Vaginal Hysterectomy (VH). Methods: Retrospective descriptive study, comparing two groups of women who underwent LAVH or VH in our department during a 24 months period, from January 2009 to December 2010. The two groups were compared regarding age, vaginal deliveries, previous abdominal surgery, uterine and adnexal pathology, intra-operative and post-operative complications, uterus weight, blood loss and number of days until discharge. Results: In our study 42 LAVH and 99 VH were included, with a patient mean age of 47 and 59, respectively. The most frequent indication for hysterectomy was fibroids (80%) for LAVH and POP(58.6%) for HV. In LAVH group 47.6% of patients had previous abdominal surgery, vs 28.2% in VH group. The medium operative time was 167 minutes for LAVH vs 99 minutes for HV. The intra-operative complications were one case (2%) of accidental incision of rectum in LAVH, and one bladder incision in the VH (1%). There were 3 conversions to laparotomy for difficult technique (7%) in LAVH group. There were no significant post-operative complications for LAVH. In VH group there were 2 cases of haemoperitoneum (2%) and 1 case requiring blood transfusion (1%). The mean time for discharge was 4.23 days for LAVH and 4.46 days for VH. Conclusions: In our study, the main advantage for VH was the reduced operative time. In terms of time to discharge there was no difference between the 2 groups. The main intra-operative complication of LAVH was the risk of conversion to laparotomy, but post-operatively this procedure had fewer complications than VH. In conclusion, LAVH is a safe option for women requiring hysterectomy in cases where VH is anticipated to be technically difficult.
- Office Hysteroscopy After Ultrasonographic Diagnosis of Thickened Endometrium in Postmenopausal PatientsPublication . Cordeiro, A; Condeço, R; Leitão, C; Sousa, F; Coutinho, S; Silva, MC; Bernardo, MJ; Mira, RThe aim of our study was to access office hysteroscopy results in postmenopausal patients with thickened endometrium. A retrospective descriptive study was carried out on 245 postmenopausal patients submitted to office hysteroscopy after sonographic diagnosis of thickened endometriumin 20 consecutive months.Women were evaluated for age, hormonal therapy, hysteroscopic findings, procedure duration, complications and associated pain, and histological diagnosis. Patients with and without uterine bleeding were considered separately. Symptomatic patients were older and had longer procedure duration. The most frequent hysteroscopic finding was endometrial polyp in both groups. Pain was subjectively assessed in a numeric scale from 0 to 10 and median value was 4. There were no complications reported. Global neoplasia rate was 2.9% for asymptomatic patients and 16.4% for symptomatic ones (p<0.05). Thickened endometrium with postmenopausal metrorrhagia gave patients a significantly higher risk for neoplasia and hyperplasia.
- Repercussions of the COVID-19 Pandemic in the Emergency Department of Gynecology and Obstetrics at a Referral Hospital in PortugalPublication . Jovina Domingues, S; Ormonde, M; Miguel, A; Martins, A; Saavedra, I; Silva, MCObjective. COVID-19 has spread worldwide and Portugal decreed the State of Emergency on March 18th, 2020. During this period, the population was encouraged to stay at home. Still, there were no restrictions on access to health care. Therefore, we aimed to compare the major causes for attending the Obstetrics and Gynaecology Emergency Department (ED) from a referral centre (Maternidade Dr. Alfredo da Costa, in Lisbon). Materials and Methods. Several variables were collected and compared between two periods of time: from 19th March to 2nd April 2020 and the same period of 2019. Results. During the COVID-19 pandemic period, 49.4% fewer patients visited the ED. We observed a higher number of urgent patients and hospitalization rate than previous year. Conclusions. We experienced a reduction number of admissions to the Obstetrics and Gynaecology ED, but apparently the severity of cases that visited the ED increased.
- Septic Shock Following Hysteroscopy. A Case ReportPublication . Meneses, T; Faria, J; Martins, AT; Delgado, E; Silva, MCIntroduction: Minimally invasive gynecological surgery such as hysteroscopy has a small risk of complications. These include uterine perforation (with or without adjacent pelvic organ lesion), bleeding and infection, and are more common in the presence of risk factors such as smoking, history of pelvic inflammatory disease (PID) and endometriosis. Case presentation: A patient submitted to a diagnostic hysteroscopy with no immediate complications was admitted five days later to the emergency department in septic shock. The diagnosis of ruptured tubal abscess was made, requiring emergency laparotomy with sub-total hysterectomy and bilateral adnexectomy. Despite multiple organ failure requiring admission to the intensive care unit, the patient made a full recovery. Conclusion: Ascending infection can be a life-threatening complication of hysteroscopy, even in the absence of previously known risk factors.