DR: Abir Mohidien Said

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About 80% of all the gyn.surgeries are

elective, this means that there are other

alternative treatments to be considered, the

appropriateness of the dicision making depends

on the physician & patient on an individual

basis, prepair for operation is

important, information about

operation, risk, alternative.

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*D&C one of the most commen minor gyn.op.

*D&C may be a diagnostic or a therapeutic procedure

*A diagnostic is performed for:

* Premenopausal irreguler menstrual bleeding

* Post menapausal bleeding

* Suspected Ca. of cervix or endometium(fractional curettage)

*Therapeutic effect with very heavy bleeding

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*Perforation of the uterus. It is not uncommen &

occurs particulary with a retroverted uterus

*Infection ( always 2 typs

antibiotic, aerobic&nonaerobic)

*Hemorrhage

*Continuing pregnancy

*Retained products of conception

*Cervical damage

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* A cone shaped portion of the cervix removed therapeutic &

diagnostic purposes

*Therapeutic ( cervical dysplasia or chronic cervicitis)

*Performed by using knive or loop electrosurgical excision or

by laser ( give nice scar & less bleeding)

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*Is commonly used to treat condylomas of the

cervix, vagina,perinium & vulva

*To treat chronic cervicitis

*Dysplasia of the vulva

*Vaporization or coagulation of endometriosis (

laproscopic)

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*Using a device called laparoscope( telescope)

*CO2 inflation ( few liters about 3-4 L)

*Laproscopy is two types:

* Diagnostic laparoscopy

*Operative Laparoscopy

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*Unexplained infertility

*Tubal patancy testing

*Adenexal, uterin pathology congenital or

acquired

*Acute abdomen, suspected ectopic gestation

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*Tubutomy & ectopic preg. removed

*Salpingectomy with Ectopic pregnancy

*Salpingo oophorectomy (prophylxic,ect)

*Exicesion of the ovarium cyst

*Oophorectomy exicesion

*Adhesion lysis

*Vaporization of the endometriosis

*LAVH

*Sterilisation & abdominal IUD removal

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*Penetrating injuries from veress needle

*Perforation of the bowel

*Perforetion of the blood vessels

*Damage to bowel and bladder during diathermy

*Gas embolism

*Bleeding

*Infection

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*Now very commen, means the visualization of the

endometrial & endocervical lining & the cavity by

using a flexible or raged telescope.

*Diagnosis or operative

*Diagnosis of any congenital ( uterin septum etc)

*Operative of uterine pathology ( endometrial

,cervical polypectomy or submucus fibroids

etc)

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*Perforation during cevix dilitation

*Uterin perforation

*Bowel or bladder damage ( diathermy )

*Fluid absorption ( manitol , NACL )

*Bleeding

*Infection

*Air embolism

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*Full bladder with water & induced the

cystoscop throw the urethra to the blader

*Rigid or flexible cystoscop

*Gynaecologist used only for diagnostic, after

recurrent cystitis, haematuria, suspected polyp

& to se perforation, after induced tape of

incontinence operation.( TVT, TOT)

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*Total hysterectomy

*Subtotal/ supravaginal hysterectomy

*Radical hysterectomy( Wertheim operation)

*Total hyterectomy with bilatral/unilateral

salpingo-oophorectomy

*Vaginal hysterectomy

*LAVH (laproscopically-assisted vaginal

hysterectomy)

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*Bleeding

*Wound infection (deep or superfacial)

*Cystitis

*Urin retention

*Embolism ( DVT, lung)

*Damage to the intestine, blader, ureter)

*Sever painfull

*Complication of GA

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*Stress incontinens (laxity of the urethra)

TVT ( Tension -free Vaginal Tape)

TOT ( Trans Obturator Tape)

Burch operation (permanent stitches

are placed near the neck of the bladder and fixed to the

back of the pubic)

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*Cystocele repair, large cystoceles may require

surgery to push up the bladder away from the

vagina & support it so it will stay in anormal

position

*Complication: bladder perforation,urge

incontinence,infection & bleeding

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*Rectocele repair, occurs when rectum start to

fall to the front & pushes against the back wall

of the vagina

*Push up the rectum away from the vagina &

support it so it will stay in amore normal

position

*Complication : intestine

perforation, infection, bleeding,stenosis of

vagina & dysparunia

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THANKS