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concerns for d&c and ablation
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An_242444 posted:
A few weeks ago I had a hysterscopy, D&C, and ablation scheduled. I have had a D&C in the past for miscarriage and everything went fine. During this procedure a perforation occurred and they were unable to complete the procedure. The perforation was severe enough that the Dr had to go in via laparoscopy through the abdomen and stitch. I have been on hormones to lessen bleeding which made the uterus thin causing the puncture. My concern.....they want to reattempt the procedure.....is puncture more likely once it has happened? I don't want to repeat this procedure a third time. I'm wondering whether I should pursue a partial hysterectomy.
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Jane Harrison Hohner, RN, RNP responded:
Dear An: The risks for perforation can include a uterus that is very flexed toward the back or front, a uterus where the thick muscular wall is thinned out (eg during pregnancy), a tight or twisted cervical canal,or the presence of a septum (wall) inside the cavity of the uterus. Given that there had been a successful D&C in the past, I would rather doubt that you had some unusual uterine structures.

If you were taking some type of progesterone to keep the lining tissue thinned out, that should not make the muscular walls thinner. If you were on a GnRH agonist (eg Lupron) uterine volume can be decreased--especially if fibroids were present.

MULTIPLE literature searches at the National Library of Medicine site did not yield any good statistics on the risk of recurrent perforation. Here are the best citations I could find:

J Am Assoc Gynecol Laparosc. 1995 Nov;3(1):11-26.
Complications of hysteroscopy-their cause, prevention, and correction.
Loffer FD.

Department of Gynecologic Endoscopy, Maricopa Medical Center, 3410 North 4th Avenue, Phoenix, AZ 85013, USA.

Complications of hysteroscopy occur more frequently in operative than in diagnostic cases. Problems related to uterine distention are common, usually preventable, and potentially extremely serious. Perforation of the uterus may occur during hysteroscopy but do not always cause significant problems. In procedures of high risk for perforation the use of mechanical energy is safer than either laser or electrical energy. Laparoscopy and ultrasonography have some limited use in facilitating operative hysteroscopic procedures. Most complications occur during the hysteroscopic surgical procedure. However, some problems may not be apparent until the post operative period.

Curr Opin Obstet Gynecol. 2002 Aug;14(4):409-15.
Complications in hysteroscopy: prevention, treatment and legal risk.
Bradley LD.


Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. bradlel@ccf.org

PURPOSE OF REVIEW:

Fortunately, gynecologists are enthusiastically embracing diagnostic and operative hysteroscopy as a means to evaluate women with menstrual disorders, infertility, post-menopausal bleeding, recurrent pregnancy loss, and for ultrasound images. In general, operative hysteroscopy is a safe procedure, is easily learned, and has excellent surgical outcomes. As more obstetricians/gynecologists perform hysteroscopy, they must remain cognizant about the salient complications. The recognition of complications and prompt intervention will prevent adverse sequelae as well as minimizing undesirable patient outcomes and reducing legal risks.
RECENT FINDINGS:

Hysteroscopy remains a relatively safe procedure. Diagnostic hysteroscopy has the fewest risks, followed by operative hysteroscopic adhesiolysis, metroplasty, and myomectomy. Fluid management is critical for intraoperative safety. Meticulous detail should be paid to fluid management, and consultation sought with a critical care specialist when fluid overload or hyponatremia is suspected. Lingering pain, fever, or pelvic discomfort after surgery requires prompt evaluation. Women becoming pregnant after operative hysteroscopic procedures need careful antepartum and intrapartum care. Special attention to unusual pain complaints during pregnancy or with fetal distress in labor need prompt intervention.
SUMMARY:

The preoperative use of misoprostol or laminara decreases the risk of uterine perforation. Expert preoperative evaluation is essential in determining the surgical skill and expertise needed, surgical time, and the likelihood of completing the operative procedure. Overall, complications in operative hysteroscopy are infrequent and are usually easy to manage. This knowledge should help physicians perform more procedures.

An_242444, you are asking all the right questions. Please discuss this with your GYN surgeon. You can always get a second opinion as well.

Yours,
Jane
 
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someonewhocares3 responded:
So sorry this happened to you! I had a hyst almost 6 years ago and wish I had a do-over. My gyn removed everything for a benign ovarian cyst. The hormonal havoc alone was awful! Finding a decent HRT was difficult but has helped with the typical meno symptoms but still dealing with feeling like an empty shell along with mild depression (I was suicidal the first 2 years post-op).

But there's no "fix" for the loss of pelvic integrity that happens after the uterus is removed. I now have the shortened upper torso, post-hyst "scrunched" midsection, and back, hip and rib cage pain.

The uterus and ovaries work as a unit so any procedure that damages or removes part of this system MAY cause problems which may not show up in the short-term. These post procedure problems have been coined post ablation syndrome, post hysterectomy syndrome, post tubal ligation syndrome. Do a web search.

Here's a lengthy discussion (114 replies) about women's experiences with endometrial ablation -
http://forums.webmd.com/3/gynecology-exchange/forum/12649/113?pg=1

Here's a video of the lifelong functions of the uterus and ovaries - http://www.youtube.com/watch?v=Ff5IOSj1l7w

Hope this helps!
 
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IrwinsLady replied to someonewhocares3's response:
look everyone does what they think is best for them. not everyone gets the same aftermath as you do. i didnt, im completely fine after my hysterectomy.
 
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someonewhocares3 replied to IrwinsLady's response:
I'm glad your recovery went well! It looks like your hyst was only 3 months ago. Absent surgical complications, it takes longer for problems to manifest. The anatomical / skeletal / physique changes are gradual and take years to become obvious. Most women don't realize the effects of having those ligaments severed nor the many other adverse effects experienced by many women. There wouldn't be so many hysterectomy support groups on the web if these problems weren't so common.
 
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Jane Harrison Hohner, RN, RNP replied to someonewhocares3's response:
Dear someone: I know you care and want to share additional information, but did you really hear what An_242444 was saying? I think she shared that she has been tried on non-surgical treatments (hormones) which were not successful. The ablation may be a better choice, in my opinion, than a hysterectomy. Yet you are giving her suggestions about reading up on post-tubal ligation syndrome (not applicable to her diagnosis!!!!), post-ablation syndrome, and post-hysterectomy syndrome.

She is likely going to need something for treatment. Being an informed consumer of medical care is good, but not all the bad things happen to all women. In fact, except in well controlled studies, there can be a reporting bias where those that have had bad outcomes are more likely to report them then those who did not.

I totally agree with you that no procedure/surgery should be taken lightly. Honestly I have known many women who have been happy, long term, with their decisions to have a hysterectomy.

Sincerely,
Jane


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