Operative Procedures

Hysterectomy

Vaginal Hysterectomy is the most common method for removal of the uterus (around 97% of the time).

Laparoscopic Assisted Vaginal Hysterectomy (LAVH) if the ovaries need to be removed at the same time.

Abdominal (only needed in about 3% of cases because the uterus is too large (usually due to fibroids).

Minimally Invasive Techniques for Heavy Menstrual Bleeding

Minimally invasive techniques for heavy menstrual bleeding suit up to 80 % of women. However, a hysterectomy is a long term cure for heavy bleeding in association with younger age, pain (which may be due to adenomyosis – or the lining of the uterus in the muscle of the uterus that causes pain with the period) or irregular and heavy bleeding.

Prolapse Surgery

This is an interesting field where there have been new developments with the use of mesh to give ideal vaginal reconstructions. Prolapse occurs mostly as a result of childbirth, in particular delivering large babies causing disruption of the muscles at the pelvic side wall or the ring structure of muscles at the top of the vagina. There are three areas that can prolapse – the anterior wall of the vagina and subsequently the bladder falls down – a cystocoele, the back upper wall of the vagina – an enterocoele and the posterior wall in front of the rectum – a rectocoele.

Very often there is damage in all compartments to a greater or lesser degree. Fixing one can result in subsequent stress on another which therefore prolapses. Prolapse can recur and can be difficult to fix but newer techniques give successful vaginal reconstructions that are impressive.

The particular technique used needs individualization – depending on the patient’s past history and particular requirements. With the new meshes, an excellent cosmetic result is usually achieved with the reconstruction of normal vaginal anatomy.

Urethral Tapes

These are a relatively new device for the control of stress incontinence. (Loss of urine with coughing, laughing, sneezing). Stress incontinence is the result of the urethra being too mobile and not being compressed against the vaginal wall during increases in abdominal pressure. Urethral tapes do not cure 'urge incontinence' which is an overactive bladder.

A Transvaginal tape (TVT) is put in under general anaesthesia, via a 2 cm incision in the anterior wall of the vagina) and the patient usually stays overnight.

Laparoscopy

This is a diagnostic procedure for infertility or pelvic pain. Endometriosis may be seen and treated with excision. Sterilisation is usually undertaken laparoscopically. Ovarian cysts that are small (< 5cm) may be removed laparoscopically or larger ones if there is very little risk of malignancy.

Polycystic Ovarian Syndrome

This is the commonest non-surgical condition I see patients for. It results in a variety of symptoms and has implications for weight maintenance, fertility and long term cardiac disease and diabetes. It is very variable in its presentation. Good management is likely to reduce the long term risks.

General Gynaecology

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