TITLE:
Laparoscopic Hemi-Hysterectomy-Retrospective Study of Case Series of over 9 Years
AUTHORS:
Divyesh V. Shukla, Shilpi D. Shukla, Amit Shah
KEYWORDS:
Hemi-Hysterectomy, Mullerian Dysgenesis, Rudimentary Non-Communicating Horns, ESHRE ESGE, Unicornuate Uterus
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.6,
June
19,
2019
ABSTRACT: Background: Word hemi-hysterectomy
and removal of rudimentary functional
horn may be used interchangeably in published data. The same term may be used
when a non-obstructive hemi-uterus
is removed when there is an associated pathology. The article tries to standardise classification of Mullerian dysgenesis where this procedure is required according to ESHRE
ESGE classification, preoperative diagnosis and discuss the operative details. Objective: The objective was to study the demographic profile,
symptoms, association of endometriosis, variation in the anatomy, accuracy of
preoperative diagnosis, to classify according to ESHRE ESGE classification and to standardize
the laparoscopic surgical steps of hemi-hysterectomy. Study Design: This is a retrospective case series of cases of Mullerian dysgenesis with
obstructive hemi-uterus or
non-obstructive hemi-uterus with
pathology treated by laparoscopic hemi-hysterectomy.
(Canadian task force classification III). Methods: Data from hospital electronic records of all cases
tagged with word laparoscopic hemi-hysterectomy
were collected for 9 years from Jan 2009 to Dec 2018. Results: Total 19 patients of hemi-hysterectomy
were analysed. Pre-operative diagnosis was made in 100% of patients. 100% patients with obstructive horn had
dysmenorrhoea. ESHRE ESGE class U4aC3V0 was more frequently seen followed by
U5aC4V4 and U3bC3V2 as obstructive and U4bC3V0, as non-obstructive. Associated
endometriosis along with other pathology was seen
in 74% of the patients. 3 patients with HWWS had ipsilateral renal agenesis.
Laparoscopic hemi-hysterectomy was
offered to all such patients. The operative steps & variants were studied. Post-operative outcome was uneventful in all. Conclusion: An experienced surgeon should deal with these
problems of Mullerian dysgenesis discussed in this study. The other variants
diagnosed also must be treated by an experienced surgeon only. Laparoscopic hemi-hysterectomy is almost the most standard
surgical method to treat pelvic pain in cases with rudimentary non-communicating
horns or in cases of non-obstructive horns
with other associated pathologies. Post-operative recovery is
uneventful, and all patients reported pain free periods as well as they are free of chronic pain which they had before surgery.