Dehiscence/Tubal ligation Flashcards
What are the 3 levels of surgical wound failure?
- Superficial separation
- Fascial dehiscence
- Evisceration
What is a superficial wound dehiscence?
Superficial separation of the skin or subcutaneous tissues
Seroma
What is an evisceration?
Complete failure of abdominal closure to peritoneal cavity
What is the management for a superficial wound dehiscence?
- Explore area of separation and debride if necessary
- Wet to dry dressings or local packing for secondary healing
- Antibiotics not necessary
What is the management for fascial dehiscence?
- Recognize this is a potential surgical emergency
- Return to OR, resect and debride all layers including fascia to healthy tissue
- Reapproximate with all mass closure
- Antibiotics ppx
What is the management for evisceration?
- Surgical emergency
- Immediate return to OR with wound and bowel covered in moist towels/plastic
- Full inspection of bowel integrity
- Irrigate peritoneal cavity copiously, inspect surgical sites
- Debridement/resection of all layers to healthy tissue
- Mass closure
- Antibiotic ppx
What are the factors that may be associated with regret for tubal ligation?
- Age<30 years old
- 1 child
- Unstable relationship/not married
- Postpartum surgery
- Children not healthy
What should your counseling include for tubal ligation?
Discussed motivating desire for tubal
Discussed points of regret
Discussed alternative methods to contraception such as LARCS and male sterilization
Discussed procedure
Discuss permanent procedure
What is the 1 year failure rate for interval tubal ligation?
7.3/1000
What is the 1 year failure rate for postpartum tubal?
1.2/1000
What is the 1 year failure rate for Copper IUD?
0.8%
What is the 1 year failure rate for progesterone IUD?
0.2
What is the 1 year failure rate for implant?
<1/100
0.05%
People who get pregnant with IUD in place, what are they at increased risk for?
Ectopic pregnancy
Spontaneous abortion
Septic abortion
Preterm labor
What are the advantages of bilateral salpingectomy for tubal ligation?
- Decrease risk of future tubal disease
- Reduce risk of ovarian cancer
- Effective contraception
What is the approach of choice for hysterectomy?
TVH
What factors should you consider when choosing the route of hysterectomy?
- Size and shape of uterus
- Length of vagina
- Caliber of vagina
- # of vaginal deliveries and size of babies
- Prolapse
- History of endometriosis, pelvic surgery or PID
- Need to do other abdominal/pelvic surgery
- Malignancy
What is the issues with morcellation?
Possible risk of disseminating an occult uterine malignancy
When is it approved to do laparoscopic power morcellation?
With a tissue containment system
What women are not candidates for laparoscopic power morcellation?
Postmenopausal or women>50
