Dehiscence/Tubal ligation

Question 1

What are the 3 levels of surgical wound failure?

Answer 1

1. Superficial separation
2. Fascial dehiscence
3. Evisceration

Question 2

What is a superficial wound dehiscence?

Answer 2

Superficial separation of the skin or subcutaneous tissues
Seroma

Question 3

What is an evisceration?

Answer 3

Complete failure of abdominal closure to peritoneal cavity

Question 4

What is the management for a superficial wound dehiscence?

Answer 4

1. Explore area of separation and debride if necessary
2. Wet to dry dressings or local packing for secondary healing
3. Antibiotics not necessary

Question 5

What is the management for fascial dehiscence?

Answer 5

1. Recognize this is a potential surgical emergency
2. Return to OR, resect and debride all layers including fascia to healthy tissue
3. Reapproximate with all mass closure
4. Antibiotics ppx

Question 6

What is the management for evisceration?

Answer 6

1. Surgical emergency
2. Immediate return to OR with wound and bowel covered in moist towels/plastic
3. Full inspection of bowel integrity
4. Irrigate peritoneal cavity copiously, inspect surgical sites
5. Debridement/resection of all layers to healthy tissue
6. Mass closure
7. Antibiotic ppx

Question 7

What are the factors that may be associated with regret for tubal ligation?

Answer 7

1. Age<30 years old
2. 1 child
3. Unstable relationship/not married
4. Postpartum surgery
5. Children not healthy

Question 8

What should your counseling include for tubal ligation?

Answer 8

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

Question 9

What is the 1 year failure rate for interval tubal ligation?

Answer 9

7.3/1000

Question 10

What is the 1 year failure rate for postpartum tubal?

Answer 10

1.2/1000

Question 11

What is the 1 year failure rate for Copper IUD?

Answer 11

0.8%

Question 12

What is the 1 year failure rate for progesterone IUD?

Answer 12

0.2

Question 13

What is the 1 year failure rate for implant?

Answer 13

<1/100

0.05%

Question 14

People who get pregnant with IUD in place, what are they at increased risk for?

Answer 14

Ectopic pregnancy
Spontaneous abortion
Septic abortion
Preterm labor

Question 15

What are the advantages of bilateral salpingectomy for tubal ligation?

Answer 15

1. Decrease risk of future tubal disease
2. Reduce risk of ovarian cancer
3. Effective contraception

Question 16

What is the approach of choice for hysterectomy?

Answer 16

TVH

Question 17

What factors should you consider when choosing the route of hysterectomy?

Answer 17

1. Size and shape of uterus
2. Length of vagina
3. Caliber of vagina
4. # of vaginal deliveries and size of babies
5. Prolapse
6. History of endometriosis, pelvic surgery or PID
7. Need to do other abdominal/pelvic surgery
8. Malignancy

Question 18

What is the issues with morcellation?

Answer 18

Possible risk of disseminating an occult uterine malignancy

Question 19

When is it approved to do laparoscopic power morcellation?

Answer 19

With a tissue containment system

Question 20

What women are not candidates for laparoscopic power morcellation?

Answer 20

Postmenopausal or women>50