Tehran University Medical Journal

Background: Infectious complications of hysterectomy remain common despite the use of antibiotic. The usual existing methods of preoperative antisepsis do not control the vaginal bacteria that are the primary cause of contamination at the surgical site. Our goal was to assess whether febrile morbidity after total abdominal hysterectomy is decreased by the addition of povidone-iodine gel at the vaginal apex after the routine vaginal preparation with povidone-iodine solution.

Methods: We carried out a prospective randomized trial on women admitted for elective abdominal hysterectomy. Inclusion criteria included planned abdominal hysterectomy for benign or malignant gynecologic conditions. Exclusion criteria consisted of emergency surgery, current treatment for pelvic infection, and known povidone-iodine allergy. A total of 168 patients were randomized to either the control group or the intervention group, who received 20 cc povidone-iodine gel placed at the vaginal apex immediately before the operation. Both groups received the routine preoperative preparation of antimicrobial prophylaxis, abdominal and vaginal scrubbing with povidone-iodine solution prior to the operation. The primary outcome was post-operative febrile morbidity. Other outcomes included abdominal wound infection, vaginal cuff cellulitis or pelvic abscess. Data was analyzed using Fisher's exact test. p<0.05 was considered statistically significant.

Results: The overall rate of febrile morbidity was 20.5%. Febrile morbidity occurred in ten of 80 (12.5%) women receiving the povidone-iodine gel preparation and 24 of 86 (27.9%) women not receiving the gel (p<0.05). The rate of abdominal wound infection was 18.6% (16) in the control group, and 5% (4) in the gel group (p<0.05). Vaginal cuff cellulitis was seen in three patients from the control group versus one woman from the gel group (p>0.05). Pelvic abscess was diagnosed in one patient from the control group and in no patients from the gel group (p>0.05).

Conclusion: Preoperative vaginal povidone-iodine gel is an effective technique for reducing febrile morbidity and the risk of abdominal wound infection after hysterectomy.

Background: Abdominal hysterectomy is one of the therapeutic options in treatment of gynecologic diseases. The most common methods are total and subtotal abdominal hysterectomy. The effect of hysterectomy on sexuality is not fully understood and, until recently, total and subtotal abdominal hysterectomies have been compared only in observational studies. In this study, we compare total vs. subtotal abdominal hysterectomy in terms of surgical complications and postoperative sexual function of patients.

Methods: In a single-blinded randomized clinical trial, we enrolled 25 patients who underwent subtotal abdominal hysterectomy (STAH), and 25 patients who underwent total abdominal hysterectomy (TAH). All patients were followed for 24 months after surgery. Three, six, 12 and 24 months after the procedures, all variables were compared between these two groups.

Results: The duration of operation (p=0.007), volume of bleeding (p=0.0007) and duration of hospital stay after surgery (p=0.03) were less in the STAH group than the TAH group. No complications were experienced during the operation, nor excessive post-operative pain or infection for either group. No significant differences were seen between the two groups with regard to dyspareunia, sexual satisfaction of the patients and their partners were. Spot bleeding in the STAH group was significantly more frequent than in the TAH group.

Conclusion: TAH and STAH do not have significantly different outcomes with regard to sexual satisfaction and function and surgical complications.