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SURGICAL MANAGEMENT OF

DYSFUNCTIONAL UTERINE

BLEEDING

K.KABILAN

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SURGICAL MANAGEMENT OF DUB

DUB is usually controlled by medical line of

management

The need for surgical management ariseswhen there is a failure in medical line of

management

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An overview o Management o

Menorrhagia

Menorrhagia

Young women Older women

Pregnancy desired Pregnancy not desiredRule out uterine pathology and cancer

Progestogens

EthamsylateNSAIDGnRH 3-4 months

COC

Progestogens

Mirena

Effective Fails

Continue for 6-9

months and

follow up

MIS

Hysterectomy

with conservation

of ovaries

Normal uterus(DUB)

Uterine pathology

Surgery

Medical theraphy

COC contraindicated

over 40 years

No response

Hysterectomy with

oopherectomy after

50 years (No MIS)

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SURGICAL MODALITY

Hysterectomy

Abdominal

VaginalLaproscopic

Laproscopic assisted vaginal hysterectomy

Ovaries must be preserved in patients agebelow 50yrs

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Indications

Failure of medical line of management and

MIS.

Family history of uterine malignancy. Premalignant endometrial pathologies.

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ABDOMINAL HYSTERACTOMY

Abdominal hysterectomy is preferred when

extensive adhesions are anticipated

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Advantages:

Good access and better visualisation.

Technically easy.

Less time consuming.

No need of advanced instrumentation as in

laproscopic procedure

P.Op bleeding and bladder injury are less in

compare to vaginal hysterectomy

Anatomical relations not altered.

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Disadvantages:

Patient recovery prolonged.

Prolonged hospitalisation. Incisional pain.

P.Op wound infection.

Uretral injury. Risk of developing hernia.

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VAGINAL HYSTERECTOMY

This approach prefferedwhen extensiveadhesions are not

anticipated.

Pre-requesties: Uterus size

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Advantages:

Faster recovery Reduced hospital stay

No risk of developing hernia

Peritoneum minimally opened, no bowelhandling hence less post operative illness

Bowel function returns soon

Quick ambulation

Less post-operative infection

Least invasive route

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Disadvantages:

Pelvic infection

Vesical injury, fistula Vaginal shortening and stenosis

Recurrent cystocele, rectocele, entrocele

Vault prolapse P.Op bleeding Haemorrhagic shock

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LAPROSCOPIC HYSTERECTOMY

&

LAVH

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Advantages:

Faster patient recovery

Reduced hospital stay

Less post operative pain

Less wound infection

Provides better visualization and access to

abdomen and pelvis

Disadvantages:

Time consuming

Expensive

Require better surgical skills

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