Role of P.T. after HYSTERECTOMYHYSTERECTOMY

ByByDr. Ali Abd El-Monsif ThabetDr. Ali Abd El-Monsif Thabet

DefinitionDefinition

Surgical removal of the uterus Surgical removal of the uterus through abdominal or vaginal incision through abdominal or vaginal incision

Indications of Indications of HysterectomyHysterectomy

A)A) Obstetrical:Obstetrical:1- Rupture of the uterus.1- Rupture of the uterus.2- Uncontrollable post-partum 2- Uncontrollable post-partum

hemorrhage.hemorrhage.3- Couvelaire's uterus3- Couvelaire's uterus4- Placenta accreta.4- Placenta accreta.

B- Gynecological:1- Inflammatory as some cases of genital

tuberculosis.2- Neoplastic: (a) Benign: some cases of fibroids

and benign ovarian tumors in old patients, (b) Malignant tumors of the cervix, body and ovaries.

3- Displacements: some cases of uterine prolapse.

4- Some cases of endometriosis.5- Some cases of dysfunctional uterine bleeding.

Types of abdominal hysterectomyTypes of abdominal hysterectomy

SubtotalSubtotal TotalTotal PanhysterectomyPanhysterectomy Radical hysterectomyRadical hysterectomy Ultraradical hysterectomyUltraradical hysterectomy

Complication of hysterectomy

1- Respiratory complications2- Excessive abdominal pain3- Deep venous thrombosis &pulmonary

embolism4- Dependant edema5- Intestinal complication6- Hemorrhage

Remote complications

• (a) Complications of the abdominal scar as keloid formation.

• (b) Vagina discharge due to infection at the vaginal vault.

• (c) Vagina vault prolapse after hysterectomy, • (d) Dyspareunia, after hysterectomy • (e) Low backache due to persistent chronic

pelvic cellulitis, • (f) Menopausal symptoms following bilateral

oophorectomy in a young patient.

Pre-operative

Aims of pre-operative treatment:

1- To prepare the patient physically and mentally for the operation.

2-Teach her the exercises that will be done post operatively.

3-To improve circulation.

4-To improve respiration.

5-To strengthen the abdominal muscles

Methods

Post operative aimsPost operative aims

1-Improve pulmonary function &prevent its 1-Improve pulmonary function &prevent its problems.problems.

2-Improve circulatory function &prevent its 2-Improve circulatory function &prevent its problems.problems.

3-Decrease incisional pain.3-Decrease incisional pain.

4-Improve wound healing.4-Improve wound healing.

6- Avoid muscle wasting6- Avoid muscle wasting

7-Correct posture .7-Correct posture .

Program of exercisesProgram of exercises

ElectrotherapyElectrotherapy

AdvicesAdvices

RETROVERSION AND RETROVERSION AND RETROFLEXION OF THE RETROFLEXION OF THE

UTERUSUTERUS

DefinitionDefinition

Retro-versionRetro-version means that the uterus is means that the uterus is directed backwards towards the sacrum directed backwards towards the sacrum by its rotation round a transverse axis by its rotation round a transverse axis passing through the external os.passing through the external os.

Retro-flexionRetro-flexion is backward flexion of is backward flexion of corpus (body) uteri on the cervix at the corpus (body) uteri on the cervix at the level of internal os level of internal os

Varieties of retro-version-Varieties of retro-version-flexionflexion

A)A) CongenitalCongenital Retroversion of a hypoplastic uterusRetroversion of a hypoplastic uterus Retroversion of a normal uterusRetroversion of a normal uterus B)B) Acquired: Acquired: Retroversion complicated by pelvic Retroversion complicated by pelvic

pathological lesionspathological lesions Puerperal retroversionPuerperal retroversion

Degrees of retro-version-Degrees of retro-version-flexionflexion

First degreeFirst degree: the fundus is directed : the fundus is directed towards the promontory of the sacrum. towards the promontory of the sacrum.

Second degreeSecond degree: the fundus is directed : the fundus is directed towards the sacral concavity. towards the sacral concavity.

Third degreeThird degree: the fundus is directed : the fundus is directed towards the tip of the sacrum.towards the tip of the sacrum.

Symptoms of RetroversionSymptoms of Retroversion

BackacheBackache Menorrhagia.Menorrhagia. DyspareuniaDyspareunia LeucorrhoeaLeucorrhoea SterilitySterility IncarcerationIncarceration

Treatment of Treatment of retroversionretroversion

Surgical TreatmentSurgical Treatment

Modified Gilliam's Modified Gilliam's VentrosuspensionVentrosuspension

Fothergill's operationFothergill's operation

Thank you