Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines. Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study. Gynaecologic surgery from uncertainty to science: evidence-based surgery is no passing fad. Prophylaxis in gynaecological surgery: a prospective randomized comparison between single dose prophylaxis with amoxycillin/clavulanate and the combination of cefuroxime and metronidazole. [Antibiotic prophylaxis in the surgical treatment of inguinal hernia: need or habit?]. A prospective randomized study comparing amoxycillin/clavulanate with cefuroxime plus metronidazole for perioperative prophylaxis in gynaecological surgery. The psychosocial needs of gynaecological cancer survivors: A framework for the development of a complex intervention. Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial Effects of Antibiotics on Dental Implants: A Review Is pain prophylaxis in minor gynaecological surgery of clinical value? a double-blind placebo controlled study of paracetamol 1 g versus lornoxicam 8 mg given orally. Prophylaxis in gynaecological and obstetric surgery: a comparative randomised multicentre study of single-dose cefotetan versus two doses of cefazolin. The Laparoscopic-Assisted Combined Hysterectomy: A New Surgical Concept Compared to the Classical Laparoscopic-Assisted Vaginal Hysterectomy by a Prospective Study Is chemical antithrombotic prophylaxis effective in elective thoracolumbar spine surgery? Results of a systematic review Comparison of ondansetron and metoclopramide for the prevention of post-operative nausea and vomiting after major gynaecological surgery. Specialist nurse supported discharge in gynaecology: a randomised comparison and economic evaluation. The effectiveness of non‐invasive complementary therapies in reducing postoperative nausea and vomiting following abdominal laparoscopic surgery in women: a systematic review Multimodal interventions (chewing gum, early oral hydration and early mobilisation) on the intestinal motility following abdominal gynaecologic surgery. A randomised prospective trial of intra‐operative oesophageal Doppler‐guided fluid administration in major gynaecological surgery Comparison of enoxaparin and standard heparin in gynaecologic oncologic surgery: a randomised prospective double-blind clinical study. A comparison of commonly used anti-emetics for the prevention of emetic sequelae after a major gynaecological surgery. Nitrous oxide reduces the cost of intravenous anaesthesia. Trial of the use of masks in the gynaecological operating theatre. Acupuncture compared to placebo‐acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo‐controlled patient and observer blind trial Does an enhanced recovery integrated care pathway (ICP) encourage adherence to prescribing guidelines, accelerate postoperative recovery and reduce the length of stay for gynaecological oncology patients? Universal prophylaxis compared with screen‐and‐treat for Chlamydia trachomatis prior to termination of pregnancy
The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis . Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and /or gynaecological procedures , not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis . This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from " r and omly occurring " bacteremia ( e.g. , from brushing teeth ) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective . A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implication s is presented BACKGROUND Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery . Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few . The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings ( GCS ) and intermittent pneumatic compression ( IPC ) or GCS alone . METHODS The study was performed on 108 patients who were r and omly assigned to two groups . The first group received GCS before the operation and IPC during the operation ( IPC + GCS group ) . The second group received GCS before the operation ( GCS group ) . To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures , the incidence of adverse reactions was assessed . RESULTS The morbidity associated with DVT was 4.8 % ( 5/104 ) in the IPC + GCS group and 12.5 % ( 14/112 ) in the GCS group . There were significant statistical differences between the two groups . There were no adverse effects in either group . CONCLUSIONS The therapeutic combination of GCS and IPC was more effective than GCS alone for thrombosis prevention in high-risk patients undergoing gynaecological pelvic surgery , and there were no adverse effects in either group BACKGROUND The r and omized controlled trial ( RCT ) is the least biased measure of the effectiveness of interventions , including surgical interventions . The aim was to review the available evidence base in gynaecologic surgery , to assess what progress has been made and to determine gaps in the evidence for clinical decision-making . METHODS Systematic review s involving gynaecological surgery interventions were extracted from the Cochrane Data base of Systematic Review s ( Issue 2 , 2007 ) and data were extracted for key primary outcomes from each of the r and omized trials in the review s. The review s were categorized as to whether they had provided evidence of effectiveness for pre-defined outcomes of most relevance to patients . RESULTS Of 371 review s or protocol s published on the Cochrane Data base of Systematic Review s ( Issue 2 , 2007 ) , only 30 were completed review s assessing surgical interventions . Seven review s concluded there was evidence of a significant effect ( whether beneficial or harmful ) of the interventions studied for pre-defined primary outcomes ; 11 review s concluded there was some evidence of significant effects for primary outcomes along with some gaps for primary outcomes ; 12 review s concluded insufficient evidence of effectiveness . Common themes of unique method ological challenges and pitfalls with trials of surgical interventions were apparent . CONCLUSIONS Cochrane review s have gone a long way to establishing a sound evidence base in gynaecologic surgery : some gaps in the evidence have been eliminated and others highlighted . In general , gynaecology has been a specialty where surgical interventions have been well exposed to the scrutiny of RCTs compared with other surgical specialties A prospect i ve r and omized comparison of a single pre-operative dose of 2.2 g amoxycillin/clavulanate versus the combination of 1.5 g cefuroxime plus 0.5 g metronidazole was conducted in 467 women , who underwent gynaecological surgery . The incidence of febrile morbidity , urinary tract infection , wound infection and the use of post-operative antimicrobial agents was similar in the two groups .  Amoxycillin/clavulanate  is as effective as a combination of cefuroxime and metronidazole and less expensive BACKGROUND Prophylactic antibiotics are recommended for clean-contaminated and selected contaminated surgery . In clean surgery antibiotics are suggested if the operation involves the insertion of prosthetic devices and a potential infection is expected to cause serious morbidity or mortality . Inguinal hernia repair is a clean operation , infections are rare ; they can usually be cured without removing the prosthesis and recurrence is uncommon even after removal of the mesh . Aim of the study is to evaluate whether the lack of antimicrobial prophylaxis increases the risk of postoperative infections in patients treated for groin hernia , compared to those treated with prophylaxis . METHODS One hundred and forty-eight patients underwent inguinal hernia repair with mesh : 64 patients ( 43 % ) received 2 g cefotaxime by intravenous bolus about 30 minutes before the operation , 84 patients ( 57 % ) did not receive any antimicrobic prophylaxis . Mean follow-up was 13 months ( range 1 - 31 months ) for both groups . RESULTS We did not observe any major complication . Among both groups , no patient had developed infection at one week and one month after surgery . CONCLUSIONS In personal experience , any advantage in terms of prevention of infections with antibiotic prophylaxis in patients operated on for groin hernia has been observed . A review of the literature showed no general agreement on this subject with different risk of infections in different trials . A new prospect i ve r and omized trial is necessary to clarify this topic A prospect i ve , r and omized , open study was performed in 199 patients at the Leyenburg Hospital comparing amoxycillin/clavulanate ( AMX/CL ) with cefuroxime plus metronidazole ( CR/MN ) in the prophylaxis of infection following gynaecological surgery .  AMX/CL was given as a single dose of 2200 mg i.v . at the start of the operation . CR/MN , 750/500 mg i.v . was administered 3 times within 24 h , beginning at the start of the operation . The study group consisted of patients undergoing either a vaginal hysterectomy , a vaginal hysterectomy with cysto/rectocele repair or a secondary caesarean section . There were no statistically significant differences in demographic characteristics , duration of surgery or anaesthetic method  between the two groups . Postoperatively , 10.6 % of patients developed a urinary tract infection , and febrile temperatures were found in 9.0 % of patients . There were no statistically significant differences between the two treatment groups . Other complications were found in less than 1 % of the study population , equally distributed between the two regimens . In this study there was a low overall percentage of infection after gynaecological surgery . AMX/CL was as effective as CR/MN as a perioperative prophylactic treatment and has the dual advantage of a single dose and lower cost PURPOSE To develop and pilot test an intervention targeting the women 's psychosocial needs during the follow-up period after surgical treatment for gynaecological cancer . METHODS The project consisted of four phases . Phase 1 involved development of an intervention on the basis of meetings with key healthcare professionals , a literature review and six semi-structured interviews with women who attended the existing follow-up program . The Guided Self-Determination ( GSD ) method developed in diabetes care was identified as an appropriate framework for the intervention . GSD consists of reflection sheets for patients and advanced professional communication skills . The GSD method was adapted to women in a follow-up program after gynaecologic cancer treatment ( GSD-GYN-C ) .  Phase 2 involved primary pilot testing of the intervention and the findings were used to modify the intervention in phase 3 . This modification involved the development of additional reflection sheets and a fidelity assessment tool . A systematic training program was arranged for the GSD-GYN-C-nurses . Phase 4 involved secondary pilot testing where nurses and women confirmed the applicability of GSD-GYN-C and final adjustments were made . Selected measurements were tested for sensitivity during pilot testing . Data from phase 2 and 4 were also used to select the primary outcome and calculate power for a future r and omized clinical trial ( RCT ) . RESULTS Pilot testing supported our hypothesis that GSD-GYN-C may be transferable and useful to survivors of gynaecological cancer . CONCLUSION GSD-GYN-C was developed and vali date d and is now ready for evaluation in an RCT Objective To examine the effect of counselling and relaxation intervention on psychological symptoms in patients with gynaecological cancer between the post‐operative period and the six‐week review There are many reasons for dental implant failure , the development of bacteremia is concern for dentists . This is due to the possibility of unfavorable result such as implant loss or the need for re-treatment . In general , antibiotic prophylaxis is recommended for high risk patients such as individuals with an immunodeficiency , infectious endocarditis , or previous prosthetic instrumentation . However regarding clinical ly healthy , low and moderate risk individuals the use of antibiotics in implant dentistry is controversial . Another major concern regarding the over prescription of antibiotics is the selection of antibiotic resistant bacteria . A better underst and ing of the efficacy of prophylactic treatments regarding dental implantation is crucial . Thus a literature review and comparison of survival rates of dental implants with regimens of no , pre or post prophylaxis was performed using systematic literature review using reliable electronic data bases . Retrospective or prospect i ve controlled studies were examined for the influence of preoperative and /or postoperative or no antibiosis on dental implant success rate . Of the 11406 implants used in this literature review , cases with no antibiotics had a 92 % success rate , cases with pre-op antibiotic alone had a 96 % success rate , cases with post-op antibiotic alone had a 97 % success rate and cases with both pre and post-op antibiotic had a success rate of 96 % . Thus , the results from this literature review show a > 90 % success rate when antibiotics are used compared to when they are not used . Thus , no benefit is seen from the use of antibiotic prophylaxis in low and moderate risk dental implant patients . Keywords Dental implants ; Pre-operative prophylactics ; Post-operative prophylactics ; Success Methods : In a prospect i ve r and omised placebo controlled double-blind study 210 ASA I-II women scheduled for elective termination of pregnancy received 1 g paracetamol , 8 mg lornoxicam or placebo orally 60 min before anaesthesia which was st and ardised with propofol , fentanyl and oxygen in nitrous oxide 1:2 .  Postoperative pain was assessed by VAS-score at 30 and 60 min after end of surgery and at discharge as primary endpoints . Need for rescue medication and time to discharge were secondary endpoints . Results : All patients had an uncomplicated course .  Overall pain intensity was low , however , the patients pretreated with lornoxicam had significantly less pain after surgery , no difference could however , be seen in need for rescue medication or time to discharge between the three groups . Conclusion : General pain prophylaxis may be argued in minor gynaecological surgical procedures where postoperative pain is of low intensity . If general prophylaxis is to be given in minor gynaecological surgery , a non steroidal anti-inflammatory ( NSAID ) such as lornoxicam , seems more efficacious as compared to a st and ard dose of 1 g paracetamol Antimicrobial prophylaxis is recommended in all clean-contaminated surgery where the critical threshold of number and virulence of the contaminating organisms with respect to host resistance is reached . Obstetric and gynaecological surgery is clean-contaminated and risk of infection due to aerobic and anaerobic bacteria without prophylaxis can be quantified at 30 - 40 % for vaginal hysterectomy , 10 - 35 % for abdominal hysterectomy and 10 - 34 % for caesarean section . To assess the role of two different cephalosporins as short term prophylaxis , we carried out a multicentre r and omised study involving a single 2 g i.v . dose of cefotetan in comparison with two doses of cefazolin ( 2 g i.v . before surgery and after 8 hours ) . Criteria for exclusion were : exposure to antibiotics within 7 days , preoperative infection , hypersensitivity to beta-lactams . Four hundred and sixty patients entered the study , of which 229 received  cefotetan and 231 cefazolin . No significant differences in mean age , obesity , preoperative weight loss , diabetes , type of disease , type of surgery ( vaginal or abdominal hysterectomies and caesarean sections ) and number of pregnancies and abortions existed between the two groups of patients . The total rate of infected patients undergoing hysterectomy  was 8.6 % ( 13/151 ) in the cefotetan group and 17.4 % ( 29/167 ) in the cefazolin group ( p less than 0.05 ) . This difference was due to cases of symptomatic bacteriuria and antibiotic retreatment , while wound infections were not significantly different ( 2.6 % and 1.8 % respectively ) . Among patients undergoing caesarean section , 9 of 78 ( 11.5 % ) and 7 of 64 ( 10.9 % ) were infected following cefotetan and cefazolin , respectively ( not significant ) . Cefotetan mean tissue concentrations in gynaecological organs were higher than those of cefazolin ( 25.5 - 44.8 vs. 7.4 - 9.5 mg/kg ) . ( ABSTRACT TRUNCATED AT 250 WORDS Background and Aims : This controlled trial with II-1 evidence compared the safety and efficacy of the new laparoscopic-assisted combined hysterectomy ( LACH ) with the st and ard surgical technique laparoscopic-assisted vaginal hysterectomy ( LAVH ) in general and in patients displaying risk factors ( large uterus , vaginal nulliparity , prior caesarean section ) . Methods : From June 2007 to September 2008 , 101 patients underwent a hysterectomy at the Clinic of Gynaecology , Obstetrics and Gynaecological Oncology at the Pius Hospital , University Hospital for Gynaecology in Oldenburg . The main outcome measures were feasibility , postoperative analgesia , postoperative inflammatory reaction , and duration of surgery . Statistical analyses were performed using SPSS for Windows ( p < 0.05 ) . Results : We observed no significant differences between LACH and LAVH regarding outcome parameters or when risk factors were considered . Within the LACH group , the duration of surgery was significantly shorter for patients with UW < 400 g. Still within the normal range , caesarean sections from both groups revealed significant differences in the number of leucocytes on the 2nd post-operative day . No urinary tract injuries , no unplanned conversion to laparotomy , no severe perioperative complications occurred in either group . Conclusion : In terms of technical feasibility , LACH represents a safe alternative for abdominal HE when LAVH is contraindicated Study design : Systematic review Study rationale and context : There is controversy regarding the efficacy and safety of chemical prophylaxis to prevent deep venous thrombosis ( DVT ) and pulmonary embolism ( PE ) in elective spinal procedures .Commonly performed elective spine surgeries done through a posterior approach have a very low associated risk of DVT/PE . The lack of consensus is due in part to a limited amount of quality evidence based literature dealing with this issue . Objective : To compare chemical prophylaxis with no chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery . Methods : We undertook a systematic review of the literature to assess the efficacy and safety of chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery . Pubmed , EMBASE , Cochrane , National Guideline Clearinghouse Data bases as well as bibliographies of key articles were search ed . Articles were review ed by two independently working review ers . Inclusion and exclusion criteria were set and each article was subject to a predefined quality rating scheme . Results : We identified only two articles meeting our inclusion criteria . Neither study demonstrated a significant difference between chemical prophylaxis versus no prophylaxis in preventing thromboembolic events . There was an increased incidence of perioperative bleeding with low dose Coumadin in one of the studies . Conclusion : The incidence of DVT and PE in commonly performed elective posterior spinal procedures is very low . While there is a limited amount of r and omized literature looking at this issue , the current literature does not support the routine use of chemical prophylaxis for low risk patients undergoing these procedures The efficacy of ondansetron 4 mg was compared with metoclopramide 10 mg for the prevention of post-operative nausea and vomiting in patients after major gynaecological abdominal surgery . Anaesthesia was st and ardized using thiopentone , atracurium and methadone for induction followed by isoflurane in nitrous oxide-oxygen mixture .  Fifty patients were r and omized in a double-blind fashion to either receive intravenous ( i.v . ) ondansetron 4 mg or metoclopramide 10 mg during closure of the pelvic peritoneum . The incidence and frequency of vomiting , and the incidence of severe nausea was recorded for 24 h after surgery . One patient was excluded because of respiratory depression . In the first 4 h after surgery , five patients ( 20 % ) in the ondansetron group ( n = 25 ) and eight patients ( 33 % ) in the metoclopramide group ( n = 24 ) vomited , whereas at 4 - 12 h , this increased to 11 patients ( 44 % ) and nine patients ( 37.5 % ) respectively . The incidence was 52 and 37.5 % respectively in the subsequent 12 - 24 h. The highest incidence of nausea was in the first 4 h after surgery , being 56 and 37.5 % in the ondansetron and the metoclopramide groups respectively . This decreased to less than 25 % in both groups in the 12 - 24 h period . Ondansetron 4 mg and metoclopramide 10 mg had similar but short lasting efficacy for the prevention of vomiting in patients who received continued opioid analgesia after major gynaecological surgery AIM To determine the effect on quality of life and cost effectiveness of specialist nurse early supported discharge for women undergoing major abdominal and /or pelvic surgery for benign gynaecological disease compared with routine care . STUDY DESIGN R and omised controlled trial comparing  specialist nurse supported discharge with routine hospital care in gynaecology . The SF-36 , a generic health status question naire , was used to measure women 's evaluation of their health state before surgery and at 6 weeks after surgery . A further question naire scoring patient symptoms , milestones of recovery , information given and satisfaction , was administered prior to discharge from hospital and at 6 weeks thereafter . SETTING Gynaecology service at the Western Infirmary Glasgow , part of North Glasgow University , NHS Trust . PARTICIPANTS One hundred and eleven women scheduled for major abdominal or pelvic surgery for benign gynaecological disease . MAIN OUTCOME MEASURES SF-36 health survey question naire baseline scores were reported before surgery and at 6 weeks follow-up . Complications , length of hospital stay , readmission , information on discharge support and satisfaction of women were recorded at discharge from hospital and at 6 weeks follow-up . A cost consequence analysis was conducted based on the perspective of the NHS . RESULTS The addition of a specialist nurse to routine hospital care in gynaecology significantly reduced the post-operative length of hospital stay p = 0.001 , improved information delivery and satisfaction of women . The specialist nurse supported discharge group was associated with significantly lower total costs to the NHS than routine care result ing principally from the difference in the cost of the post-operative length of stay . CONCLUSIONS Women undergoing major abdominal and pelvic surgery were discharged home earlier with provision of support from a specialist gynaecology nurse . The results of this study suggest that duration of hospital stay can be shortened by the introduction of a specialist nurse without introducing any adverse physical and psychological effects . This process of care is associated with receipt of information on health and lifestyle issues and maintenance of high levels of patient satisfaction and demonstrates the effectiveness of the specialist nurse role in the provision of health information for women . Earlier hospital discharge at 48 h after major abdominal and pelvic surgery is an acceptable , cost effective alternative to current routine practice in the absence of further r and omised evidence Background Postoperative nausea and vomiting ( PONV ) are common adverse events following surgery and anaesthesia . The reported incidence is particularly high in patients undergoing laparoscopic surgery , ranging from 40‐77 % . PONV can be very distressing for patients and can result in unplanned readmission in ambulatory surgery . Antiemetics are only partially effective for both prophylaxis and treatment , can have adverse effects and in the case of the newer medications are expensive . The effectiveness of a number of complementary therapies in reducing the incidence of PONV continues to be investigated , given their relative ease of application , relatively low cost , lack of significant side effects , and patient interest and acceptability . Objectives The objective of this review was to determine from the available evidence the most effective non‐invasive complementary therapies for reducing the incidence and /or severity of postoperative nausea and vomiting in women undergoing abdominal laparoscopies . Search strategy A literature search was undertaken using : relevant health care data bases ( eg . AMED , CINAHL , MEDLINE / PubMed , Current Contents , Science Direct ) ; data bases of reports , theses , and conference papers ( eg Dissertation Abstract s , Conference Papers Index , National Research Register [ UK ] ) ; and major sources of evidence ‐based practice information ( e.g. Cochrane Library , Agency for Healthcare Research Quality , and clinical trials data bases or registers ) between the years 1980 and 2007 . In addition reference lists of relevant journal articles and selected web sites were checked . Selection criteria R and omised controlled trials and quasi‐experimental studies investigating the effects of non‐invasive complementary interventions on postoperative nausea and /or vomiting , and the need for rescue medication following abdominal laparoscopic surgery in women were considered for inclusion in the review . Trials with only a ' no‐treatment ' control group were not included . Data collection and analysis Assessment of the eligibility of studies for inclusion in the review and the method ological quality of eligible studies , and data extraction from included studies were undertaken independently by two review ers . Odds ratios and relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95 % confidence intervals . Where pooling of data was inappropriate , studies were considered separately and a narrative summary reported . Main results Twenty‐one studies involving a total of 2286 participants were included in the review . Thirteen studies investigated the effect of four interventions on PONV following gynaecological laparoscopy : ginger , acupressure , guided imagery and music . Eight studies examined the effect of two interventions on PONV following laparoscopic cholecystectomy : stimulation of acupoints by various means and oral carbohydrate rich beverage . Six trials with a total of 554 participants investigated the effectiveness of varying dosages of ginger powder ( Zingiber officinale )  following gynaecological laparoscopy . There is some limited evidence to support providing ginger in doses between 1 g and 1.5 g to prevent or reduce the level of nausea postoperatively and to reduce the need for rescue medication whereas there is currently no evidence to support either a lower or higher dosage , i.e. < 1000 mg or > 1.5 g . Ginger in this dosage range ( 1‐1.5 g ) has not been demonstrated to be effective in preventing vomiting . Four trials , with a total of 399 participants , investigated the effectiveness of acupressure as prophylactic treatment for PONV in patients undergoing laparoscopic gynaecological procedures ; two using the P6 acupoint on the lower arm and two using the Korean K‐K9 acupoint on the h and . There is evidence that stimulation of the K‐K9 acupoint is effective , however the evidence for stimulating the P6 acupoint in this group of patients is equivocal . Six trials involving 719 participants investigated the effectiveness of stimulation of acupoints in patients undergoing laparoscopic cholecystectomy . There is some evidence to suggest that acupressure or acustimulation at P6 may be somewhat more effective in reducing nausea and vomiting following this surgical procedure for male and female patients . One study with 186 participants ( male and female ) assessed the application of capsaicin ointment to the Korean h and acupressure point K‐D2 . The treatment demonstrated efficacy in both the early ( 0‐6h ) and later periods ( 6‐24h ) for both the reduction of PONV and the need for rescue antiemetics . In treating established PONV postoperatively there were two trials , with a total of 172 participants , examining one category of intervention ‐ inhalation of isopropyl alcohol ( IPA ) . These two trials focusing on laparoscopic gynaecological procedures produced strong evidence that the administration of IPA is much quicker in achieving a 50 % reduction in the level of nausea than the antiemetic ondansetron ; however there is no evidence that it reduces the need for rescue antiemetics . The remaining three trials , two investigating oral carbohydrate rich beverage and the other guided imagery and music , did not demonstrate that these interventions were effective . Conclusions There is sufficient evidence to suggest that several of the interventions assessed could play a role in a multimodal approach to minimise PONV following abdominal laparoscopic surgery , albeit requiring further research to confirm that promise . The two interventions of note are the use of the Korean H and acupoints for prophylactic purpose s , particularly acupressure applied to the acupoint K‐K9 , and the use of impregnated pads for the inhalation of 70 % isopropyl alcohol to treat established nausea in females . There is also some evidence to suggest that acupressure or acustimulation at P6 may be effective in reducing nausea and vomiting in patients ( females and males ) having a laparoscopic cholecystectomy AIMS AND OBJECTIVES To determine the effects of chewing gum , early oral hydration and early mobilisation on the time of first bowel sounds , first passage of flatus and first defecation following abdominal gynaecologic surgery . BACKGROUND A major complication of abdominal surgical procedures is paralytic ileus which results in patient discomfort , prolonged length of hospital stay and increased cost of treatment . DESIGN Prospect i ve r and omised case-control study . METHODS Women who underwent abdominal gynaecological surgery for benign disorders under general anaesthesia were r and omised into eight groups according to different combinations of interventions consisting of chewing gum , early oral hydration and early mobilisation . The effects of these interventions on the time of first bowel sounds , first passage of flatus and first defecation following abdominal gynaecologic surgery were investigated . The data were analysed using chi-square tests , t-test for independent sample s , Tukey 's HSD test , pairwise comparison test , one-way analysis of variance . RESULTS It was found that the time when bowel sounds were heard was shorter , the time first passage of flatus was shorter and first defecation occurred earlier in the 1st group of women who chew gum , were hydrated orally and were mobilised early after surgery than the other groups . It was also determined that these periods were longest in the women who did not receive any intervention and received the routine hospital care when compared with other groups . Duration of hospital stay was shorter in the women who chew gum , were hydrated orally and were mobilised early than the other groups . CONCLUSIONS Early oral feeding , early mobilisation and chewing gum are effective methods in terms of preventing paralytic ileus following abdominal gynaecological surgery , improving patient comfort and shortening the duration of hospitalisation . RELEVANCE TO CLINICAL PRACTICE Nurses may cause early recovery , improve the patient comfort , prevent paralytic ileus and shorten the duration of hospitalisation after gynaecologic abdominal surgery by recommending gum chewing , early mobilisation and early hydration Intra‐operative oesophageal Doppler monitor‐guided fluid management has been associated with improved postoperative length of hospital stay and morbidity in gastrointestinal and orthopaedic surgery . We design ed a r and omised controlled trial to test the hypothesis that this approach to intra‐operative fluid management in major elective open gynaecological surgery would shorten the length of postoperative stay , defined as time to readiness for hospital discharge . Postoperative morbidity was evaluated as a secondary outcome . The oesophageal Doppler monitor group underwent intra‐operative fluid management using an oesophageal Doppler‐guided stroke volume optimisation algorithm . Control group ( conventional fluid therapy ) intra‐operative fluid management was based on conventional haemodynamic indices . In a single centre , 102 patients were r and omly assigned : 51 to the oesophageal Doppler monitor group ( 51 analysed ) and 51 to the control group ( 50 analysed ) . Evaluators who were blinded to patient assignment collected postoperative outcome data . There was no difference in the length of postoperative hospital stay between the groups : median ( IQR [ range ] ) number of days until ready for discharge was 6 ( 5–8 [ 4–25 ] ) days in the oesophageal Doppler monitor group compared with 7 ( 5–9 [ 4–42 ] ) days in the control group , p = 0.5 . There was no difference between the groups in postoperative morbidity survey scores on postoperative days 1 , 3 or 5 . Seven patients in the oesophageal Doppler monitor group and 11 in the control group experienced postoperative complications ( p = 0.41 ) . These findings question whether intra‐operative oesophageal Doppler‐guided fluid therapy is of benefit in patients undergoing open gynaecological surgery OBJECTIVE This study aim ed to compare the haemorrhagic complications and efficacy of enoxaparin , a low molecular weight heparin ( LMWH ) , and conventional st and ard heparin ( SH ) in gynaecological oncologic surgery . MATERIAL S METHODS A double blind , r and omised trial was performed on 102 consecutive women undergoing gynaecologic cancer surgery with pelvic and paraaortic lymphadenectomy . The women were separated into those who were given 2,500 IU enoxaparin once daily and SH in a dose of 5,000 IU three times daily . The groups were analysed for intraoperative blood loss , drainage , transfusion requirements , perioperative haemoglobin decrease , wound haematoma , and clinical deep venous thrombosis . RESULTS The two groups were well matched for age , weight , and other factors , which could predispose to the development of deep venous thrombosis ( DVT ) and haemorrhage . No patient developed clinical significant DVT , wound haematoma or intra-abdominal bleeding . There was no significant difference in bleeding complications between the two regimens . The antiFXa level in the plasma was correlated strongly with patient weight . CONCLUSIONS A dose of 2,500 IU enoxaparin/day does not cause more bleeding complications than SH 5,000 IU three times daily when used to prevent thrombosis . However , the dose of enoxaparin must be adjusted to the patient 's weight STUDY DESIGN Prospect i ve , r and omized , double-blind , placebo-controlled study involving one hundred ASA I-II patients undergoing major gynaecological surgery . OBJECTIVE To study anti-emetic efficacy of intravenous ( IV ) ondansetron ( 4 mg ) , droperidol ( 2.5 mg ) , metoclopramide ( 10 mg ) , and placebo . PATIENTS AND METHODS 100ASA physical status I-II undergoing major gynaecological surgery were r and omized to receive intravenously ( IV ) , one of the four test drugs 10 minutes before the end of anaesthesia . The incidence of postoperative nausea and vomiting following a st and ard anaesthetic technique was assessed . RESULTS A significantly large number of patients who received ondansetron ( 88 % ) and droperidol ( 72 % ) were free of emetic sequelae when compared to placebo ( 41 % ) ; p < 0.05 ( power of this observation is approximately 80 % at the given significance level ) . Metoclopramide was ineffective . Patients given droperidol were significantly more se date d than those receiving ondansetron ; p < 0.05 . This is not surprising , as the dose of droperidol used in this study was higher than that currently recommended because we found lower doses to be ineffective in controlling nausea and vomiting in this group of patients . CONCLUSION It was concluded that , of the drugs studied ondansetron is the best choice for anti-emetic prophylaxis after major gynaecological surgery One hundred and one women ( ASA grade s I and II ) were anaesthetized for routine gynaecological surgery using an intravenous ( i.v . ) anaesthetic technique combining propofol and alfentanil . The patients were allocated r and omly into groups . Group one received 33 % oxygen in nitrous oxide and group two received 33 % oxygen in air ( total i.v . anaesthesia ) . The group receiving nitrous oxide required significantly less ( P < 0.05 ) of the  propofol and alfentanil mixture to maintain anaesthesia and this was found to reduce the mean cost of anaesthesia by 1.70 pounds , ( P < 0.05 ) . There was no significant difference in the incidence of postoperative complications between the two groups . We suggest that nitrous oxide may be used to reduce the cost of total i.v . anesthesia with propofol and alfentanil without causing any increase in post-operative morbidity in patients undergoing routine gynaecological surgery A r and omly controlled trial was performed on 41 women having gynaecological surgery in which the team of surgeons and nurses wore or did not wear masks .  After major abdominal surgery , 3 of 5 patients in the unmasked group developed wound infections whereas no infection was observed in the 4 patients of the masked group . A greater number of Streptococci were also found by settle-plates on the operating table in the unmasked group . No infection was recorded after minor or vaginal surgery This r and omised , placebo‐controlled , patient and observer blinded trial was conducted to determine whether acupuncture at the acupuncture point P6 is effective in preventing postoperative nausea and vomiting ( PONV ) compared to placebo acupuncture .  Female patients ( n = 220 ) scheduled for gynaecological or breast surgery were r and omly assigned to two groups receiving either acupuncture ( n = 109 ) or placebo acupuncture ( n = 111 ) . Each group was stratified for type of surgery and included two subgroups receiving intervention either before or after induction of anaesthesia . The incidence of PONV and /or antiemetic rescue medication within 24 h after surgery was the main outcome measure which showed no statistically significant difference between groups ( 43.7 % acupuncture , 50.9 % placebo , p = 0.27 ) . The differences were more pronounced for patients having gynaecological surgery ( 48.9 % acupuncture , 67.6 % placebo , p = 0.07 ) than for those having breast surgery ( 38.7 % acupuncture , 40.3 % placebo , p = 0.86 ) . The secondary outcome , vomiting , was significantly reduced by acupuncture from 39.6 % to 24.8 % ( p = 0.03 ) . Subgroup analysis showed no difference between applications of acupuncture before compared to after induction of anaesthesia A new integrated care pathway ( ICP ) proforma for gynaecological oncology patients was developed and introduced in early 2010 . The ICP is a goal -defined and time-specified documentation by gynaecological oncology doctors and nurses , guided by certain parameters to be achieved in pre and postoperative days . All patients were admitted to the same unit and underwent a major abdominal/pelvic procedure for confirmed or suspected gynaecological malignancy , including hysterectomy and oophorectomy . The control group included 58 r and omly selected patients from May 2008 to March 2009 and the intervention group comprised 52 patients , after the introduction of the ICP .  The effectiveness was assessed with a variety of measurements : the duration of intraperitoneal drains , urethral catheters and intravenous fluids postoperatively ; time taken for the patient to eat and drink ; time taken to mobilisation ; and the total length of stay in hospital . We also assessed whether the implementation of the care pathway was associated with an increase in adherence to prescribing guidelines for thromboprophylaxis and postoperative antibiotics and sodium docusate . The new ICP encouraged clearer documentation and regular review of fluids , drains and catheters . There was a modest reduction in the length of stay and an increase in prescribed thromboprophylaxis and sodium docusate ( 1 ) Induced abortion is one of the most commonly performed gynaecological procedures in Great Britain , with over 12,000 terminations being performed annually in Scotl and and over 170,000 in Engl and and Wales . In Scotl and , 98 % of these are performed in NHS hospitals , whereas in Engl and and Wales , 51 % are performed in NHS hospitals and the remainder in the private sector or under NHS-funded agency agreements . Post-abortal pelvic inflammatory disease is a recognised complication of induced abortion and Chlamydia trachomatis is a pathogen which is commonly implicated in such cases . The prevalence of C. trachomatis among women requesting a termination of pregnancy in the UK has recently been reported to be 6–8 % . In order to reduce post-abortal infective morbidity from chlamydial infection and to prevent the long term sequelae ( infertility , ectopic pregnancy and pelvic pain ) , one of three management strategies may be adopted , namely , a screen- and -treat policy , universal antibiotic prophylaxis or a combined ‘ belt- and -braces approach ’ of both screening and prophylaxis . However , considerable controversy exists as to which strategy is most appropriate and , as a result , there is no agreed policy in the UK . There exists even further controversy as to whether a screen- and -treat strategy should include screening for pathogens other than C. trachomatis and as to which antibiotic regime is most suitable for a strategy of universal prophylaxis . In 1996 , the Royal College of Obstetricians and Gynaecologists recommended that for women undergoing induced abortion , a screen- and -treat strategy for C. trachomatis should include screening for gonorrhoea and bacterial vaginosis . Likewise , universal prophylaxis should use a regimen that was effective against C. trachomatis and anaerobic organisms associated with bacterial vaginosis . Since the prevalence of gonorrhoea has been shown to be only 0.2 % within this population , the necessity of screening for this pathogen in asymptomatic women is question able . As regards bacterial vaginosis , although the prevalence has been reported to be between 17 % and 28 % , its role in post-abortal pelvic infection remains unclear . C. trachomatis is more frequently detected in women with bacterial vaginosis than without and it has been postulated that bacterial vaginosis may facilitate the entry of chlamydia to the upper genital tract through the activity of enzymes such as mucinase and sialidase . A recent r and omised , placebo-controlled trial in women with bacterial vaginosis before surgical abortion provided weak evidence that treatment with metronidazole decreased the risk of post-abortal pelvic infection , although a chance finding could not be excluded . In addition , r and omised trials have shown no benefit in treating partners of women with bacterial vaginosis , so contact tracing would not be indicated for bacterial vaginosis . The remainder of this commentary will focus exclusively therefore on screen- and -treat versus prophylaxis strategies as relates to C. trachomatis only
Results Prophylactic antibiotics  prevent inflammatory complications after gynaecological surgery .
Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina .
Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin .
No benefit has been shown for the combination of antibiotics as prophylaxis .
No difference has been shown between the long-term and short-term use of antibiotics .
There is no need for the primary use of an anaerobic antibacterial agent .
Conclusion Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries
Purpose The aim of this study was to systematic ally review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations .