Operative site infection after AH refers cumulatively to wound infection and pelvic infection. Pelvic infection can, in turn, be broken down into: (1) pelvic cellulitis, (2) vaginal cuft abscess. and (3) pelvic abscess. The rate of operative site infection in patients undergoing AH is 9% provided the patient receives prophylactic antibiotics. Prophylactic antibiotics have been proven to reduce the incidence of wound infection. They also may decrease the risk of petvic intection, although this point is controversial.
One should realize that the use of prophylactic antibiotics carries some risk. There are several reports of patients developing hemolytic anemia after the administration of cephalosporins. Some of these cases follow the administration of a single dose of prophylactic antibiotics. Although both first and second generation cephalosporins have been implicated in the development of acute hemolytic anemia. Garratty reported that second generation cephalosporins may carry a higher risk. This author has observed two cases of hemolytic anemia after the administration of a single 2-g dose of Cefotetan. One case resulted in a fatality.
With vaginal hysterectomy, there is no abdominal wound; consequently, operative site infection is synonymous with pelvic infection. According to the CREST study, the rate of petvic infection after VH is 3.9%. The operative site infection rate of LH consistently is reported at lower figures than traditional hysterectomy. A recent review reported an operative site infection rate of 1.4%. Many of the same arguments used to explain the decrease in unexplained fever also can be used to explain the decrease in operative site infection. The ability to view the pelvis immediateiy before completion of LH gives the surgeon one last opportunity to irrigate the field, remove detritus, and obtain meticuious hemostasis. This is a clear advantage over VH. The smaller size of the incisions leads to a much lower rate of wound infection, which is a major advantage over AH.
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