So if the hysterectomy & prolapse repair is being done in conjunction with
a c-section, it would not be laparoscopic and the risk of cuff dehiscence
is reduced, correct?

Ginger Chun, BA, IBCLC, RLC
Breastfeeding Education and Support
www.freshmilkbaby.com


On Sat, Sep 21, 2013 at 3:26 AM, Elizabeth Boggs <[log in to unmask]> wrote:

> Several posters seemed concerned about the assertion that estrogen is
> associated with wound healing. When I replied to the initial post I did not
> have access to my references.
>
> Estrogen has been demonstrated to increase vascularity of the vaginal
> tissues in postmenopausal women.
>
> Am J Obstet Gynecol. 1982 Jun 15;143(4):375-8.
> Effect of conjugated estrogens on vaginal blood flow in surgically
> menopausal women.
> Abrams RM, Stanley H, Carter R, Notelovitz M.
>
> There are studies that have demonstrated that estrogen is associated with
> improved wound healing.
>
> Cornea. 2012 Oct;31(10):1158-64. doi: 10.1097/ICO.0b013e31823d03ca.
> Effects of 17β-estradiol on human corneal wound healing in vitro.
> Oh TH, Chang DJ, Choi JS, Joo CK.
> Source
> Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital,
> College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul,
> Korea
>
> Int Urogynecol J. 2012 Dec;23(12):1763-9. doi: 10.1007/s00192-012-1793-0.
> Epub 2012 May 12.
> Vaginal incisional wound healing in a rabbit menopause model: a histologic
> analysis.
> Abramov Y, Golden B, Sullivan M, Goldberg RP, Sand PK.
> Source
> Division of Urogynecology and Reconstructive Pelvic Surgery, Carmel
> Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa,
> Israel. [log in to unmask]
>
> Prevalence, pathophysiology and current management of dehisced perineal
> wounds following childbirth (784kb)
> Lynn Dudley, Christine Kettle, Khaled Ismail
> British Journal of Midwifery, Vol. 21, Iss. 3, 07 Mar 2013, pp 160 - 171
> (this article references a midwifery textbook that cites vaginal blood
> flow as a primary effector of perineal wound healing, re:Abrams above)
>
>
> Cuff dehiscence is not a common occurrence, but the rate can approach 5%
> if the woman has a total laparoscopic hysterectomy.
>
> J Minim Invasive Gynecol. 2007 May-Jun;14(3):311-7.
> Incidence and patient characteristics of vaginal cuff dehiscence after
> different modes of hysterectomies.
> Hur HC, Guido RS, Mansuria SM, Hacker MR, Sanfilippo JS, Lee TT.
>
>
> And a relatively recent study looked specifically at postoperative tissue
> and estrogen therapy.
>
> Female Pelvic Med Reconstr Surg. 2012 Jul-Aug;18(4):211-5. doi:
> 10.1097/SPV.0b013e31825e6401.
> A randomized clinical trial of the impact of local estrogen on
> postoperative tissue quality after vaginal reconstructive surgery.
> Karp DR, Jean-Michel M, Johnston Y, Suciu G, Aguilar VC, Davila GW.
> Source
> Section of Female Pelvic Medicine and Reconstructive Surgery, Department
> of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta,
> GA 30322, USA. [log in to unmask]
>
>
> I want to be clear that I am not advocating that the original poster's
> patient stop breastfeeding; I am only seeking to answer her question about
> why a pelvic floor surgeon would want estrogen levels to be normal.
> Personally, I endorse Joanne's approach of an open discussion with her
> surgeon.
>
>
>
> Elizabeth Boggs, MD
> Women Physician Associates
> Columbia SC
>
>
>
>
>
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