ACTA FACULTATIS

MEDICAE NAISSENSIS

UDC: 618.1-089

Scientific Journal of the Faculty of Medicine in Niš 2011;28(2):125-133

Professional article ■

Preoperative Preparation of Patients

for Gynecologic Surgery
Goran Lilić1, Radomir Živadinović1,2, Aleksandra Petrić1,2, Vekoslav Lilić1,2

1
Clinic of Gynecology and Obstetrics, Clinical Center Niš, Serbia
2
University of Niš, Faculty of Medicine, Serbia

SUMMARY

Surgical treatment of the patients with gynecologic diseases is warranted

only when all the conservative treatment approaches have been exhausted. Surgi-
cal treatment is a stress for the patient, and associated risks and complications
may be life-threatening. Surgery may be performed after the patient has been
informed and her written consent obtained regarding the risks associated with sur-
gery. In order to avoid the risks and complications of surgery, preoperative patient
preparation constitutes an important step and is done according to a precise sequ-
ence of procedures and measures. The aim of the paper is to present a systema-
tized sequence of procedures and measures to be taken before a planned gyneco-
logic surgical treatment, and to demonstrate the significance of preoperative pre-
paration of patients for the surgery itself and postoperative recovery. After the
first visit and talk of a gynecologist with his patient, gynecologic and general
clinical examinations, blood and urine laboratory, and various consultative
specialist exams (for internal diseases, anesthesiology, etc), the decision is made if
and how the surgery should be done. General and special surgical risks are
estimated and the decision on the type of surgery is made. Two hours before
surgery, a dose of pro- phylactic antibiotic therapy is aministered, and
thromboembolic disease is preven- ted with low doses of subcutaneous heparin.
The operation field is treated with dis- infectants immediately before surgery,
with mandatory placement of the Folley catether in the bladder.

Key words: gynecologic surgery, preoperative preparation, risk factors

Corresponding author:
Goran Lilić•
tel. 065/ 650 5000•
e.m ail: lilicgoran@yahoo.com •
1
ACTA FACULTATIS MEDICAE NAISSENSIS, 2011, Vol 28, No 2

the person’s name. A detailed medical history and

INTRODUCTION examination are the preconditions for any preoperative
assessment, and the information obtained can
Preoperative care involves a number of determine perioperative
various measures and procedures conducted before
surgery. Prior to any surgical treatment, all
conservative metho- ds of therapy must be
exhausted to determine if the patient can safely
sustain the risk of the surgery pla- nned (1).
During preoperative care, the gynecologic surgeon
is fully acquainted with the patient's physical
condition, and all the relevant data obtained during
the interview with the patient must be inserted
into the history of disease. After admission into
hospital, the general clinical, gynecological and
various additional specialist examinations are
undertaken, supplemented by the information
relevant for surgical treatment plann- ing. The
surgeon who is to undertake surgery is obliged to
introduce to the patient all the reasons of the
surgi- cal treatment. The patient must be fully
acquainted with procedures and risks of the
surgery planned and must not be persuaded to
undergo surgery against her own will. The patient
must submit an informed written consent to
confirm that she takes the risk of the planned
surgical treatment (2). There are two groups of
indications for gynecological surgery: absolute -
when surgery must be undertaken, when its
cancellation is life-threatening, and relative -
when surgery can be postponed till the most
appropriate occasion for its per- forming. Before
making a decision on surgery, one of the three
requirements must be fulfilled: relief of pain and
suffering, preservation of life, correction of an exi-
sting deformity. If none of the three goals can be
achie- ved by surgery, the surgery should be
given up (3).

PREOPERATIV E EXAMINATION

Preoperative examination should help a gyneco-

logic surgeon to prepare his patients for
operation. In most cases it involves a physical
exam, various tests, risk stratification and
modification of risk factors. The surgeon can thus
reduce any delays in the preparation phase, to
improve patient's safety, to recognize and treat
complex medical problems, and to reduce costs
and surgery cancellations. A detailed medical
history consists of the following elements:

Patient history

Any assessment of patient’s ability to

sustain the risks of the planned surgical
treatment begins with the initial talk with the
patient, i.e. recording of history data (anamnesis,
i.e. recollection). If the patient cannot talk to the
surgeon (comatous, affected by some mental dis-
order, children), the talking is done with the
accompa- nying person (heteroanamnesis), recording
 Goran Lilić et
breast diseases (discharge, pain, past
al. problems,
risk. The patients undergoing minor surgery can family history of breast cancer, surgery).
be exa- mined by their surgeon and A comprehensive history, as described, is
anesthesiologist on the operation day during the first step helping surgeons to determine the
preoperative preparation. However, those with more scope of
serious conditions should be examined at least a
week before surgery, allowing the time for risk
assessment, specialist consultations, and
preparation, since many medical conditions can
change within a few weeks, days, or hours after
preoperative investigations. These more
complicated cases require additional work- up or
treatments before the surgery in question
(4).

General medical history

General medical history contains the data

on personal and family diseases, history of
drug use, aller- gies to drugs, foods, and other
environmental allergens, hospitalizations, earlier
diseases (including previous operations and
tolerance of anesthetics). A gynecologic surgeon
learns about the patient’s cardiovascular disea-
ses (congenital anomalies, blood pressure,
arrythmias), respiratory system (chronic
obstructive pulmonary dise- ase), endocrine and
gastrointestinal diseases, neurolo- gic status
(cerebrovascular, peripheral, or central neuro-
logic processes), hematologic condition (anemias,
coa- gulation disorders), health habits (smoking,
intake of alcohol, drugs, diets, physical exercise),
and socioeco- nomic status (marital status,
occupation, education). Important family data
refer to malignancies, cardiovas- cular diseases,
diabetes mellitus, cerebrovascular disea- ses, and
osteoporosis (5).

Gynecologic and obstetric history

Each gynecologic anamnesis should

contain the data about major complaints of the
current disease (beginning, duration,
symptoms), menstrual cycle data (intervals,
duration, copiousness, dysmenorrhea, pre-
menstrual syndrome, intermenstrual bleeding);
menar- che; data on the last menstruation; if
the patient is postmenopausal, age at
menopause, recent vaginal bleeding, vasomotor
symptoms, hormone replacement therapy; past
pregnancies (description of each, durati- on,
complications, type of delivery); birth control
(if sexually active - active contraception,
methods in the past; if sterilized - time and
mode of sterilization); sex- ual history (sexual
partners - homosexual, heterosexu- al, bisexual;
orgasms; dyspareunia; problems; com- plaints;
questions); birth control (conception difficulti- es,
infertility treatment, vaginal infections,
Papanicolau test (the last, abnormalities),
infections (vaginal dis- charge, previous vaginal
infections, sexually transmi- tted diseases, small
pelvis inflammations), vaginal pro- lapse with
urinary problems (retention, incontinence);
general physical examination, laboratory, and establish if the disease process is stable and are
radiolo- gic tests (6).
there any improvements or exacerbations. A
surgeon should discuss with the patient about the
Clinical (physical) examination extent of surgery, pla- nned incision, variations in
the technique or extent, depending on the
The aim of the physical examination is to intraoperative findings. The discussion and detailed
esta- blish the physical, health status, in view of examination serves also to encourage both the
history and medical condition. An adequte patient and his doctor. A history and physical exa-
examination consists of the parameters such as: mination serve to get the answers to some
vital signs (blood pressure, puls, breathing, body questions (7). Table 1 presents some specific
temperature), habitus and physical appearance questions to be ans- wered before the operation. As
(head, ears, eyes, nose, bone system, ex- tremities), already stated, adequate history and physical
airways and lung auscultation, heart auscul- tation examination require some routine preoperative
with rhythm determination; neurologic condition with laboratory tests and additional specialist
mental status observation, function of the cranial examinations in order to establish objective patient
nerves, and sensorimotor abilities; detailed exam of sta- tus and perform assessment of the tolerability of
the abdomen and pelvis, as the main component opera- tion (Table 1).
of the procedure. The physical examination should
serve us to

Table 1. Specific questions wich should be answered before operation

Questions

1. Are extra questions needed and which ones? If yes, which?

2. Does the present disease imitate any nonsurgical disease?
3 Is it now the right time for operation or will its delay increase chances for success?
4. Is there a possibility for applying some therapeutic procedures that will increase
chances for success of the operation?
5. Will the patient be able to provide autogenic blood transfusion is postponed?
6. Is the patient at too many risk factors endangering the success of the operation?.
7. Is the patient mentally and physically ready to endure operation?

Preoperative indications for laboratory other analyses are done: electrolytes (sodium, calium,
tests chlor,

Patient age, diagnosis of the disease, risk of

the procedure with careful and detailed history and
physical examination establish the need for specific
preoperative testing. Laboratory analyses of the
blood involves blood group determination, complete
blood count with the leukocyte formula,
sedimentation, bleeding and coagu- lation time,
thrombocytes, fibrinogen. Renal function is checked
(diseases, urea, creatinin, diuretic therapy, seri- ous
or prolonged hypertension) and liver function as well
(suspect liver diseases, suspect or proven cirrhosis,
po- tential hepatitis, anticoagulant treatment,
bleeding dis- order symptoms, abnormal PT and
aPTT, bilirubin, se- rum alanine-aminotransferase,
serum aspartate amino- transferase) (8). Glucose
in the blood is determined as well (history of
diabetes, hypoglycemia, adrenal glands, current
corticosteroid treatment). General analysis of the
urine and urinoculture is performed. If required,
calcium), cholesterol, triglicerides, tests for
inflammatory processes (9). Previous ECGs are
useful to the surgeon only if it can reveal the
abnormalities undetected with other approaches
(10). After admission and history tak- ing (history,
physical examination), the female patient gives
her informed written consent about the suggested
diagnostic-therapeutic procedures.

Complete gynecologic examination

A complete gynecologic examination is

done preoperatively, involving the control of
cytologic Papani- colau smear of the uterine
cervix, vaginal discharge test- ing, colposcopy of
the mucosa of the lower portion of the vaginal
tract (vulva, vagina, uterine cervix), bimanual
palpatory and endovaginal sonographic examination
of the uterus, ovaries, and Fallopian tubes. If
there are signs of cervical inflammation
(cervicitis) or vaginal mu- cosa (colpitis), it is
necessary to take additional swabs for
microbiologic analysis (bacteria, chlamydia,
urea-
 By the help of medical consultations and additio-
mycoplasms, human papillomavirus, and herpes nal examinations the objective status of the patient
simplex virus) (11). is established, assessing the tolerability of the
If the patient is admitted for the treatment of planned
pro- lapsed genital organs, special attention is paid
to bima- nual and rectovaginal examination to
establish the type, degree, and site of the disorder
(prolapse of the uterus, vaginal walls, Douglas
pouch, etc.). If there is unvolun- tary urination that
cannot be controlled, complete uro- dynamic
examination should be performed, or at least the
tests to objectify incontinence, since any
instability of the bladder detrusor muscle in the
form of proven ur- gent incontinence, requires
conservative, medicamen- tous treatment or
electrotherapy before the operation. Stress
incontinence associated with other genital disea- ses
requires surgical treatment combined with other
planned surgery whenever required or technically
feasi- ble (12).
Before the planned operation, we must not
miss the pregnancy or malignant diseases. If
pregnancy is suspected, the values of beta subunit
of human chorio- nic gonadotropin from the blood
(beta hCG) should be tested. If before surgery, after
various diagnostic proce- dures, a pathologist has
diagnosed or suspected of a malignancy of
female genital organs, it is necessary to employ
additional diagnostic procedures in order to
assess the spread to adjacent tissues and
organs. A sonographic examination of the upper
abdomen and small pelvis imaging (computerized
tomography, electro- magnetic resonance) are
warranted. As required, endo- scopic examination of
the bladder mucosa (cystoscopy) and large bowel
(rectosigmoidoscopy, colonoscopy, irigography,
etc) are done as well (13).
A planned radical operation requires that pre-
or intraoperatively all ureteral visualization
proceedings should be done (for the purpose of
avoiding their injury), since with tumors or
inflammations in the small pelvis they are
commonly dislocated (14). In uterine cervix
carcinoma, a rectovaginal examination is mandatory
in order to assess clinically the involvement of the
connec- tive tissue in the small pelvis bottom
(parametria). If ovarian cancer is suspected, blood
tumor markers are measured preoperatively (CA
125, CA 19-9, HE4, AFP, etc). Histopathology of
the removed tumor is done intraoperatively (ex
tempore histopathology), and when tumorous
changes are encountered in the left ovary, special
attention should be paid preoperatively to large
bowel since ovarian cancers are prone to spread to
the sigmoid part of the colon (15).

OTH ER P R E O P E R A T I VE
EX A M I N A T I O N S

Preoperative consultations and other

additional examinations
 systemic im- pact;
surgery. At best, medical consultants involved II group - moderate systemic disease without
in preo- perative evaluation, should be those functional impediments;
involved in conti- nued postoperative care. III group - severe systemic disease with serious
Consultants should review the risks by the organ functio- nal impediments;
systems: cardiovascular, respiratory, endocrine IVgroup - severe systemic life-threatening disease;
(hyperthyreosis, thyroid storm, hypothyreosis),
gastrointestinal, urinary, hematopoietic.
Psychologic con- siderations are of special
importance, since any surgery of the female
genitals stimulate various emotions asso- ciated
with the status of womanhood. In addition to the
concerns related to their disease, women are also
worri- ed about their rehabilitation, conspicuous
changes, po- ssible sexual dysfunctions, and
return to the general well
- being. A surgeon must address these
questions in a rational and affirmative way
(16).
A female patient should be able talk to
her sur- geon in an open, frank way, and the
surgeon should help her to better understand
the suggested procedure. Consultations should
answer the following questions: What is the
diagnosis? What way it was established? Are
more precise, additional tests required? Is the
pati- ent optimistic about the outcome? Are there
steps to be taken to improve her condition? Are
additional informa- tion about the risk
assessment available? Are there any
suggestions about the course of the surgery
and post- operative follow-up? (17).

Anesthesiologic preoperative
examination

An anesthesiologist has to examine the

patient before her operation. The examination
helps him to get an insight into the general
health condition, and to assess whether the
patient is able to tolerate the risks and
duration of anesthesia for the planned surgery
(using internal examination, ECG, lung x-ray,
lab test results). That is the moment when the
type and route of anesthesia, available
anesthetics, possible postoperati- ve pain
management, are discussed. A special stress is
put on the state of consciousness and vital
functions of the heart, blood vessels, liver, and
kidneys. Chronic di- seases of these organs are
significant in that regard, as well as the current
disease status, because of possible
acutizations/remissions. Anesthesiologist orders
additio- nal tests if required, and any pathology
in the upper airways is significant (nose,
mouth, larynx, pharynx), as well as thyroid
diseases, since these may disturb endo-
tracheal intubation (18).
Anesthesiologic surgical risk is assessed
based on the assessment of physical status
created by the American Society of
Anesthesiology - ASA), classifying them into 6
categories defining the risk of death:
I group - original disease, if it is without a
V group - moribund patient, with life expectancy operations. Adequate antibiotic concentration has to
below 24 hours; and
be present in the tissues in the beginning and
VI group - confirmed brain death (19). during the surgery. A single dose of antibiotic
immediately before the operation is sufficient for
Principles of preoperative use of most surgical procedures. A maximum
antibiotics concentration of antibiotic in the pelvic ti- ssues is
reached 20 minutes after an i.v. administration,
Wound infection occurs as the consequence of and after two hours it markedly drops. In time -
complex interactions between the bacteria reaching consu- ming interventions intramuscular
the wound intraoperatively, and local and systemic administration of anti- biotics is preferred. If the
immunity of the host. The amount of inoculated operation is going to take mo- re than 3 hours,
bacteria is directly associated with the risk of administration of antibiotics should be repeated.
postoperative infections. The factors such as Intravenous use of antibiotics is an optimal way
prolonged postoperative hospitalization and overuse to provide an adequate level of presence in the ti-
of antibiotics increase the risk of wound co- ssues for most gynecologic operations (21).
lonization. Provision of optimal local immunity to Prophylactic use of antibiotics have been
infec- tion is primarily a surgical task. Various demon- strated to be more successful for vaginal
factors, such as the presence of blood, foreign compared to abdominal operations. A recommended
bodies, ischemia, or ne- crotic tissue in the surgical regimen for patients undergoing vaginal hysterectomy,
field, can have an adverse impact on local patient abdominal or radical hysterectomy consists of a
defense and increase the risk of infection. By way dose of i.v. cefazolin (1 g) or cefotetan (1 g) at
of meticulous surgical technique we can avoid the induction of anesthesia, or aminoglycosides
many of these factors. A principal benefit rela- ted with metronidazole (22). Table 2 lists the
to preoperative use of antibiotics is the recommendations for prophylactic administration of
elimination or prevention of growth of endogenous antibiotics before gynecologic surgery, and Table 3
bacterial flora, which can induce infection in the pre- sents the risk factors for postoperative
surgical field (20). infections. Ade- quate use of antibiotics is able to
The most important principle is that the reduce the rate of infections, as well as morbidity
chosen antibiotic should be effective against the and associated costs
pathogens most commonly responsible for (23) (Tables 2 and 3).
infection after certain

Table 2. Recommendation for choosing antibiotcs in postoperative infection prophilaxy

Choice of antibiotics and doses

1. Cephalosporins first generation: up to 2,0 grammes

2. Metronidazole 0,5 - 1,0 grammes + gentamicin 1,5 mg/kg iv.
3. Clindamycin 600 - 900 mg iv + Gentamicin 1,5 mg/kg
4. Ciprofloxacin 400 mg iv

Table 3. Risk factors of developing postoperative infection in gynecologic surgery

Risk factors

1. Age of patient (senium)

2. Body mass (extremly obese - thin)
3. Presence of regional infection
4. Chronic disease (malignant disease, diabetes, hypertension, liver, lang disease etc)
5. Duration of operation (risk of infection doubles after 60 min. following the first hour)
6. Previous long lasting antibiotic apply
7. Patient's weak immune system
8. Problems with intestinal tract (ileus, previous operations, radiations etc)
9. Contamination with endogenic flora by a surgeon and other staff
10. Bad surgical techique( stitching bigger tissue parts than necessary, tissue maceration
etc)
11. Unacarefull hemostasis
12. Noise and conversation in the operating theatre, air-borne contmination
 Prevention of thromboembolic disease stration of low-dose preparations, infusion
administra- tion of dextran, and by various
Deep venous thrombosis (DVT) and venous mechanical methods and procedures (25). Low-
thromboembolic (VTE) disease of the lungs are dose heparin preparations are administered
signifi- cant and statistically confirmed complications subcutaneously and initiated 2 hours before
of surgical treatment. The rate of postoperative surgery, continuing for 7 postoperative days in 8-
VTE ranges from 15% to 40% in women 12 hour intervals. Infusion administration of
undergoing major gynecologic surgery without dextran from 70-40.000: adminstration of 500-
thromboprophylaxis. About 40% of all deaths after 1000 ml of dextran 70 as an infusion in 3
gynecologic surgery are directly associated with fractions: 500 ml intra- operatively, 500 ml
pulmonary thrombosis. Over 90% of pulmonary em- immediately after operation, and 500 ml on the
bolisms originates from the venous system distal first postoperative day. In patients with
to the vena cava, i.e. from the pelvis and lower disturbed cardiac and renal function, the use of
extremities. A German pathologist Virchow dex- tran can result in excessive fluid retention and
described first as early as 1858 the causative anaphy- lactic reaction (26).
factors of venous thrombosis: hypercoagulability Mechanical methods are very important as
of the blood, venous stasis, and trau- ma of the well, involving the reduction of stasis of the
intima of blood vessels (24). blood with a short preoperative hospitalization, and
Important factors in the occurrence of early postopera- tive mobilization. Feet elevation
postopera- tive venous thrombosis in gynecologic while in bed above the heart level supports venous
surgery are age (years) and extent of the surgery. drainage and reduces sta- sis. However, the most
Additional risk factors for DVT and pulmonary VTE important methods from this group are external
disease are trauma associa- ted with prolonged pneumatic compression and elastic stockings. The
surgery (interventions lasting over 300 minutes use of elastic stockings is the most sig- nificant
and loss of over 600 ml of blood), earlier DVT, method (after heparin) of prevention of thrombo-
varicose veins, infection, malignancy (cancer treat- embolic disease in the medium and high risk
ment), estrogen treatment, earlier pelvic radiation patient group (27). Preoperatively, the patients
thera- py, smoking, insufficiency of the heart or should be cla- ssified in accordance with the
respiratory sys- tem, obesity, immobility. Most levels of risk of thrombo- sis (given above) in
authors agree that the combination of order to establish the advantages and risks of
intraoperative venous stasis and hyper- coagulability pharmacologic and physical methods of pre- vention
of the blood have the most prominent role in the of thromboembolism. Related to the prevention of
occurrence of venous thrombosis. A thromb most thromboembolic disease, all patients can be
commonly occurs in the period of 24 hours after classi- fied in four risk groups (Table 4).
surge- ry.
Prevention of VTE disease in gynecologic
surgery is performed in three ways: by
subcutaneous admini-

Table 4. Risk groups according to thromboembolic disease prevention

Risk groups in thromboembolic prevention

1. Low risk
- do not have risk factors, younger than 40 years of age and surgery lasting less than 30
minutes

2. Moderate risk
- surgery lasting less than 30 minutes in patient with additional risk factors
- surgery lasting less than 30 minutes in patients aged 40-60 years with no additional risk
factors
- major surgery in patients younger than 40 years with no additional risk factors

3. Higs risk
- major surgery in patients older than 40 years or with additional risk factors
- surgery lasting less than 30 minutes in patients older than 60 years or with additional risk
factors

4. Higest risk
- major surgery in patient older than 60 years plus deep vein trombosis, cancer or hypercoagulable
13
0
 state
- pelvic exentration
- radical vulvectomy with inguinofemoral lymphadenectomy
- mayor surgery + deep vein thrombosis history and lung thrombosis
- mayor surgery + expressed postthrombotic arrest changes on low extremities

13
1
 Immediate preparation of patients for rative complications, enabling a successful outcome
gynecologic surgery of surgery. Preoperatively, the diagnosis of a disease
requ- iring surgery has to be made, with the
In addition to disease history, a patient list assessment of safety and tolerability of the
should contain all the agents and procedures planned intervention. This can be accomplished by
performed during preoperative patient preparation. It a well taken history, gynecolo- gic examination,
is necessary to use a drug for bowel emptying 24 laboratory tests of the blood and urine, internal and
hours before surgery, and if required a deep enema anesthesiologic assessment (involving an ECG,
in the evening before or morning on the day of chest x-ray, and additional specialist examinati-
operation. In the evening before surgery a nurse ons). Based on the criteria of the American
should remove all pubic hair from the patient’s Society of Anesthesiologists, all patients are divided
external genitals, performs vaginal toilette and into six groups of risk of death during gynecologic
applies an antiseptic vaginal tablet, and the patient surgery, based on the assessment of physical
may take a shower and clean her anterior status. A precise diagnosis has to be made
abdominal wall if abdo- minal surgery is planned. preoperatively in order to minimize intraope- rative
Immediately before going to bed, the patient must surprises. The decision to operate is made if at
take a dose of sedative (Bensedin 5 mg tablet, or least one of the following reasons is present: relief
something else). On the day of operati- on, two of pain and suffering, preservation of life, correction
hours before operation, a planned dose of he- of an existing deformity. If none of the reasons is
parin is administered, and prophylactic present, the operation should be waived.
administration of antibiotics and bandaging of the Preoperative prophylactic use of antibiotics aims at
lower extremities with an elastic bandage or elimination and prevention of growth of
compressive stockings is done 30 minutes before endogenous bacterial flora which could cause an
surgery. After a short talk with the gyne- cologic infection in the surgical field. The measures taken
surgeon, the patient is transported to the opera- to prevent thromboembolic disease are of special
tion room. Before the induction of anesthesia, impor- tance, since 40% of all deaths after
disinfec- tion of the vagina and anterior abdominal gynecologic surgery are caused by this event. After
wall is perfor- med, and a Folley catether is placed preoperative preparation for gynecologic surgery,
into the bladder. The operation field is delineated and in order for surgery to be successful, a
with sterile surgical clo- thes and the operation gynecologic surgeon should answer the following
may commence (28). questions: should I operate, may I operate, and do I
know how to operate?
CONCLUSION

Preoperative patient preparation for gynecologic

surgery is to avoid or minimize both intra- and
postope-

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PREOPERATIVNA PRIPREMA BOLESNICA ZA GINEKOLOŠKE OPERACIJE

Goran Lilić1, Radomir Živadinović1,2, Aleksandra Petrić1,2, Vekoslav Lilić1,2

1
Klinika za Ginekologiju i akušerstvo, Klinički centar Niš, Srbija
2
Univerzitet u Nišu, Medicinski fakultet, Srbija

Sažetak

Za operativno lečenje bolesnice obolele od ginekološke bolesti odlučujmo se nakon što su is-
crpljene sve mogućnosti konzervativnog lečenja. Operativno lečenje predstavlja stres za bolesnicu, a
rizici i komplikacije koje ono nosi mogu ugroziti i njen život. Zbog toga se operativno lečenje može
sprovesti nakon obavljenog razgovora sa bolesnicom i dobijanja njene pismene saglasnosti o prihvatanju
rizika operativnog lečenja. Da bi se izbegli rizici i komplikacije kod operativnog lečenja, preoperativna
priprema bolesnice čini važan korak u sprovođenju operativnog lečenja i sprovodi se prema tačno
utvrđenom redo- sledu postupaka i mera koje treba sprovesti pre planiranog operativnog lečenja.
Cilj rada bio je prikaz sistematizovanog redosleda postupaka i mera koje treba sprovesti uoči plani-
ranog operativnog lečenja u oblasti ginekologije, kao i ukazati na značaj preoperativne pripreme
bolesni- ca za sam operativni tok i postoperativni oporavak posle ginekološke operacije. Nakon prvog
susreta i razgovora ginekologa sa bolesnicom, ginekološkog i opšteg kliničkog pregleda, kontrole
laboratorijskih analiza iz krvi i mokraće, i različitih konsultativnih specijalističkih pregleda

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(internističkog, anesteziološkog i drugih) donosi se odluka da li se i na koji način može sprovesti
operativno lečenje. Procenjuju se opšti i

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posebni rizici operativnog lečenja i donosi odluka o izboru operacije. Dva sata pre operacije ordinira se
profilaktička doza antibiotika, načini prevencija tromboembolijske bolesti niskim dozama subkutano
ordini- ranog heparina. Operativno polje se tretira dezificijensima neposredno pred operaciju i obavezno
se plasira Foly kateter u mokraćnu bešiku.

Ključne reči: ginekološke operacije, preoperativna priprema, faktori rizika