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At least 289 records · Page 16Linked to original sources
PubMed2005

Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy?

OBJECTIVE: Benefits of laparoscopy over laparotomy in patients with endometrial cancer (EC) are well known. As many patients with EC carry co-morbid conditions, surgery is exposing them to increased risk of complications. A review of the patients with EC recruited so far in a clinical trial comparing laparoscopy to laparotomy was performed. The goal was to identify patients carrying specific risk factors for complications, who would most benefit of laparoscopy and be the ideal candidates for this surgical approach. PATIENTS AND METHODS: Between July 1995 and December 2002, 122 patients with uterine cancer entered the study. Sixty-three patients were allocated to the laparoscopy (LPS) arm (group A), while 59 were allocated to the laparotomy (LPT) arm (group B). Rate and type of intra-, early and late post-operative complications were prospectively recorded. Risk factors for complications are analyzed to define a group of patients truly benefiting from laparoscopy. RESULTS: Overall, 12 patients out of 122 (9.8%) have experienced intra-operative, 43 patients out of 122 (35.2%) early post-operative and 25 patients out of 122 (20.4%) late post-operative complications. Rate of intra-operative complications was 4.7% in group A (3 patients out of 63) vs. 15.2% in group B (9 patients out of 59), P = 0.082. Early post-operative complications rate was 23.8% in group A (15 out of 63) and 47.4% in group B (28 out of 59), P = 0.011. Rate of late post-operative complications was 7.9% (5 out of 63) in group A vs. 35.5% (21 out of 59), P = 0.001. Univariate analysis shows co-morbid medical conditions, weight >80 kg, Quetelet index >30 and age >65 years to be predictive of complications and, in fact, a subgroup of patients presenting with these characteristics (n = 57, 30 in group A and 27 in group B) has been recognized to accumulate 60% of the overall complications. In these patients, multivariate analysis identifies the surgical technique (LPS vs. LPT) to be the only significant risk factor for complications. CONCLUSION: At least one third of the patients with EC carry serious co-morbidities with an increased surgical risk for complications. For this subgroup of patients, a laparoscopic-vaginal approach significantly reduces the rate of complications and should be the standard of surgical treatment.

Adult↗
PubMed1995

Retroperitoneal radical hysterectomy.

A surgical technique is presented which combines both the abdominal and vaginal approaches to radical hysterectomy with significant modifications to allow it to be named "retroperitoneal" radical hysterectomy. Small oblique skin incisions are made 1 cm superior to the inguinal ligament exposing the retroperitoneal structures. The round ligament, uterine artery, ovarian vessels, and cardinal ligament are divided without entering the peritoneal cavity. The remainder of the procedure is completed by a modified Schauta technique. Eight patients with Stage I cancer of the cervix underwent this operation. The expected surgery time should be 3 1/2-4 hr once the surgical team becomes familiar with the procedure, with a blood loss similar to that of the Meigs procedure. Patients tolerated the procedure with minimal discomfort. Total hospital days was limited to 4 days or less in all but the first patient. One patient was discharged on the evening of surgery. No significant complications were reported except some degree of bladder atony that required self-catheterization for a short period of time. We believe that this surgical procedure fulfills the principles of a radical abdominal hysterectomy with less operative time and shorter hospital stay, and employs conventional surgical skills.

Adult↗
PubMed2001

Repair of a vaginal evisceration following colpocleisis utilizing an allogenic dermal graft.

Vaginal evisceration following colpocleisis is a very rare event and, to our knowledge, there has only been one previous case report. An 86-year-old woman presented to the Emergency Department with acute onset of abdominal pain occurring following a bowel movement. Six months previously, she had undergone a colpocleisis for recurrent vaginal vault prolapse. On presentation to the emergency room, she was noted to have 60 cm of necrotic small bowel protruding through her vaginal introitus. She was taken to the operating room for resection of the small bowel and closure of her colpocleisis. The closure of the vaginal defect was difficult and required a vaginal approach employing an allogenic dermal graft. This was accomplished and the patient had an uneventful recovery and was discharged home. At 18 months followup, she has had no complication or recurrence. Evisceration following colpocleisis is a rare event, but can be very difficult to manage and we suggest consideration of employing a graft to reinforce the repair.

Aged↗
PubMed2003

Voiding dysfunction after surgery for stress incontinence: literature review and survey results.

Postoperative voiding dysfunction is a potential complication of anti-incontinence procedures. Reported rates of urethral obstruction range from 5% to 20%. There is a lack of consensus in the literature regarding the appropriate evaluation and management of this distressing problem. A literature search was carried out using Medline (1966-2001) for postoperative voiding dysfunction. The key word urethrolysis was cross-referenced with surgical complications and stress urinary incontinence to identify all published English-language articles. The bibliographies of reviewed articles were searched manually. We also mailed a survey to the members of American Urogynecologic Society (AUGS) regarding their management of this problem. Overall, 262 members (31.4%) responded to the survey. Success rates reported in the literature between retropubic and vaginal techniques of urethrolysis are comparable, but morbidity is lower with the vaginal approach. The success rates are equivalent with (68%) or without (74%) resuspension following transvaginal urethrolysis. The incidence of postoperative SUI is acceptably low even without resuspension of the urethra (6% for both). Results of the AUGS survey reveal that most providers favor a transvaginal approach (74%) when performing urethrolysis, and they do not routinely resupport the bladder neck (82%).

Female↗
PubMed2005

Prolapse of neovagina created with labia minora: a case report.

Prolapse of a neovagina created in patients with congenital vaginal aplasia is rare. A 55-year-old woman with a neovagina was referred for management of complete prolapse and stress urinary incontinence. At the age of 19 she had undergone surgery for creation of a neovagina using the labia minora. She accepted vaginal surgical treatment to correct her prolapse. A posterior intravaginal slingplasty was successfully performed, associated with tension-free vaginal tape through the obturator foramens. There is no other case of prolapse of a labia minora neovagina described in the literature. The common procedures were not adapted in this case. Indeed, the vaginal tissues were extremely fragile, making the dissection more difficult. The vaginal approach sounded interesting to us to correct this prolapse.

Female↗
PubMed2000

Vaginal repair of a sigmoidocele.

Sigmoidocele is an uncommon accompaniment of pelvic prolapse. It is difficult to detect a sigmoidocele during clinical pelvic examination, and as a consequence a sigmoidocele may be unexpectedly encountered during vaginal repair of pelvic prolapse. The author has discovered and repaired a sigmoidocele during vaginal surgery in 4 patients with either complete procidentia or vaginal vault eversion. The procedure involves a modification of the bilateral sacrospinous vaginal vault fixation using two additional sutures to suspend the sigmoid colon from the sacrospinous ligament. Clinical and functional results have been excellent. This is the first description of a vaginal approach to the repair of a sigmoidocele.

Female↗
PubMed1994

Vesicocervical fistula--a rare cause of urinary incontinence.

A vesicocervical fistula is reported. This extremely rare and late sequela of caesarean section, secondary to a lesion in the bladder and unrecognized intraoperatively, was followed with a distressing, long-lasting urinary incontinence unreactive to conservative treatment. Not until 7 years after the primary operation was this lesion diagnosed and treated successfully by vaginal approach. Etiological factors, clinical features and treatment possibilities are discussed.

Adult↗
PubMed1996

Gasless laparoscopic gynecologic surgery.

OBJECTIVE: Evaluate gasless laparoscopic gynecologic surgery as an alternative to conventional technique with carbon dioxide insufflation. STUDY DESIGN: Retrospective study of 49 cases. RESULTS: Gasless laparoscopic gynecologic surgery was successful in 90% of cases. The gasless technique permits the surgical team to use the laparoscopic and vaginal approach simultaneously. CONCLUSIONS: Gasless laparoscopic gynecologic surgery seems to be a reliable alternative to conventional laparoscopy for selected indications.

Adult↗
PubMed2006

[Pelvic pain by acute symphysis pubis separation after vaginal delivery].

Pelvic pain during pregnancy and postpartum period is common. Pubic separation is a physiologic phenomenon caused by pregnancy and delivery. It's an aetiology of pregnancy and postpartum pain requiring a specialized management in case of severe pain. We report the case of a 34-year-old multiparous woman suffering from severe pubic symphysis pain after twin delivery by vaginal approach, with extraction support, under epidural analgesia. Pubic symphysis separation was diagnosed according both to the clinical symptoms and to the radiology. A local anesthetic infiltration was performed twice to substantially relieve the patient.

Adult↗
PubMed2005

Oxytocin during myomectomy: a randomized study.

OBJECTIVE: To evaluate the influence of oxytocin on peroperative blood loss during myomectomy. STUDY DESIGN: From October 1998 to May 2002, 94 patients requiring surgical myomectomy by laparotomy or by the vaginal approach were enrolled in a randomized double blind study. Patients were randomized to two groups. In the first group (47 patients) oxytocin was administered during myomectomy and in the second group (47 patients) a placebo was used. The main outcome measures were peroperative blood loss and rates of blood transfusion and autotransfusion. RESULTS: Peroperative blood loss was no different between the oxytocin group and the placebo group (508 +/- 558 ml versus 451 +/- 336 ml; P=0.55). Rates of autotransfusion and blood transfusion were also similar in both groups. CONCLUSION: Administration of oxytocin during myomectomy did not reduce peroperative blood loss in our study. The benefits of using oxytocin to prevent hemorrhage during myomectomy seem to be limited.

Adult↗
PubMed2004

[Hysterectomies in patients with no history of vaginal delivery. A study of 243 cases].

OBJECTIVE: The object of this study was to audit the policy of hysterectomy in nulliparous women in a university hospital. PATIENTS AND METHODS: A retrospective medical records analysis of all hysterectomies performed during an 8-year period. Patients with no history of vaginal delivery were stratified into three groups: group 1, patients who underwent abdominal hysterectomies; group 2, patients undergoing vaginal hysterectomy (2a) or laparoscopy-assisted vaginal hysterectomy (2b). The groups were compared as to demographic data, surgical complications and outcomes. RESULTS: During the study period, there were 243 hysterectomies in patients with no history of vaginal delivery. Among these, vaginal hysterectomies (group 2) were undertaken in 75% (182 patients) and successfully performed in all but 13 patients (7.1%). Mean uterine weight was 943 grams in group 1 and 370 grams in group 2. Abdominal route (group 1) was associated with longer operative time (average: 105 min) than vaginal route (group 2a; 81 min) but shorter operative time that laparoscopy-assisted vaginal route (group 2b; 173 min). There was no significant difference in mean estimated blood loss and complications rates between groups 1 and 2. Hospital stay was shorter in group 2. Laparoscopic assistance was not associated with bigger uteri, neither with fewer complications. DISCUSSION AND CONCLUSION: Nulliparity should no longer be considered a contraindication to vaginal hysterectomy. In such patients, many more hysterectomies should be carried out vaginally and laparoscopic assistance does not offer obvious advantages over the standard vaginal approach.

Adult↗
PubMedDate not supplied

Changing hysterectomy technique from open abdominal to laparoscopic: new trend in Oslo, Norway.

STUDY OBJECTIVE: To evaluate the change in hysterectomy technique. DESIGN: Retrospective study (Canadian Task Force classification XXX). SETTING: University tertiary referring center in Norway. PATIENTS: A total of 1963 women treated with hysterectomy over a 5-year period in Oslo. INTERVENTIONS: The operative records and techniques were investigated in all treated patients. MEASUREMENTS AND MAIN RESULTS: A total of 1963 hysterectomies were performed from 2001 through 2005. The operative patient records were investigated with the main focus on indication for surgery and the technique used in the operative procedure. In 2001, 62 (17.7%) laparoscopic hysterectomies were performed, while 256 (73.1%) of the hysterectomies were done with laparotomy. The operative technique has gradually changed during the last 5 years. In 2005, 220 (53.5%) of the surgical procedures were laparoscopic, 177 (43.1%) were done by laparotomy, while the vaginal approach in all these years was less than 10%. CONCLUSION: From 2001 to 2005, a trend shift of the operative technique has been observed in Oslo, increasing the endoscopic hysterectomy rate from approximately 18% to 54%. During the same time, enlarged uteri with myomas equivalent to 10 to 12 weeks' gestation and endometrial cancer were more often treated by laparoscopic hysterectomy instead of open abdominal hysterectomy. With modern equipment and trained staff, more routine hysterectomies can be managed with laparoscopy.

Female↗
PubMed2003

A randomized study of total abdominal, vaginal and laparoscopic hysterectomy.

OBJECTIVES: To evaluate operative time, blood loss and inflammatory response in patients submitted to hysterectomy. METHODS: Sixty patients referred for hysterectomy were prospectively randomized to total abdominal hysterectomy (n=20), vaginal hysterectomy (n=20), or laparoscopic hysterectomy (n=20). The operative time, blood loss (variation in erythrocyte and hemoglobin) and inflammatory answer (CRP and interleukin-6 dosages) were compared by using Kruskal-Wallis, Dunn non-parametric test and variance analysis with repeated measurements. RESULTS: Operative time was shorter for vaginal hysterectomy, and there was no significant difference between total abdominal hysterectomy and laparoscopic hysterectomy. Reduction in erythrocyte and hemoglobin was more noticeable after vaginal hysterectomy, followed by total abdominal hysterectomy and laparoscopic hysterectomy. CRP levels increased steadily from vaginal hysterectomy to laparoscopic hysterectomy and then to total abdominal hysterectomy. The increase in interleukin-6 was substantially higher in total abdominal hysterectomy, whereas no difference was noted between vaginal and laparoscopic hysterectomy. CONCLUSIONS: Vaginal hysterectomy presents superior results in terms of operative time and inflammatory response when compared with total abdominal and laparoscopic hysterectomy and it should be the first option for hysterectomy. Laparoscopic hysterectomy should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.

Adult↗
PubMed1997

Oral or vaginal misoprostol for induction of labor.

OBJECTIVE: To compare vaginal versus oral misoprostol for induction of labor. METHOD: Induction of labor was carried out in 40 women near term in two equal and randomized groups (according to a computer generated table) using misoprostol. Group I received vaginal misoprostol (100 micrograms) every 3 h while group II patients were given the same dose via the oral route. The dose was doubled if no response was detected under continuous cardiotocographic (CTG) tracings. RESULT: The vaginal route of administration induced a higher success rate in a shorter time interval using a lower dose but was associated with more abnormal FHR patterns and instances of uterine hyperstimulation. CONCLUSION: It is recommended to use the vaginal approach with cardiotocographic monitoring.

Administration, Intravaginal↗
PubMed2000

The levator myorraphy repair for vaginal vault prolapse.

Various techniques have been described for the repair of vaginal vault prolapse after hysterectomy. Because of inherent difficulties associated with the sacrospinous fixation, a new repair, the levator myorraphy, was devised to simplify reconstruction of the pelvic floor 10 years ago. This repair results in a restored vaginal axis and prevention of posterior enterocele recurrence by recreating the levator shelf high within the peritoneal cavity and fixing the vault in that position. Because this procedure can be performed from a vaginal approach, morbidity is minimized. Over this 10-year time period, we have performed the levator myorraphy in over 120 women. We believe this approach can be easily taught, is highly effective, and results in a repair that most closely restores the normal anatomic position.

Female↗
PubMed1998

Vaginal paravaginal repair in the surgical treatment of anterior vaginal wall prolapse.

Objective: To describe our technique and report our clinical experience with the vaginal paravaginal repair in the surgical treatment of displacement cystocele.Methods: Forty-five patients with bilateral paravaginal support defects underwent vaginal paravaginal repair during a 2-year period at our institution. The technique of vaginal paravaginal repair will be illustrated through the use of anatomic photographs taken at the time of surgery. Demographic data were collected for each patient. Preoperative evaluation, intraoperative parameters, and postoperative course were reviewed.Results: The technique of vaginal paravaginal repair was standardized with transvaginal entrance into the retropubic space bilaterally. The paravaginal defects were identified and repaired using permanent suture in a 3-point closure incorporating the pubocervical fascia, arcus tendineous, and vaginal wall. Concurrent repairs were performed as appropriate.Mean age of the patients was 65.9 +/- 2 years (range 35-76). Thirty-eight patients had advanced prolapse of the anterior vaginal wall beyond the introitus, and 21 patients had coexisting stress incontinence. Postoperatively, the length of stay was 2.6 +/- 1.1 days (range 1-6) and urethral catheterization was required for a median 7 days. Intraoperative complications included 1 case of bilateral ureteral obstruction, and postoperative morbidity included 1 retropubic hematoma requiring re-exploration, 2 vaginal abscesses, and 2 postoperative transfusions.Conclusion: The vaginal paravaginal repair is a safe and effective technique in the surgical correction of vaginal wall prolapse due to a displacement cystocele. The vaginal approach provides adequate exposure to the relevant anatomy and good clinical results.

Journal Article↗
PubMed1998

Management of tubal prolapse after hysterectomy.

Uterine tube prolapse into the vaginal vault is an uncommon complication after hysterectomy, and our 6 patients bring to 90 the number of cases reported in the literature. Symptoms consist almost exclusively of vaginal bloody discharge and/or leukorrhea, persistent pelvic pain, and dyspareunia. Surgical treatment must be individualized according to the patient's symptoms. In our series, sexually active women with pelvic pain and dyspareunia had the best outcome when a combined laparoscopic and vaginal approach was used.

Adult↗