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PubMedDate not supplied

Intraoperative sigmoidoscopy in gynecologic surgery.

Intraoperative sigmoidoscopy is underused by the majority of practicing gynecologists and is not widely taught in obstetrics and gynecology training programs. In this report, a step-by-step approach is provided in order to perform sigmoidoscopy. Indications for use, along with various intraoperative applications, are discussed. Results from our center's experience with its use during laparoscopic treatment of adhesions, endometriosis, and associated disease of the bowel also are provided. Intraoperative sigmoidoscopy is a safe and efficacious procedure that can aid in the evaluation and treatment of pelvic pathology and facilitate identification and management of bowel injuries. It should be considered a valuable adjunct when such cases are encountered by gynecologic and pelvic surgeons.

Endometriosis↗
PubMedDate not supplied

[Prevention of thromboembolic disease in gynecologic surgery].

The authors present the results of their blind prospective comparative study of the postoperative thromboembolic protection of 490 gynecologic patients. Among them 250 (51%) were protected by a low dose heparin (LDH) subcutaneously in 12-hour intervals, 240 (49%) received heparindihydergot (HDHE). Thromboembolisms diagnosed by the 125J fibrinogen uptake test appeared in 26 (10.4%) patients protected by LDH and 23 (9.6%) by HDHE. The most frequent risk factors in patients with thromboembolisms were malignant diseases, obesity, varicose veins, hypertension and a history of deep vein thrombosis or pulmonary embolism. Haemorrhages appeared in 7 (2.8%) patients protected by LDH and 8 (3.3%) by HDHE.

Adult↗
PubMed1977

[Urological complications following gynecological surgery (author's transl)].

Lesions of the urinary tract occur in a constant percentage no matter what type of gynecological operation is performed. In the last 11 years we saw 150 immediately postoperative complications, 85 of which involved the ureter, 58 the bladder and 7 the urethra. 8 lesions of the ureter healed spontaneonsly. 15 ureters were mounted with a stent. Surgical treatment had to be performed on 62 ureters. 50 of which were ureteroplasties: 21 ureteroneocystostomies, 28 ureteroplasties with a bladder flap (Boari-Küss), 1 uretero-ureteral-anastomosis. The results were good in 80%. Therapy of vesical-fistulae consisted in operative closure 3 month after the primary lesion. (54 cases: 30 vaginal approaches, 7 transvesical approaches, 14 transvesical a. with a peritoneal flap and 3 transvesical a. with interposition of the omentum.) Continence was achieved in all but one cases. Two cases required a second intervention. 4. fistulas were treated only conservative, in 3 times successfull, one event of bladder abdominal-wall fistula. The 4th case was not closed because of the rejection of the operation from the patient. All urethral fistulae could be closed successfully.

Adult↗
PubMed1980

Venous thromboembolism associated with gynecologic surgery.

There are three effective means of prophylaxis against venous thrombosis in high-risk patients, including general surgical and gynecologic patients. Two of these are practical--low-dose heparin and external pneumatic calf compression. The results with dextran are currently equivocal, and its use has the disadvantage of requiring intravenous injection. Although oral anticoagulants are effective in reducing deep-vein thrombosis, significant bleeding occurs, limiting their usefulness. Platelet function-suppressing drugs have not proved to be sufficiently effective for general use.

Adult↗
PubMed1987

Retroperitoneal dissection in gynecologic surgery for benign disease.

In this study, the pelvic retroperitoneal anatomy was dissected during 140 consecutive exploratory laparotomies for benign gynecologic disease. In addition, 110 bilateral hypogastric artery ligations were done both to teach the technique and to attempt to determine whether such a procedure reduces blood loss in elective abdominal hysterectomy. Fifty-eight hysterectomies with hypogastric artery ligation were compared to an equal number done without bilateral hypogastric ligation. The data indicate that prophylactic hypogastric artery ligation during hysterectomy did decrease blood loss, though other variables may account for this, and that teaching retroperitoneal dissection to residents is paramount, teaching them a potentially life-saving procedure essential to gynecologic and obstetric training. Only one complication occurred in this series.

Adolescent↗