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At least 577 records · Page 32Linked to original sources
PubMed2006

Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals.

BACKGROUND: Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders. METHODS: Of the 15 university hospitals belonging to Collégiale de Gynécologie-Obstétrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach. RESULTS: In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients' mean age (+/-SD), BMI, parity and previous Caesarean sections were 51.4 +/- 10.3 years, 25 +/- 5.7 kg/m(2), 2 +/- 1.6 children and 0.2 +/- 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P < 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P < 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53-5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39-4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01-4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P < 0.0001). CONCLUSIONS: This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.

Adult↗
PubMed1996

The feasibility of vaginal hysterectomy.

OBJECTIVE: To assess the feasibility of vaginal hysterectomy for benign uterine disease and to assess how frequently laparoscopic assistance is necessary. METHODS: A prospective series of 806 hysterectomies for benign disease of the uterus without prolapse which were performed in our institution from 1 March 1991 to 28 February 1994 is discussed. The report is an evaluation of a planned approach for hysterectomy. Vaginal hysterectomy was performed whenever possible-laparoscopic hysterectomy was indicated for adnexal pathology, known or anticipated significant pelvic adhesions and for a narrow vaginal access with a moderately enlarged uterus-abdominal hysterectomy was chosen when both laparoscopic and vaginal surgery were judged to be impossible. RESULTS: Vaginal hysterectomy was performed in 80.6% of patients. Laparoscopic assistance was needed in 9.4% of cases. The need for laparotomy was reduced to 10% with an acceptable pre- or postoperative complications rate.

Feasibility Studies↗
PubMed1982

Anesthesia for pregnancy-induced hypertension.

Women with severe pregnancy-induced hypertension are often critically ill; their fetuses are usually compromised. An ideal anesthetic method does not exist for the parturient with severe hypertension, hypovolemia, and organ failure. Optimal anesthetic results depend upon thorough preanesthetic evaluation and best medical control of pathophysiology, regardless of the technique employed for vaginal or cesarean delivery. The anesthesia team must be consulted early, communicate freely and effectively with other perinatal team members, and have extensive knowledge of the pathophysiology involved. Time must be allowed for preparation of necessary monitoring and anesthetic facilities. In patients under good medical control, judiciously administered continuous epidural block is the better approach for labor, vaginal delivery, or cesarean section.

Anesthesia, Obstetrical↗
PubMed1997

Labial skin-flap vaginoplasty using tissue expanders

In severe vaginal malformations, when the distance between the upper vaginal pouch and perineum is too long (6 cm or more), reconstruction of the vagina can be performed by colonic interposition or by long cutaneous flaps obtained by the tissue expansion technique. Two female adolescents were treated using expanded labial skin flaps. Dissection and anastomosis between the vaginal remnant and cutaneous tube was performed by the transtrigonal approach. Results were satisfactory at 2.5-year follow-up. In our opinion, expanded labial skin-flap vaginoplasty has three main advantages: (1) it permits the construction of a large, soft, well-vascularized neovagina using non-hair-bearing labial skin; (2) it obviates postoperative dilations and prevents delayed strictures; and (3) a transtrigonal approach permits an easy vaginal dissection and a careful, tension-free anastomosis.

Journal Article↗
PubMed1997

Labial skin-flap vaginoplasty using tissue expanders.

In severe vaginal malformations, when the distance between the upper vaginal pouch and perineum is too long (6 cm or more), reconstruction of the vagina can be performed by colonic interposition or by long cutaneous flaps obtained by the tissue expansion technique. Two female adolescents were treated using expanded labial skin flaps. Dissection and anastomosis between the vaginal remnant and cutaneous tube was performed by the transtrigonal approach. Results were satisfactory at 2.5-year follow-up. In our opinion, expanded labial skin-flap vaginoplasty has three main advantages: (1) it permits the construction of a large, soft, well-vascularized neovagina using non-hair-bearing labial skin; (2) it obviates postoperative dilations and prevents delayed strictures; and (3) a transtrigonal approach permits an easy vaginal dissection and a careful, tension-free anastomosis.

Adolescent↗
PubMed2005

A randomized comparison of post-operative pain, quality of life, and physical performance during the first 6 weeks after abdominal or vaginal surgical correction of descensus uteri.

AIMS: With respect to urogenital function, vaginal hysterectomy combined with anterior and/or posterior colporraphy has been shown to be superior to abdominal sacrocolpopexy with preservation of the uterus. We performed a randomized trial to compare the effects of both procedures on pain, quality of life and physical performance during the first six weeks after surgery. METHODS: Eighty-two patients were randomized to have surgery either by vaginal or abdominal approach. All patients were asked to complete the RAND-36 before surgery and 6 weeks after surgery and to keep a diary for the first 6 weeks after surgery. This diary assessed the pain perception and use of pain medication, bother of limitations due to the surgery and performance of daily activities after surgery. These outcomes were compared. RESULTS: All patients completed the RAND-36 and 68 patients completed the diary. Patients who had undergone abdominal surgery had a statistically lower score on the health change domain (56 vs 68), bodily pain domain (63 vs 80) and mental health domain (74 vs 81) of the RAND-36, as compared to patients who had undergone vaginal prolapse surgery. During hospital stay, the abdominal group experienced on average more days of pain (4.5 vs 3.0) and impaired mobility (3.7 vs 2.9) as compared to the vaginal group. Patients received more pain medication following abdominal surgery as compared to vaginal surgery. CONCLUSIONS: The vaginal operation to correct a descensus uteri is associated with less pain, better quality of life and better mobility during the first 6 weeks of the recovery period as compared to the abdominal approach.

Abdomen↗
PubMedDate not supplied

Commensal bacteria as vectors for mucosal vaccines against sexually transmitted diseases: vaginal colonization with recombinant streptococci induces local and systemic antibodies in mice.

There is a need to develop vaccines to control the spread of sexually transmitted diseases (STDs). Novel immunization strategies that elicit a mucosal immune response in the genital tract, may show improved protection by preventing or at least limiting entry of the pathogenic micro-organism. However, it has proven difficult to obtain a local immune response in the vaginal mucosa. Our approach is based on the use of recombinant bacteria capable of colonizing mucosal surfaces as live vaccine vectors. The human commensal Streptococcus gordonii, engineered to express the E7 protein of human papillomavirus type 16, was used for intravaginal immunization of mice. A single inoculum of recombinant bacteria was sufficient to establish colonization of the murine vagina and therefore induce papillomavirus-specific vaginal IgA and serum IgG. Evidence that mucosal colonization with recombinant commensal bacteria can induce a local immune response in the female genital tract represents a significant step toward the development of new vaccines against STDs.

Animals↗
PubMed2005

Laparoscopy-assisted vaginal pelvic exenteration.

OBJECTIVE: The aim of this study was to evaluate the feasibility, morbidity and survival outcome of laparoscopy-assisted vaginal pelvic exenteration. METHODS: Since 2000, we have performed 5 cases of en-bloc pelvic exenteration combining a vaginal or perineal approach and laparoscopic approach. All patients had received previous pelvic irradiation. One patient underwent a total type II exenteration with ileal-loop diversion, an omental flap and a temporary colostomy. Two patients underwent a middle and posterior exenteration: one was a type III exenteration with perineal rectal resection and a gracilis myocutaneous flap; the second one was a type II exenteration with a colorectal anastomosis and a vaginal reconstruction using a gluteal thigh flap. Two patients underwent a type I anterior and middle exenteration with continent Miami pouch and vaginal reconstruction by omental cylinder. RESULTS: Mean time of the procedure was 6 h (range: 4.5-9). Peroperative bleeding was less than 500 cm3. Two patients presented minor complications: a perineal abscess after perineal rectal resection and an abdominal wound abscess. Mean length of hospital stay was 27 days. Three patients are free of disease. Two patients presented groin metastasis. One patient died of disease after 8 months. CONCLUSION: Laparoscopic or laparoscopy-assisted vaginal pelvic exenteration followed by reconstruction is feasible with curative intent in selected patients.

Adult↗
PubMed1985

Angiographic arterial embolization in the management of postoperative vaginal hemorrhage.

Recently great success was achieved at the Toronto General Hospital in treating patients with postoperative vaginal hemorrhage by angiographic methods. A retrospective review was performed from 1975 to 1984 on eight patients treated by this technique for nine separate episodes of hemorrhage with a mean estimated blood loss in excess of 5000 ml. Success was achieved in seven episodes despite failure of various vaginal and abdominal approaches. One of the failures was due to previous bilateral hypogastric artery ligation that made the bleeding branch inaccessible to the angiography catheter. The other patient developed bleeding following cesarean section which did not respond to angiographic embolization due to faulty technique. Both of these patients were eventually cured by abdominal surgery. We feel that angiographic embolization is the procedure of choice in the management of postoperative vaginal hemorrhage when conservative management has failed or is inappropriate; it can be lifesaving when all other attempts to stop the hemorrhage have failed.

Adult↗
PubMed2006

Anterior vaginal wall prolapse and voiding dysfunction in urogynecology patients.

We investigated whether women with and without anterior vaginal wall prolapse have voiding differences. Women (n=109) who presented to a urogynecology practice were categorized into two groups based on anterior vaginal wall prolapse: stages 0 and 1 and stages 2, 3, and 4. Women with prolapse were older than the women without prolapse but the groups were otherwise similar demographically. There was a higher rate of activity-related urine loss and use of wetness protection amongst women without prolapse. There was no significant difference for urgency symptoms or urge incontinence. Urodynamic testing found no significant differences for maximal flow rate or maximal urethral closing pressures. Postvoid residual volume and detrusor overactivity were not different but approached significance. Anterior vaginal wall prolapse of stage 2 or greater was not associated with urge incontinence or voiding function in this population. Women without prolapse were more likely to report stress incontinence.

Adult↗
PubMed2005

Defining criteria for anti-mannan antibodies to protect against candidiasis.

Prevention of hematogenously disseminated candidiasis and mucocutaneous disease, including Candida vaginitis, through immunological approaches is appealing for the following reason. A long-acting and safe vaccine that protects against both serotypes of Candida albicans and other important species, such as C. tropicalis and C. glabrata, should significantly reduce the incidence of various forms of candidiasis by these etiologic agents. Through extensive experimentation on protective responses in experimental animals against Candida mannan components, others and we have evidence that antibodies specific for short-chain beta-linked oligomannosides are protective against candidiasis. Although the mechanism of protection against vaginal infection requires further investigation, experimentally the ability of antibody to rapidly deposit high amounts of complement factor C3 onto the yeast cell wall is requisite for enhancing resistance against disseminated candidiasis.

Animals↗
PubMed1983

Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps.

In a population of 1065 singleton, low birth weight infants (1000 to 2500 g) delivered vaginally from vertex presentation, the neonatal mortality and morbidity of 394 delivered by low forceps were compared with those of 671 delivered spontaneously. There were no significant differences between the groups, either across the population as a whole or among any of the following birth weight subgroups: 1000 to 1500 g, 1501 to 2000 g, and 2001 to 2500 g. The data in the current study, as well as those from previous reports, argue against the routine use of prophylactic low forceps delivery and in favor of a more individualized approach to the vaginal delivery of infants in vertex presentation in this weight group.

Birth Weight↗
PubMed2002

Hysterectomy in Denmark. An analysis of postoperative hospitalisation, morbidity and readmission.

INTRODUCTION: The aim of this study was to describe the incidence of "standard" hysterectomy in Denmark, including surgical procedure, postoperative hospitalisation, morbidity, mortality and readmission rate within 30 days. MATERIAL AND METHODS: Analysis of data from the Danish National Patient Register for a two-year period (1998-2000) concerning hysterectomies for benign indications, carcinoma in situ cervicis uteri and endometrial carcinoma stage I. A stratified sample of 821 discharge resumés was reviewed for detection of complications. RESULTS: During the two years 10,171 women underwent "standard" hysterectomy followed by a median postoperative hospitalisation of 4 days. In departments performing more than 100 operations per year, the median hospital stay varied from 3 to 5.5 days. Eighty per cent were performed by laparotomy, 6% laparoscopically assisted and 14% by the vaginal route with marked regional variation in the choice of surgical approach. The number of vaginal hysterectomies varied from 0-67% in departments with a surgical activity of more than 100 per year. The mortality rate was 0.06% and 8% were readmitted within 30 days after the operation. If allowing extrapolation from the random sample to the entire population the complication rate was estimated to a minimum of 18%. CONCLUSION: "Standard" hysterectomy in Denmark is associated with considerable morbidity and marked regional variation in choice of surgical approach. The present study emphasizes the need for a national hysterectomy database with the possibility of evaluating surgical activity, reducing morbidity rates and developing homogeneous guidelines.

Adolescent↗
PubMed2004

Risk factors for febrile morbidity after hysterectomy.

OBJECTIVE: To identify risk factors for febrile morbidity after hysterectomy for nonmalignant indications. METHODS: We performed a retrospective cohort study of 686 women who had a hysterectomy between January and September 1997 by abdominal (n = 408), laparoscopic-assisted vaginal (n = 90), or vaginal (n = 188) approaches. Potential risk factors for febrile morbidity were extracted from the medical records. By means of multivariable logistic regression, we evaluated demographic, reproductive, clinical, and operative risk factors for febrile morbidity. RESULTS: The risk of postoperative febrile morbidity in this population was 14%. Only 50% of women received prophylactic antibiotics, whereas almost 20% received no antibiotics at all, and 30% were administered antibiotics after surgical incision. Risk factors for febrile morbidity after hysterectomy, after controlling for age, body mass index, operative time, and prophylactic antibiotic administration, were abdominal approach (odds ratio 2.7; 95% confidence interval 1.6, 4.3) and blood loss at surgery of more than 750 mL (odds ratio 3.5; 95% confidence interval 1.8, 6.8). CONCLUSION: Hysterectomy by abdominal approach and increased blood loss at the time of surgery significantly increase the risk of febrile morbidity. Preventive efforts should focus on methods to reduce postoperative febrile morbidity, including meticulous surgical technique and routine use and appropriate timing of prophylactic antibiotic therapy.

Adult↗
PubMed2006

Vaginal versus oral indomethacin in a rabbit model for non-infection-mediated preterm birth: an alternate tocolytic approach.

OBJECTIVE: We examined the hypotheses that vaginal indomethacin is more effective for prolonging gestation, and mediates its tocolytic actions via changes in cervical matrix metalloproteinase (MMP) activity, compared to oral. STUDY DESIGN: Pregnant rabbits induced with mifepristone received oral or vaginal indomethacin; or oral or vaginal vehicle once daily for 2 days. Premature delivery, fetal ductus arteriosus, and cervical MMP activity were assessed. RESULTS: Vaginal indomethacin delayed delivery >72 hours in 100% of the rabbits, extending gestation to 28.2 +/- 0.5 (P < .01) versus 26.4 +/- 0.3, 25.8 +/- 0.5, and 26.5 +/- 0.3 days, for vaginal placebo, oral indomethacin, and oral vehicle, respectively. Fetal ductus arteriosus was patent in all groups. Vaginal indomethacin decreased MMP-1, -8, and -9 activities and increased TIMP-1 levels in the cervix. CONCLUSION: Vaginal indomethacin is more effective than oral for prolonging gestation in the rabbit. Its tocolytic effects may be mediated, in part, by alterations in cervical MMP activity.

Administration, Intravaginal↗
PubMedDate not supplied

Transendoscopic Nd:YAG laser ablation of vaginal septa in a bitch.

A vaginal septum was diagnosed in an English bulldog bitch during routine estrous cycle staging. The septum extended 16 cm from the vestibulo-vaginal junction to just caudal to the cervix. The septum was removed by two applications of an Nd:YAG laser via a flexible fiberoptic endoscope. Complete healing occurred over a 5-week period and was uneventful. The bitch was bred and subsequently delivered four puppies vaginally. Transendoscopic laser ablation provided a noninvasive approach to surgically remove a vaginal septum in the dog.

Animals↗
PubMed1996

Leiomyoma of the vagina.

Approximately 250 cases of leiomyoma of the vagina have been reported. A case of a 46-year-old female with leiomyoma of the anterior vaginal wall, not associated with uterine leiomyomas is presented. The practical approach to such a vaginal mass entails immediate careful excision.

Female↗
PubMed2006

[Laparoscopy-assisted vaginal pelvic exenteration].

OBJECTIVE: The aim of the study was to evaluate the feasibility, morbidity and survival outcome of laparoscopy-assisted vaginal pelvic exenteration. PATIENTS AND METHODS: Since 2000, 7 en-bloc pelvic exenteration combining a vaginal or perineal approach and laparoscopic approach have been performed in our cancer center associated with complex laparoscopic reconstruction. All patients but one received previous irradiation. Two patients underwent a total pelvic exenteration; three patients an anterior and middle exenteration; two patients a middle and posterior exenteration. Urinary system was reconstructed with an ileal loop in one case, with a hand-assisted laparoscopic Miami pouch in four cases. Reconstruction of the vagina was performed with an omental cylinder in three cases, with a gluteal thigh flap in one case. A colorectal anastomosis was performed in three patients, one patient had an end colostomy. A mini-laparotomy conversion was necessary in one case because of a pelvic side involvement to perform an intraoperative irradiation. RESULTS: Mean time of the procedure was 6.5 hours with peroperative bleeding less than 500 cm3. Four patients presented minor complications. No revision of the Miami pouch was necessary. Mean length of hospital stay was 27 days. The four patients with a Miami pouch were able to self catheterize at the time of discharge. Mean follow-up was 14 months. Four patients died of the disease (three were metastatic). One patient presented a local recurrence. Two patients are free of disease. DISCUSSION AND CONCLUSION: Laparoscopic or laparoscopy-assisted vaginal pelvic exenteration followed by reconstruction is feasible with curative intent in selected patients.

Adult↗