BACKGROUND: This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis. METHODS: In this prospective observational cohort study, 254 women with chronic ...pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis. Of these, 216 women underwent surgical assessment and 176 were confirmed to have endometriosis. Questionnaires and visual analogue scale (VAS) scores for dysmenorrhoea, non‐menstrual pelvic pain, dyspareunia and dyschesia as well as quality of life instruments; the EQ‐5Dindex and EQ‐5Dvas, Short‐Form 12 (SF‐12) and sexual activity questionnaires were completed pre‐operatively. Intra‐operative details of revised American Fertility Society (rAFS) stage, site of disease, associated tests, duration of surgery and complications were noted. Follow‐up was performed by postal questionnaire and chart review. For women who had further surgery, rAFS stage, site of disease, other procedures and histology were all recorded. RESULTS: Pain scores were all significantly reduced at 2–5 years for dysmenorrhoea (median VAS baseline versus follow‐up 2–5 years); 9 versus 3.3 (P < 0.0001), non‐menstrual pelvic pain 8 versus 3 (P < 0.0001), dyspareunia 7 versus 0 (P < 0.0001) and dyschesia 7 versus 2 (P < 0.0001). Quality of life was improved for the EQ‐5Dindex (P = 0.008 and the EQ‐5Qvas (P = 0.03) and for sexual function with pleasure (P = 0.001) and habit (P = 0.012) being improved and discomfort being decreased (P = 0.001). The chance of requiring further surgery as determined by the Kaplan–Meier survival curve was 36%. A rAFS score of >70 was predictive of requiring further surgery (P = 0.03). Of women who had further surgery, endometriosis was found histologically in 68%. CONCLUSIONS: Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years. The probability of requiring further surgery is 36%. Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence.
The aim of this study was to compare the treatment effects of high-intensity focused ultrasound (HIFU) and laparoscopic excision (LE) in patients with adenomyosis and infertility.
A total of 93 ...patients with adenomyosis and infertility who were treated with HIFU (50 patients) or LE (43 patients) from January 2012 to January 2017 at the Third Xiangya Hospital of Central South University were retrospectively analyzed. Clinical characteristics including dysmenorrhea severity pain score, menorrhagia severity scores, reproductive outcomes, complications during pregnancy and delivery, adverse effects, surgical complications, and other clinical variables were compared between the HIFU and LE groups.
Of the total 93 patients with adenomyosis and infertility, 50 were treated with HIFU and 43 underwent LE. Both HIFU and LE treatments achieved significant relief of dysmenorrhea and menorrhagia. The total hospital stay was shorter in patients treated with HIFU than in those who underwent LE surgery. Neither HIFU nor LE treatment led to severe complications after treatment. Most importantly, patients treated with HIFU showed significantly higher pregnancy rates and natural conception rates than those who underwent LE surgery. Notably, in the HIFU treatment group, those with diffuse adenomyotic lesions had significantly lower postoperative pregnancy rates than those with focal adenomyosis.
HIFU showed a safe and effective profile as a therapeutic management option for patients with adenomyosis. In comparison with LE, HIFU treatment achieved better postoperative reproductive outcomes. HIFU treatment should be encouraged and implemented in clinical practice.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Laparoscopic excision of endometrioma and subsequent hemostasis have detrimental effects on ovarian reserve.
Objectives
To evaluate which hemostatic approach after stripping cystectomy ...shows less damage on ovarian reserve.
Search Strategy
Embase, MEDLINE, Scopus, Scielo.br, LILACS, Cochrane Library at the CENTRAL Register of Controlled Trials, Clinicaltrials.gov, CINAHL, conference s, and International Clinical Trials Registry Platform were searched from inception until April 2022.
Selection Criteria
Randomized controlled trials of women undergoing laparoscopic endometrioma excision that compared at least two hemostatic approaches.
Data Collection and Analysis
Relevant data were extracted and tabulated. Network meta‐analysis based on random‐effects model for mixed multiple treatment to rank hemostatic strategies using the surface under the cumulative ranking curve area (SUCRA) was performed. Quality assessment was performed using Cochrane criteria. The primary outcome was serum antimullerian hormone levels 3 months after surgery.
Main Results
Ten studies, including 748 women, were selected. Suturing the ovary with barbed suture (SUCRA, 82.80%) seem the most effective strategy to avoid antimullerian hormone reduction. Similarly, for ultrasonographic antral follicular count, barbed (SUCRA, 30.70%) and simple suture (SUCRA, 30.70%) were ranked the best choices. Ovarian suturing with simple suture demonstrated lower follicle‐stimulating hormone levels (SUCRA, 88.70%).
Conclusions
Suturing the ovary, with simple or barbed suture, seems the most effective approach to keep ovarian reserve higher.
Synopsis
Achieving hemostasis by suturing the ovary seems the best method to avoid ovarian reserve reduction after laparoscopic stripping excision of endometrioma.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract
Castleman disease is a rare and benign disorder, characterized by enlarged lymph nodes and angiofollicular lymphoid hyperplasia. We report a case of a 57-year-old male, who was admitted to ...our surgical department because of a retroperitoneal nodular mass measuring about 4 cm in maximum diameter, incidentally discovered on a radiologic exam performed for the onset of vague abdominal pain with posterior irradiation. The patient was subdue to laparoscopic removal of the mass and no intra- and post-operative complications were recorded. Histologic diagnosis of hyaline-vascular variant of the Castleman disease was confirmed. Only two cases have been found in the literature reporting the paraduodenal unicentric Castleman disease localization like our case. Although rare, the Castleman disease must be considered in the differential diagnosis among all the lymph nodes diseases, for avoiding improper therapies.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cesarean scar ectopic pregnancy is a leading cause of life-threatening complications in the first trimester. It poses a diagnostic and management challenge; if not diagnosed and adequately treated in ...early pregnancy, it may lead to considerable maternal morbidity and mortality. We report a case series of cesarean scar ectopic pregnancies managed successfully by laparoscopy. Laparoscopic excision is the gold standard management approach for cesarean scar ectopic pregnancy.
An accessory cavitated uterine mass (ACUM) is a rare congenital Mullerian anomaly where an accessory cavity with normal endometrial lining lies within a normally functioning uterus. It is common ...among young and nulliparous women presenting with severe dysmenorrhea and infertility.
We present two cases of ACUM. The first case was a 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with non-communicating rudimentary horn The second case was a 36-year-old woman who presented with primary infertility and dysmenorrhea. Gynecological examination and ultrasound scanning were done for both patients. Subsequently, laparoscopic excision of the ACUM was performed on both patients. Histopathological examination confirmed the diagnosis. Postoperatively, both patients did well, with no further dysmenorrhea. The second patient conceived spontaneously at the first attempt and at the time of writing was 33 weeks pregnant without any maternal or fetal problems.
The diagnosis of ACUM is often confused with non-communicating rudimentary uterine horn, true cavitated adenomyosis and degenerating fibroids. It is important to understand and distinguish ACUM. A thorough history, detailed gynecological examination and correct radiological modalities are critical to a proper diagnosis so that the correct surgery can be performed, especially when fertility is desired.
•Accessory cavitated uterine mass is rare congenital Mullerian anomaly.•It happens among young, nulliparous women presenting with dysmenorrhea and infertility.•It is a diagnostic challenge and often confused with other differential diagnosis.•A thorough history, detailed and proper examination and imaging are mandatory.•Laparoscopic excision is crucial to relieve symptoms and improve reproduction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Choledochal cysts can present with abdominal pain, jaundice and stones.MRI is the standard imaging tool and the type of biliary enteric anastomosis depends on the cyst type.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Uterocutaneous fistulae are rare fistulas of the female genitourinary tract. It mostly follows caesarean section and subsequent post-operative wound infection. Only a handful of cases have been ...published in the literature. Surgical excision is the definitive management in most cases. Laparoscopic management has been used by many authors and gives good results. A 30-year-old multigravida presented with symptoms typical of uterocutaneous fistula and confirmed by magnetic resonance imaging of the pelvis. On diagnostic laparoscopy, the tract was delineated by methylene blue dye both through the opening in the skin as well as through the cervix. The complete excision of fistulous tract was done laparoscopically along with omental interposition between the uterus and the abdominal wall at the site of the fistula. Histopathologic examination of the tract confirmed endometriotic tissues without any chronic inflammation, typical of uterocutaneous fistula. The patient had an uneventful recovery, was started on diet the following day and discharged the next day. There was minimal post-operative pain and helped in early ambulation. On follow-up at 12 months, the tract had completely healed and the patient was completely asymptomatic. Uterocutaneous fistula is a rare complication that follows wound infection or suboptimal wound closure following caesarean section. As compared to the traditional excision by laparotomy, laparoscopy not only aids in confirmation of the diagnosis but also helps in complete excision of the tract with good results.
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