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1.
Ahmed M. Abbas Ahmed M. Elzargha Abdel Ghaffar M. Ahmed Ibrahim I. Mohamed Ahmed Altraigey Ahmed Y. Abdelbadee 《Journal of minimally invasive gynecology》2019,26(4):709-716
Study Objective
To compare the efficacy of oral diclofenac potassium versus hyoscine-N-butyl bromide (HBB) in reducing pain perception in patients undergoing diagnostic office hysteroscopy (OH).Design
A randomized double-blind placebo-controlled trial (Canadian Task Force classification I).Setting
A university hospital.Interventions
One-hundred twenty-nine patients were divided randomly into 3 groups (n?=?43 in each group); group 1 received 50mg diclofenac potassium, group 2 received 20mg HBB, and group 3 received placebo tablets. All tablets were taken orally 1hour before OH. The primary outcome was the participant's self-rated pain perception using the 10-point visual analog scale during the procedure. The secondary outcomes included the visual analog scale score 30 minutes after OH, ease of OH assessment using a 10-cm scale, duration of OH, and adverse effects of the study medications.Measurements and Main Results
Both the diclofenac and HBB groups showed significant pain score reduction compared with the placebo group (p?=?.001). The mean pain score in the diclofenac group was significantly lower than the HBB group (2.12 ± 1.03vs 3.02 ± 1.55, respectively; p?=?.002). The pain scores in the diclofenac and HBB groups immediately after OH were significantly lower than the placebo group (p?=?.001), and the mean pain score in the diclofenac group was significantly lower than the HBB group (1.23 ± 0.57vs 1.56 ± 0.73, respectively; p?=?.024). The ease of procedure score was significantly lower in the diclofenac and HBB groups than the placebo group (p?=?.003 and p?=?.005, respectively). The mean duration of the procedure was significantly less in the diclofenac group (p?=?.01). Fourteen women (32.6%) in the HBB group experienced dizziness and 2 women (4.6%) had nausea, whereas only 4 women (9.3%) in the diclofenac group had dizziness and 2 women (4.6%) had vomiting.Conclusion
Oral diclofenac potassium administration 1hour before diagnostic OH reduces the procedure pain with subsequent easier and shorter OH duration. Oral HBB is less effective than diclofenac potassium with more adverse effects. 相似文献2.
Neha Jeirath Cindy M. Basinski Max A. Hammond 《Journal of minimally invasive gynecology》2018,25(5):836-841
Study Objective
To assess if follow-up confirmation testing 3 months after hysteroscopic sterilization with the Essure device (Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ) improved with recommendation for transvaginal ultrasound (TVUS) versus hysterosalpingogram (HSG).Design
Retrospective, observational case-controlled cohort study (Canadian Task Force classification II-2).Setting
Two-physician private practice in Evansville, Indiana.Patients
Compliance rates for a TVUS confirmation test on 100 women who underwent hysteroscopic sterilization compared with a previously published cohort of 1004 women who were scheduled to undergo an HSG confirmation test.Intervention
Acquisition of 3-month confirmation testing after Essure hysteroscopic sterilization.Measurement and Main Results
All women who underwent Essure hysteroscopic sterilization with recommendation for TVUS confirmation testing between July 2015 and January 2017 were compared with a previously published cohort of 1004 patients with recommendation for HSG confirmation testing (HSG cohort). In addition, an HSG subgroup cohort (HSG subgroup) similar in size and closest chronology to the TVUS cohort was drawn from the original 1004 patients and analyzed for HSG follow-up. Records for all patients were reviewed for demographic, procedural, and confirmation testing and outcome data. One hundred patients were identified with successful Essure device placement and a recommendation for TVUS confirmation testing. Eighty-eight patients (88.0%) returned for TVUS at 3 months. In the HSG cohort 1004 successful Essure devices were placed, and 778 patients returned for the recommended HSG follow-up (77.5%). There was a significantly higher follow-up rate for TVUS compared with the HSG cohort (88.0% vs 77.5%, p?=?.008). In the HSG subgroup 184 patients were identified, and 133 patients presented for HSG follow-up (72.3%), indicating a significantly higher follow-up rate in the TVUS cohort (88.0% vs 72.3%, p?=?.001). No pregnancies after any confirmation testing were noted.Conclusion
Confirmation testing with TVUS rather than HSG 3 months after Essure device placement results in increased patient compliance that may lead to improved patient outcomes with reduction of unintended pregnancy. 相似文献3.
Roberta Venturella Gianmarco Miele Katia Cefalì Daniela Lico Pietro D&#x;Alessandro Bruno Arduino Annalisa Di Cello Fulvio Zullo Constantino Di Carlo 《Journal of minimally invasive gynecology》2019,26(1):143-147
Study Objective
To investigate the effects of 3 cycles of subcutaneous progesterone administered during the luteal phase on the regression rate of symptomatic and asymptomatic endometrial polyps in premenopausal woman.Design
A retrospective study (Canadian Task Force classification II-2).Setting
A department of obstetrics and gynecology in a university hospital.Patients
One hundred twenty-seven reproductive-aged women presented with endometrial polyps from January to December 2016.Interventions
A retrospective comparison of patients treated with subcutaneous progesterone and those managed by the “wait and see” approach.Measurements and Main Results
Patients were divided into 2 groups: the group treated with subcutaneous progesterone (cases) and the wait and see group (controls). Women in the treatment group were administered 25?mg subcutaneous progesterone during the luteal phase for 7 days for 3 months. The wait and see group included patients refusing progesterone therapy who were reevaluated 3 menstrual cycles after the transvaginal sonographic diagnosis. Both the treatment group (n?=?61) and the wait and see group (n?=?32) were evaluated with a follow-up ultrasound examination after 3 months. The regression rate of endometrial polyps in women treated with subcutaneous progesterone was compared with the wait and see patients. The regression in the number and/or dimensions of the polyps was greater in the treatment group than the control group. The regression rate was 47.5% and 12.5%, respectively (p?<?.001).Conclusion
Progesterone appears to be a valid therapeutic alternative for the management of endometrial polyps. A prospective, randomized study is ongoing at our institution to further validate these findings. 相似文献4.
Sarah Maheux-Lacroix Catherine Bergeron Lynne Moore Marie-Ève Bergeron Jessica Lefebvre Iseult Grenier-Ouellette Sylvie Dodin 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):593-598
Objective
This study sought to examine whether hysterosalpingosonography (sono-HSG) is as effective as hysterosalpingography (HSG) in facilitating conception by comparing pregnancy rates in the 6 months following the procedures.Methods
This retrospective noninferiority study (Canadian Task Force classification II-2) was conducted at a tertiary university centre. The investigators studied 440 consecutive eligible infertile women. Bilateral tubal occlusion, severe male infertility, and having undergone both procedures were exclusion criteria. Tubal testing, as part of the infertility workup, was performed by either sono-HSG or HSG. The primary outcome was pregnancy, defined as a positive fetal heartbeat on ultrasonographic examination, in the 6 months following the procedure.Results
A total of 57 pregnancies (26%) were observed in the HSG group and 33 (15%) in the sono-HSG group. Adjusted and non-adjusted relative risks of pregnancy in the 6 months following sono-HSG compared with HSG were 0.61 (95% CI 0.42–0.89) and 0.58 (95% CI 0.39–0.85). Adverse events were infrequent with both procedures (sono-HSG, 1%; HSG, 4%; P?=?0.16).Conclusion
This study suggests that uterine flushing as performed during sono-HSG is not as effective as when performed during HSG to increase the chances of pregnancy, but further studies will be required because of bias related to the retrospective study design. 相似文献5.
Jaimin S. Shah Michael Mackelvie David M. Gershenson Preetha Ramalingam Marylee M. Kott Jubilee Brown Polly Gauthier Elizabeth Nugent Lois M. Ramondetta Michael Frumovitz 《Journal of minimally invasive gynecology》2019,26(1):87-93
Study Objective
To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital—academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists—and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor.Design
Retrospective study (Canadian Task Force classification II-1).Setting
Tertiary care, academic, and community hospitals.Patients
Women with an intraoperative frozen section diagnosis of borderline ovarian tumor at 1 of 3 types of hospital from April 1998 through June 2016.Interventions
Comparison of final pathology with intraoperative frozen section diagnosis.Measurements and Main Results
Two hundred twelve women met the inclusion criteria. The frozen section diagnosis of borderline ovarian tumor correlated with the final pathologic diagnosis in 192 of 212 cases (90.6%), and the rate of correlation did not differ among the 3 hospital types (p?=?.82). Seven tumors (3.3%) were downgraded to benign on final pathologic analysis and 13 (6.1%) upgraded to invasive carcinoma. The 3 hospital types did not differ with respect to the proportion of tumors upgraded to invasive carcinoma (p?=?.62). Mucinous (odds ratio, 7.1; 95% confidence interval, 2.1–23.7; p?=?.002) and endometrioid borderline ovarian tumors (odds ratio, 32.4; 95% confidence interval, 1.8–595.5; p?=?.02) were more likely than serous ovarian tumors to be upgraded to carcinoma. Only 88 patients (41.5%) underwent lymphadenectomy, and only 1 (1.1%) had invasive carcinoma in a lymph node.Conclusions
A frozen section diagnosis of borderline ovarian tumor correlates with the final pathologic diagnosis in a variety of hospital types. 相似文献6.
Ahmed M. Abbas Nahed A. Abo-Elela Ehab M. Mosa 《Middle East Fertility Society Journal》2018,23(1):57-62
Objectives
The current study aims to investigate the analgesic effect of oral hyoscine-N-butyl bromide (HBB) for alleviating pain during hysterosalpingography (HSG).Study design
Randomized, double-blind, placebo-controlled study.Study setting
Assiut University Hospital, Egypt.Materials and methods
The study was conducted between March and May 2016. Infertile women scheduled for HSG were randomized (1:1) to HBB or Placebo group. All women received oral 20 mg HBB or placebo tablets 30 min before the procedure. The primary outcome was the participant's self-rated pain perception utilizing a 10-cm Visual Analogue Scale (VAS) with 0 = no pain, and 10 = worst imaginable pain during the HSG procedure.Results
Ninety-four women were enrolled (n = 47 in each group). No difference in the baseline characteristics. Oral HBB does not reduce the median VAS pain scores during injection of the dye (3.75 vs. 4.5, p = 0.195), immediately post-procedure (3 vs. 3, p = 0.102) and 30 min post-procedure (2 vs. 2.5, P = 0.745). No significant differences in women satisfaction score (p = 0.302). The rate of side effects was higher in the HBB group especially nausea (14.9%) and dizziness (10.6%) (p = 0.0001).Conclusion
Utility of oral HBB 30 min before HSG has no benefit in alleviating the induced pain during and 30 min after the HSG procedure. 相似文献7.
Pouya Javadian Alexander Juusela Farr Nezhat 《Journal of minimally invasive gynecology》2019,26(1):31
Study Objective
To illustrate a robotic-assisted laparoscopic resection for cervicovaginal myomectomy.Design
Step-wise instruction using video and case report (Canadian Task Force classification III).Setting
A tertiary referral center.Patient
A 39-year-old woman.Intervention
Robotic-assisted laparoscopy resection of leiomyoma.Measurements and Main Results
A 39-year-old woman, gravida 0, body mass index of 23.0?kg/m2, with a known cervicovaginal myoma that in the past underwent uterine artery embolization, presented with recurrence of her severe abnormal vaginal bleeding. She was referred for surgical resection of the mass. Magnetic resonance imaging revealed a 5-cm posterior cervicovaginal leiomyoma. The patient wanted to preserve her reproductive organs. A total robotic procedure lasted 123 minutes, with an estimated blood loss of 100?mL. She was discharged uneventfully on the day 0 postoperatively. Pathology results showed a 37-g leiomyoma of the uterus. The patient presented at her 2-weeks postoperative visit with no more complaint of vaginal bleeding.Conclusion
Robot-assisted laparoscopic surgery is a feasible approach for cervicovaginal myoma with minimal complications. 相似文献8.
Angelos G. Vilos Cici Zhu Basim Abu-Rafea Helen C. Ettler Michele M. Weir George A. Vilos 《Journal of minimally invasive gynecology》2019,26(1):105-109
Study Objectives
To report 2 cases of uterine tumors resembling ovarian sex cord tumors (UTROSCTs) and examine the clinical significance of these tumors found during hysteroscopic endometrial ablation despite benign preoperative endometrial biopsy analysis and imaging suggestive of leiomyoma.Design
Case report (Canadian Task Force classification III).Setting
Tertiary care hospital.Patients
Two patients with abnormal uterine bleeding.Interventions
Hysteroscopic endometrial ablation/resection.Measurements and Main Results
Pathological analysis of intrauterine tissue/lesions obtained by curettage or resection identified 2 unexpected UTROSCTs masquerading as leiomyomas. Following hysterectomy, no residual UTROSCT was identified in the specimens, and both women are well, one at 1 year postsurgery and the other at 3 years postsurgery.Conclusion
Obtaining additional tissue by routine curettage before endometrial ablation and/or endomyometrial resection, in conjunction with removal of any intrauterine lesions, can identify rare unexpected endometrial lesions not sampled by endometrial biopsy, not detected with ultrasound, and masquerading as leiomyomas during endometrial ablation. 相似文献9.
Yi-Le Lee Teh-Fu Hsu Ling-Yu Jiang Hsiang-Tai Chao Peng-Hui Wang Yi-Jen Chen 《Journal of minimally invasive gynecology》2019,26(1):135-142
Study Objective
Previous studies suggest female-to-male transgender men tend to choose less invasive procedures, but the superior route of hysterectomy for them remains undetermined.Design
A retrospective study (Canadian Task Force Classification II-3).Setting
An academic tertiary hospital.Patients
Fifty-six female-to-male transsexuals received total vaginal hysterectomy (VH) with bilateral salpingo-oophorectomy (BSO) between April 2008 and August 2016 at Taipei Veterans General Hospital, Taipei, Taiwan.Interventions
The patients underwent natural orifice transluminal endoscopic surgery (NOTES) (n?=?14) or the conventional approach (n?=?42).Measurements and Main Results
Medical charts and surgical records were reviewed retrospectively. The general characteristics of the patients were similar in both groups. There were no statistically significant differences in operative time, estimated blood loss, intraoperative and immediate postoperative complications, or length of hospital stay between the 2 groups. However, postoperative pain was significantly reduced in the NOTES group compared with the conventional group as evidenced by lower mean scores on the visual analog scale (4.9?±?3.0 vs 7.1?±?1.4 at 2 hours, p?=?.008; 1.5?±?1.2 vs 3.0?±?1.7 at 48 hours, p?=?.001; and 1.7?±?1.0 vs 2.7?±?1.1 at 72 hours, p?<?.001) and a lower mean accumulated dose of postoperative analgesics (38.9?±?49.2?mg vs 88.8?±?82.3?mg meperidine hydrochloride, p?=?.037). Analysis of variance with repeated measures with a Greenhouse-Geisser correction also showed that the mean scores for wound pain were statistically lower in the NOTES group (p?<?.001). There was no significant difference in the complication rate between the NOTES and conventional groups (7% vs 12%, p?=?.618). There were no severe complications, including infection episodes or internal bleeding events, within the NOTES group.Conclusion
NOTES VH with BSO in female-to-male transgender men significantly decreases postoperative pain and analgesic use. NOTES in female-to-male sex reassignment surgery provides a novel choice for transgender men, with equivalent safety compared with VH. 相似文献10.
Xueying Li Ling Wu Yanfei Zhou Xing Fan Jufang Huang Juhua Wu Renxiu Yu Jianying Lou Mengjie Yang Zhihong Yao Min Xue 《Journal of minimally invasive gynecology》2019,26(1):94-99
Study Objectives
To evaluate the efficacy of a new crosslinked hyaluronan (NCH) gel in reducing the formation of intrauterine adhesions (IUAs) after dilation and curettage (D&C).Design
Randomized controlled trial (Canadian Task Force classification I).Settings
Six hospitals for maternal and child healthcare in China.Patients
A total of 300 patients were randomized to undergo D&C for delayed miscarriage without previous history of D&C. Twenty-six patients (9%) were lost to follow-up and were excluded from the analysis.Interventions
Women were randomly assigned to D&C alone (control group; n?=?150) or D&C plus NCH gel application (NCH gel group; n?=?150) with 1:1 allocation.Measurements and Main Results
All patients were evaluated using the American Fertility Society classification of IUAs during follow-up diagnostic hysteroscopy, scheduled at 3 months after D&C procedure. The primary endpoint was the number of women with IUAs at 3 months, and the secondary endpoints were adhesion scores and severity of IUAs. Postoperative efficacy data were available for 274 women (137 in each group). Intrauterine adhesion formations were observed in 13 of the 137 women (9.5%) in the NCH gel group and in 33 of the 137 women (24.1%) in the control group (p?=?.0012; relative risk [RR], 0.3939; 95% confidence interval [CI], 0.2107–0.7153), a difference of 14.6% (95% CI, 5.92%–23.28%) between the 2 groups. The extent of intrauterine cavity involved, type of adhesion and menstrual pattern, and cumulative adhesion scores were significantly lower in the NCH gel group compared with the control group (p?=?.0007, .008, .0012, and .0006, respectively). The proportion of women with moderate to severe IUAs was significantly lower in the NCH gel group than that in the control group (1 of 137 [0.7%] vs 16 of 137 [11.7%]; p?=?.0002; RR, 0.0625; 95% CI, 0.0084–0.4648), a difference of 11.95% (95% CI, 5.39%–16.51%) between the 2 groups.Conclusions
The current study demonstrates that IUAs are frequently formed after D&C for delayed miscarriage in women without a previous history of D&C procedures, and the application of NCH gel significantly reduces IUA formation. 相似文献11.
Study Objective
To demonstrate the proper use of vessel-sealing devices during vaginal hysterectomy.Design
Educational video (Canadian Task Force classification level III).Setting
University hospital.Intervention
The video reviews the principles on the use of energy in minimally invasive surgery. We focus on how vessel-sealing devices function and the benefits of their use in difficult vaginal hysterectomy. The video explains the 2 major types of complications, inadequate vessel sealing and undesired thermal injury, and demonstrates techniques to avoid these complications.Measurements and Main Results
Laboratory, intraoperative, and cadaveric recordings demonstrate proper use and the complications that may arise in the setting of improper use.Conclusion
Vessel-sealing devices may be a useful tool for surgeons performing vaginal hysterectomy. This video demonstrates their use and underlines the importance of understanding the principles of energy devices and their proper usage in surgery. 相似文献12.
Marcello Ceccaroni Matteo Ceccarello Giuseppe Caleffi Roberto Clarizia Stefano Scarperi Mauro Pastorello Alberto Molinari Giacomo Ruffo Stefano Cavalleri 《Journal of minimally invasive gynecology》2019,26(1):78-86
Study Objective
To investigate the efficacy of laparoscopic ureteroneocystostomy in patients with deep infiltrating endometriosis (DIE) with ureteral, parametrial, and bowel involvement.Design
Prospective study (Canadian Task Force classification II-2).Setting
Tertiary referral center for endometriosis care.Patients
One hundred sixty patients with DIE underwent laparoscopic radical eradication and ureteroneocystostomy between January 2009 and December 2016.Interventions
Laparoscopic nerve-sparing radical treatment with ureteroneocystostomy, parametrectomy, and, if necessary, segmental bowel resection.Measurements and Main Results
Surgical eradication was radical, and ureteral endometriosis was histologically confirmed in all patients (45.6% intrinsic and 54.4% extrinsic). In 58.7% of patients ureteroneocystostomy was performed with the psoas hitch technique. Bowel resection was performed in 121 patients (75.6%), and 115 of them had a concomitant ileostomy (71.9%). Unilateral parametrectomy was performed on the left side in 61.9% of patients and on the right side in 30% of patients, respectively, whereas bilateral parametrectomy was completed in 33 patients (20.6%). Postoperative complications were infrequent: 7 patients underwent reoperation (4.4%), 8 patients experienced fever (5%), 4 patients required blood transfusion (2.5%), 3 patients had intestinal fistulas (1.9%), and 24 patients experienced impaired bladder voiding (15%) after 6 months. Mean follow-up time was 20.5 months (range, 1–60). The study reported good clinical and surgical results, with a regression of symptoms (p?<?.001) and recurrence of parametrial endometriosis of 1.2% that required opposite-side ureteroneocystostomy.Conclusion
This is the largest documented series of patients with DIE undergoing laparoscopic radical eradication and ureteroneocystostomy. The collected data show that in patients with ureteral endometriosis, this technique is feasible, effective, and safe and provides good results in terms of relapses and symptoms' control. 相似文献13.
Boshra Hosseini Marli Leibl Jayson Stoffman Amanda Morris 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):660-665
Objective
To discuss the finding of hypercalcemia in pediatric ovarian dysgerminoma.Methods
Two cases of pediatric ovarian dysgerminoma that presented with hypercalcemia are discussed.Results
Hypercalcemia is a rare finding in ovarian dysgerminoma.Conclusion
Ovarian dysgerminoma should be considered in pediatric patients presenting with signs of hypercalcemia. Parathyroid hormone, parathyroid hormone related protein, and 1,25 dihydroxyvitamin D may elucidate the cause of hypercalcemia. 相似文献14.
Objective
To evaluate if the use of lidocaine gel applied to the cervix prior to manual vacuum aspiration (MVA) in addition to paracervical blockade is useful in reducing the level of pain associated with the procedure.Methods
A total of 88 patients were randomized to receive either 5?mL of lidocaine gel or a placebo applied topically to the cervix 5 minutes prior to paracervical blockade. Both groups received the same drugs for pain control (tramadol hydrochloride, diazepam, and sodium diclofenac). A visual analogue scale (VAS) was used for evaluation of pain intensity at two times: 2 minutes before the blockade (directly after tenaculum clamping of the anterior aspect of the cervix) and after MVA of the uterine cavity.Results
There was a statistically significant difference in pain intensity between the arms of the study. At the first evaluation time (cervical clamping), VAS pain score for the placebo group (control) was 3.6 (2.1) and that for the lidocaine gel group (case) was 1.2 (1.4) (P?<?0.01). At the second evaluation time (after manual vacuum aspiration), VAS pain score perceived by the control group was 5.3 (2.5) and that for the case group was 3.1 (1.9) (P?<?0.01). The use of lidocaine gel was not associated with any adverse effects of interest.Conclusion
The use of a topical lidocaine gel plus paracervical blockade was effective in reducing the intensity of pain associated with MVA when compared to paracervical blockade alone. 相似文献15.
Hisao Osada Shokichi Teramoto Hirotsune Kaijima Tomoya Segawa Osamu Miyauchi Masaji Nagaishi Makio Shozu Keiichi Kato Victor Gomel 《Journal of minimally invasive gynecology》2019,26(1):129-134
Study Objective
To evaluate the efficacy of a nonsurgical treatment for cervical pregnancy (CP) and cesarean section scar pregnancy (CSP).Design
Retrospective clinical study (Canadian Task Force classification III).Setting
Private assisted reproductive technology practice.Patients
Nineteen women with CP (n?=?16) or CSP (n?=?3), including 6 patients with positive fetal heartbeat.Intervention
Transvaginal local injection of absolute ethanol (AE) into the hyperechoic ring (lacunar space) around the gestational sac under ultrasound guidance.Measurements and Main Results
Serum beta-human chorionic gonadotropin (β-hCG) was measured at frequent intervals, and ultrasound and/or magnetic resonance imaging was used to observe the gestational sac. In 9 patients, the serum β-hCG level was effectively reduced with a single AE injection at 2 hours. In the remaining 10 patients, the level decreased but then increased in 4 and slowly decreased in the other 6; all of these 10 patients required 2 to 5 repeat AE injections. In all patients, serum β-hCG level was reduced by 50% within 3 days and decreased to <10% of the initial level within 14 days. In 18 patients (95%), the level was decreased to 1.0 mIU/mL within 40 days. Seven patients were treated on an outpatient basis. Twelve patients received no anesthesia. Five patients subsequently became pregnant, and each had a live birth. There was no recurrent CP or CSP. The procedure was successful in all 19 patients.Conclusion
This procedure is an effective treatment for CP or CSP that could be used in place of conventional surgical interventions and medical treatment using MTX. 相似文献16.
Elisa Bertocchi Giuliano Barugola Marco Benini Paolo Bocus Roberto Rossini Marcello Ceccaroni Giacomo Ruffo 《Journal of minimally invasive gynecology》2019,26(1):100-104
Study Objective
To evaluate the incidence, risk factors, and treatment of colorectal anastomotic stenosis in patients who undergo rectosigmoid resection for deep infiltrating endometriosis (DIE).Design
Retrospective analysis of a prospective database (Canadian Task Force classification III).Setting
Public medical center.Patients
All women who underwent laparoscopic rectosigmoid resections for DIE at our hospital between January 2002 and December 2016.Intervention
All patients were evaluated clinically and endoscopically at 1 month and 3 months after bowel resection. Stenosis was defined as a lack of passage through the anastomosis of a 12-mm proctoscope. Symptomatic stenosis was defined as the presence of endoscopically confirmed stricture accompanied by at least 2 of the following symptoms: constipation, need to push, tenesmus, and ribbon stools. Only patients with symptomatic stenosis were studied. Demographic data, surgical techniques, and postoperative complications were recorded prospectively. Treatments and outcomes of anastomotic symptomatic strictures were analyzed.Measurements and Main Results
A total of 1643 patients underwent laparoscopic rectosigmoid resection at our hospital between January 2002 and December 2016. Among these, 104 patients (6.3%) presented with symptomatic anastomotic stenosis. The median patient age was 27 years (range, 23–44 years), and the median interval between diagnosis and the onset of symptomatic stenosis was 57 days (range, 21–64 days). The only statistically significant predictors of anastomotic stenosis were the presence of ileostomy (p?=?.01) and previous pelvic surgery (p?=?.002). Treatment of choice was always conservative. Of the 104 patients in the study cohort, 90 (86.5%) underwent 3 endoscopic dilatations. No patient required reoperation.Conclusion
The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication. 相似文献17.
Shayesteh Jahanfar Kenneth Lim Eugenia Oviedo-Joekes 《Journal d'obstetrique et gynecologie du Canada》2019,41(1):52-58
Objective
Stillbirth is an important adverse outcome associated with twin pregnancy. We aimed at investigating the association between birth weight discordance (BWD) and stillbirth.Methods
We carried out two retrospective cohort studies including twin births registered in British Columbia from 2000 to 2010 and a subsample with chorionicity information. Generalized estimating equation models for binary outcome were used to account for the correlation in twin outcomes.Results
The province-based cohort included 12 814 twins. In the nonstratified analysis, an increase in BWD was found to be associated with an increased risk of stillbirth even after accounting for potential confounding factors (13.69; 95% CI 7.32–25.62). In the analysis stratified by fetal growth, the stillbirth rate was determined to be higher in subjects with a BWD ≥30% compared with the reference group. BWD-related stillbirth was dependent on fetal growth, parity, GA, twin size, sex discordance, and chorionicity. A subgroup analysis showed that odds of stillbirth were 5.21 times higher in twins with BWD ≥30% than the reference category (95% CI 2.17–12.47) after adjustment for chorionicity.Conclusions
In screening twin pregnancies, special attention should be paid to fetal growth, parity, GA, twin size, and chorionicity. Sex discordance is a good proxy for chorionicity when these data are not available. 相似文献18.
Gaby Moawad Paul Tyan Victoria Vargas Daniel Park Hannah Young Cherie Marfori 《Journal of minimally invasive gynecology》2019,26(1):122-128
Study Objective
To identify predictors of overnight admission after laparoscopic and robot-assisted hysterectomy to improve preoperative counseling and patient optimization.Design
A single-center retrospective cohort study (Canadian Task Force classification III).Setting
Academic university hospital.Patients
Patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by fellowship-trained minimally invasive gynecologic surgeons for benign indicationsInterventions
Straight-stick laparoscopic and robot-assisted hysterectomy.Measurements and Main Results
Data from 396 consecutive minimally invasive hysterectomy procedures were collected for analysis. Three hundred twelve patients (79%) were discharged the same day, and 84 (21%) were admitted for at least 1 night. Data from the 2 groups were compared. Overnight stay compared with same-day discharge was associated with older age (47.3 vs 43.4 years, p?<?.001), lower preoperation hematocrit (35.8% vs 37.3%, p?=?.035), history of prior laparotomy (31% vs 14.1%, p?=?.003), prolonged operative time (190.5 vs 115.2 minutes, p?<?.001), estimated blood loss (244.6 vs 104.1?mL, p?<?.001), lysis of adhesion (27.4% vs 13.5%), and intraoperative organ injury (17% vs 3%, p?=?.005). Logistic regression analysis, adjusting for all included variables as confounders, showed that hematocrit increments of 5% were protective against any overnight stay (odds ratio, .622; p?=?.015), and a 30-minute increase in operative time increased the odds of an overnight stay by 1.6 (p?<?.001). History of a laparotomy remained a significant predictive factor for an overnight stay (odds ratio, 3.2; p?=?.006). Later surgery end time, in 60-minute increments, increased the odds of an overnight stay by 1.2 (p?<?.01).Conclusion
Perioperative factors such as age, hematocrit, surgery time, and surgical history as well as intraoperative factors such as prolonged operative time are predictive of overnight hospital stay. 相似文献19.
K Dreyer R van Eekelen RI Tjon-Kon-Fat JW van der Steeg P Steures MJC Eijkemans F van der Veen PGA Hompes BWJ Mol N van Geloven 《Reproductive biomedicine online》2019,38(2):233-239
Research question
Hysterosalpingography (HSG) with an oil-based contrast has been shown to increase ongoing pregnancy rates compared with HSG with water-based contrast, but it remains unclear if an effect of HSG occurs compared with no HSG.Design
A secondary data-analysis of a prospective cohort study among 4556 couples that presented with unexplained subfertility in 38 clinics in the Netherlands between January 2002 and December 2004. A time-varying Cox regression with inverse probability of treatment weighing was used to analyse ongoing pregnancy rates in women after undergoing the HSG procedure (with the use of either water- or oil-based contrast media) compared with women who did not undergo HSG.Results
The probability of natural conception within 24 months after first presentation at the fertility clinic was increased after HSG, regardless of the type of contrast medium used, compared with no HSG (adjusted hazard ratio 1.48, 95% CI 1.26 to 1.73, corresponding to an absolute increase in 6-month pregnancy rate of +6%). When this analysis was limited to HSGs that were made with water-contrast, the treatment effect remained (adjusted hazard ratio 1.40, 95% CI 1.16 to 1.70).Conclusions
HSG increases the ongoing pregnancy rate of couples with unexplained subfertility compared with no HSG, regardless of the contrast medium used. Results need to be validated in future, preferably randomized, studies. 相似文献20.
Kristin A. Riley Andrea S. Benton Timothy A. Deimling Allen R. Kunselman Gerald J. Harkins 《Journal of minimally invasive gynecology》2019,26(1):71-77