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C Chapron

Publications and source records attributed to C Chapron.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Complications of laparoscopy in gynecology].

In the field of surgery the development of operative laparoscopy has been one of the most important steps forward over the past fifteen years. This technique has become the surgical treatment of choice for a number of indications in gynaecology. The advantages of laparoscopy as compared with laparotomy are weil known, and assessment of the risk of complications is essential. A multicentric study was carried out in seven top French centres for laparoscopic gynaecological surgery. This series runs over a period of nine years and covers 29,966 diagnostic and operative laparoscopies. The risk of complications has been assessed according to the complexity of the laparoscopic procedure in question. The means of diagnosis and treatment of the complications have been analysed together with the importance of the surgeon's degree of experience. The mortality rate is 3.33 per hundred thousand laparoscopies. The overall complication rate is 4.64 per thousand laparoscopies (139 cases). The rate of complications requiring laparotomy is 3.20 per thousand (96 cases). The complication rate is significantly correlated with the complexity of the laparoscopic procedure (p = 0.0001). One out of three complications (34.1%; 43 cases) occurred while setting up for laparoscopy, and one out of four complications (28.6%) were not diagnosed during the operation. As new indications for laparoscopic surgery in gynaecology have appeared, there has been a parallel and statistically significant increase in the rate of urological complications (p = 0.001). Increased experience of the surgeons has had three consequences: a statistically significant drop in the number of bowel injuries (p = 0.0003), a drop in the rate of complications requiring laparotomy for those laparoscopic surgical procedures which are weil-defined (p = 0.01) and a change in the way complications are treated, with a significant increase in the proportion of incidents treated by laparoscopy (p = 0.0001). Laparoscopic surgery is a reliable technique. The risk of complications exists whatever the indication for laparoscopy. None of the phases in the operation must be neglected. The risk of accidents being overlooked means that the methods for postoperative follow-up must be adapted, bearing in mind the shorter hospital stay. The part played by the surgeon's experience raises the major problem of practitioner training.

Female↗
PubMed2001

Laparoscopic myomectomy: predicting the risk of conversion to an open procedure.

BACKGROUND: Laparoscopic myomectomy (LM) has some advantages over laparotomy; however, it is reputed to be technically difficult, and the risk of conversion to laparotomy might be an obstacle in using this procedure. The aim of this study was to identify the pre-operative factors affecting the risk of conversion to an open procedure (either laparoscopic assisted myomectomy or laparotomy), and to develop a simple prediction model based on available pre-operative data with the use of multiple logistic regression. METHODS: A total of 426 women presenting with a subserous or intramural myoma measuring 20 mm or more underwent LM between March 1989 and October 1999. Of these patients, 378 had successful LM. Forty eight patients [11.3%, 95% confidence interval (CI) 8.3--14.3] had a conversion to an open procedure. A total of 265 women had adequate pre-operative ultrasonography (US) and were used for the analysis. RESULTS: The best prediction model included four pre-operative factors that were found to be independently related to the risk of conversion: size > or = 50 mm at US (adjusted OR = 10.3; 95% CI = 2.8--37.9), intramural type (adjusted OR = 4.3; 95% CI = 1.3--14.5), anterior location (adjusted OR = 3.4; 95% CI = 1.3-9.0) and pre-operative use of gonadotrophin-releasing hormone (GnRH) agonists (adjusted OR = 5.4; 95% CI = 2.0--14.2). The regression coefficients were then scaled and rounded to integers to provide an estimate of the risk for conversion. For a given patient with selected characteristics the predicted risk varied from 0--73%. CONCLUSIONS: This prediction model provides a useful tool that enables multiple criteria to be taken into account simultaneously to help select cases for LM. GnRH agonists should been used only in selected cases. US evaluation is essential before performing LM.

Adult↗
PubMed2001

Laparoscopic myomectomy fertility results.

The appearance of uterine myomas has been linked to infertility. It has been suggested that surgical management of myomas by laparoscopic myomectomy improves fertility rates in these group of patients. In this paper we initially describe specific aspects of the surgical technique of laparoscopic myomectomy including the set-up, precise technique for hysteroromy, enucleation of the myoma, suturing of the uterus, and extraction of the myoma. We detail recent findings that demonstrate improved fertility rates in women undergoing laparoscopic myomectomy. We recommend that, when criteria for selection of patients is strictly adhered to and patients present with no other associated infertility, laparoscopic myomectomy be used to increase the implantation rate.

Female↗
PubMed2001

Management of deep endometriosis.

Deep endometriosis is defined as an endometriotic lesion that penetrates the retroperitoneal space for a distance of > or =5 mm. Deep endometriosis is extremely active, occurs in phase with eutopic endometrium, evolves progressively with age, and is most often located in the pouch of Douglas, the rectovaginal septum, the uterosacral ligaments, and occasionally in the uterovesical fold. These lesions are associated with pelvic pain, the intensity of which is proportional to the depth of penetration. It is clear that choice of treatment depends on the location of the endometriotic lesion. In this paper we describe our methods for the initial diagnosis and subsequent treatment of deep endometriosis. These include consultation and clinical examination protocols, use of rectal endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), and transvaginal ultrasonography techniques in diagnosis and surgical treatment approaches.

Endometriosis↗
PubMed2001

Differential regulation of protein kinase C isoforms in human uterine leiomyoma.

The protein kinase C (PKC) isoenzyme expression pattern in human uterine leiomyoma was compared with that obtained in homologous myometrium distal from the tumor. The six PKC isoforms (PKCalpha, PKCbeta1, PKCbeta2, PKCdelta, PKCepsilon and PKCzeta) evidenced in the myometrium were found to be similarly expressed in leiomyoma. Quantitative immunoblotting revealed that all PKC isoforms were preferentially localized in the particulate fraction. To gain insight into the possible functional consequences of PKC expression patterns, subcellular redistribution in response to the mitogenic peptide endothelin-1 (ET-1) was studied. After stimulation with ET-1, differential redistribution occurred in leiomyoma and myometrium, suggesting a selective role of PKC isoforms in the myometrial growth process.

Adult↗
PubMed2001

Potentiation response of cultured human uterine leiomyoma cells to various growth factors by endothelin-1: role of protein kinase C.

OBJECTIVE: Factors responsible for the abnormal proliferation of myometrial cells that accompanies leiomyoma formation are unknown, although steroid hormones and peptide growth factors have been implicated. We hypothesized that endothelin-1 (ET-1) is a physiological regulator of tumor growth. DESIGN: In this study, we investigated the role of ET-1 on growth of human leiomyoma cells and its synergistic effect with growth factors, as well as the signaling pathway involved in this interaction. METHODS: Leiomyoma cell proliferation was assayed by [H]thymidine incorporation and cell number. Protein kinase C (PKC) isoforms were analyzed by Western blot using specific antibodies. RESULTS: ET-1 on its own was unable to stimulate DNA synthesis but potentiated the leiomyoma cell growth effects of basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), IGF-I and IGF-II. The failure of a protein tyrosine kinase (PTK) inhibitor, tyrphostin 51, to affect the potentiating effect of ET-1, supports the hypothesis of non-involvement of PTK in this process. The inhibition of PKC by calphostin C or its down-regulation by phorbol 12,13-dibutyrate (PDB) eliminated the potentiating effect of ET-1, but did not block cell proliferation induced by the growth factors alone. Five PKC isoforms (alpha, beta1, epsilon, delta and zeta) were detected in leiomyoma cells, but only phorbol ester-sensitive PKC isoforms (PKCalpha, epsilon and delta) contribute to the potentiating effect of leiomyoma cell growth by ET-1. CONCLUSIONS: We have demonstrated that ET-1 potentiates leiomyoma cell proliferation to growth factors through a PKC-dependent pathway. These findings suggest a possible involvement of ET-1 in the pathogenesis of leiomyomas.

Blotting, Western↗
PubMed2001

Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum.

BACKGROUND: Two aims: 1) To assess the results of laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum (RVS); 2) to pinpoint the differences between this procedure and that used for deep endometriotic lesions located on the uterosacral ligaments (USL). METHODS: Descriptive retrospective study. Twenty-nine consecutive patients operated for deep endometriosis infiltrating the RVS were included in this series. RESULTS: One patient only (3.5%) presented a major complication of the recto-vaginal fistula type. After a one step reoperation under anesthesia, the post operative history was uncomplicated and no sequelae are to be deplored. With respect to dysmenorrhea (DM), deep dyspareunia (DP) and chronic pelvic pain (CPP), there was an improvement in respectively 91.7% (22 patients), 100% (24 patients) and 92.9% (13 patients) of cases. For each of these 3 symptoms the median score according to the visual analog scale was significantly lower after the operation (for DM: 7.6+/-2.0 versus 1.7+/-2.6; for DP 7.5+/-1.9 versus 0.5+/-1.1; for CPP 5.9+/-2.8 versus 1.4+/-3.2) (p<0.0001). CONCLUSIONS: These results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic infiltrating the RVS. From the technical point of view the rectum must be freed, leaving the deep endometriotic nodule attached to the posterior wall of the vagina. Resection of the whole lesion requires the posterior wall of the vagina to be resected, whereas ureterolysis is often unnecessary. So for lesions located on the RVS the vagina is opened systematically, unlike the situation when resecting deep endometriotic lesions infiltrating the USL. Deep pelvic endometriosis is not synonymous with endometriosis of the RVS. Lesions truly infiltrating the RVS represent only a small proportion of all deep endometriosis lesions.

Adult↗
PubMed2001

[Management of endometriosis ovarian cysts].

The efficacy of medical treatment as unique treatment for endometrioma is not demonstrated. Operative laparoscopic management is the gold standard for surgical treatment. There is no indication to prescribe preoperatively medical treatment before cystectomy. Post-operative administration of low-dose cyclic oral contraceptive does not significantly affect long-term recurrence rate of endometriosis after surgical treatment. In cases of infertility, management of endometriomas is controversial. Recurrent ovarian surgery is not recommended.

Contraceptives, Oral, Combined↗
PubMed2000

Total hysterectomy for benign pathologies: direct costs comparison between laparoscopic and abdominal hysterectomy.

OBJECTIVES: The aim of this study is a direct costs comparison between laparoscopic and abdominal total hysterectomy when theses procedures are indicated for benign pathologies. STUDY DESIGN: To this end we compared the direct costs of total laparoscopic hysterectomy (TLH) calculated from a series of 105 patients with that obtained for a comparable series of 30 patients who underwent hysterectomy by laparotomy. RESULTS: The direct costs of total hysterectomy for a benign pathology by laparoscopic surgery and laparotomy are comparable (respectively 7693 French francs (FF) and 7759 FF). Whatever the type of operation the cost for staff represents 60% of the total cost. Expenditure for staff during the operation represents 41.0% of the total cost of TLH (3154 FF/7693 FF) whereas it represents only 31.0% of the cost of the operation when carried out by laparotomy (2406 FF/7759 FF) (P<0.0001). Inversely the expenditure due to staff during the post operative phase represents 24.1% of the total cost of the operation when laparotomy is used (1875 FF/7759 FF) and only 13.4% of the cost of the operation by laparoscopic surgery (1029 FF/7693 FF) (P<0.0001). When the operation uses laparoscopic surgery the increase in expenditure during the surgical act is compensated by the statistically significant shortening in the hospital stay. Expenditure connected with the laparoscopic surgery equipment is minimal compared to the costs connected with the staff. CONCLUSION: Provided that TLH is carried out with reusable laparoscopic surgery equipment, by skilled surgeons working in suitable hospital structures making the particularly heavy investment in laparoscopic surgery equipment economically viable, TLH is an economically viable technique as an alternative to laparotomy.

Adult↗
PubMed2000

[Major vascular complications from gynecologic laparoscopy].

OBJECTIVE: To specify the circumstances of occurence, the means of diagnosis, the risk factors and the means of prevention for major vascular injuries (MVI) during gynecologic laparoscopic procedure. STUDY DESIGN: Retrospective case review study of 24 patients. RESULTS: Twenty-four patients with 31 MVI were identified. The average age of the patients was 32.8 +/- 10.6 years and the mean body index mass was 22.4 +/- 4.0 kg/m2. Three of four of the MVI occurred during the setting-up phase of laparoscopy (19 cases; 79.2%). In five cases (20.8%) MVI occurred during the laparoscopic surgical procedure. Fifteen of the MVI occurring during the set up phase were secondary to insertion of the umbilical trocar and four to insertion of the needle used to create the pneumoperitoneum. A minimum of six MVI secondary to insertion of the umbilical trocar were observed with disposable trocars. In every case diagnosis was performed during the laparoscopic procedure. Five patients (20.8%) died and three others (12.5%) presented serious complications (phlebitis (one case); ischemia (two cases) with a reoperation for one patient). CONCLUSION: MVI are rare but serious complications of gynecologic laparoscopy. Prevention relies on the surgeon's experience and strict respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.

Adult↗
PubMed2000

Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications.

BACKGROUND AND STUDY AIMS: The main area of the gastrointestinal tract affected by deep pelvic endometriosis is the rectosigmoid colon in 3-37% of cases. Due to the risk of infiltration and the clinical symptoms of endometriosis, with pain and infertility, the condition may require surgical resection. Preoperative imaging diagnosis of rectosigmoid involvement is therefore important. Rectal endoscopic ultrasonography (EUS), which is already used for the staging of anorectal carcinoma and submucosal lesions, may be a promising technique for this indication. The present study was conducted in order to describe the endosonographic appearance of rectosigmoid endometriosis, and to define the potential relevance of the technique to the choice of resection method. PATIENTS AND METHODS: Between 1993 and 1997, 46 women (mean age 31) with deep pelvic endometriosis underwent imaging investigations and surgical resection. The clinical and imaging findings, and the surgical and histological features identified--mainly with regard to infiltration of the rectal wall--were compared retrospectively. The impact of the EUS findings on the decision on whether or not to carry out resection, either by laparoscopy or open abdominal surgery, was also examined. RESULTS: When there was deep pelvic endometriosis with suspected rectal wall infiltration, EUS showed normal anatomy in nine patients, endometriotic lesions without rectal wall infiltration in 12, and typical rectal infiltration in 25. The lesions were confirmed by the surgical findings during therapeutic laparoscopy (n = 22) and laparotomy (n = 25), as well as by clinical follow-up. Rectal wall infiltration, demonstrated in all cases using EUS, had initially been suspected on the basis of clinical examinations, rectoscopy, barium enema, computed tomography, and magnetic resonance imaging in 62%, 50%, 33%, 67% and 66% of cases, respectively. CONCLUSIONS: EUS is a simple and noninvasive technique capable of correctly diagnosing rectal wall infiltration in deep pelvic endometriosis. It may be helpful in determining the choice between laparoscopy and laparotomy when complete resection is indicated.

Adult↗
PubMed2000

Pregnancy outcome and deliveries following laparoscopic myomectomy.

Uterine rupture after myomectomy by laparotomy is not a common occurrence. Some case reports of uterine rupture after laparoscopic myomectomy (LM) raise the question of the quality of the uterine scar produced when this technique is performed. In order to assess the outcome of pregnancies and deliveries after LM and to assess the risk of uterine rupture, we performed an observational study. Questionnaires were mailed to all women who had had LM for at least one intramural or subserosal myoma of more than 20 mm diameter and who were aged <45 years. Ninety-eight patients became pregnant at least once after LM, giving a total of 145 pregnancies. Among the 100 patients who had delivery, there were three cases of spontaneous uterine rupture. Because only one of these uterine ruptures occurred on the LM scar, the risk of uterine rupture was 1.0% (95% CI 0.0-5. 5%). Seventy-two patients (72.0%) had trials of labour. Of these, 58 (80.6%) were delivered vaginally. There was no uterine rupture during the trials of labour. Spontaneous uterine rupture seems to be rare after LM. This risk should not deter the use of LM if needed. When performing LM, particular care must be given to the uterine closure.

Adult↗
PubMed2000

Prognostic factors of reproductive outcome after myomectomy in infertile patients.

The objective of this study was to identify the prognostic factors for conception after myomectomy carried out in cases of infertility. A total of 91 infertile patients presenting at least one subserous or intramural myoma measuring >2 cm underwent myomectomy. The characteristics of the patients, myomata and associated infertility factors were collected in a uniform and systematic way. A postal questionnaire was sent to patients. For each of the various factors studied, the specific cumulative probability of spontaneous intrauterine conception was estimated using the Kaplan-Meier method. Multiple regression analysis was then carried out using Cox's proportional hazards model. The cumulative probability of spontaneous intrauterine conception at 2 years follow-up was 44% (95% confidence interval: 32-56%). The cumulative probability of conception was less after removal of a posterior or intramural myoma, after a sutured hysterotomy, and when accompanied by a male factor, associated tubal or ovulation pathology. The cumulative probability of conception was greater after ablation of myomata responsible for menometrorrhagia. The size, deforming effect on the cavity and age played no role in our sample. Our results indirectly suggest that post myomectomy adhesions could have an adverse effect on fertility. Myomata responsible for menometrorrhagia are also the cause of infertility. In the presence of an associated male, tubal or ovulatory factor, the results were poor and it was not possible to determine if a myomectomy should be performed in these cases in order to enhance fertility.

Adult↗
PubMed2000

Expression of endothelin receptors in human myometrium during pregnancy and in uterine leiomyomas.

The distribution of mRNAs for endothelinA and B (ET(A) and ET(B)) receptors and their binding properties was studied in human nonpregnant and pregnant term myometrium and in uterine leiomyomas. ET(A)- and ET(B)-receptors functionally coupled to phospholipase C (PLC) coexisted in myometrial tissues, but only the functional ET(A)-receptor subtype was detected in leiomyomas. ET(A)-receptor mRNA and three other spliced variants were distributed in all tissue studied. We reported an increase in the proportion of ET(A)-receptors coupled to PLC in term pregnant myometrium when compared to nonpregnant tissue. These results suggest that upregulation of the myometrial ET(A)-receptors may account for or contribute to the control of normal development and growth of human myometrium during pregnancy. They also support a pathological role for the endothelin-1 (ET-1)/ET(A)-receptor system in leiomyoma development.

Azepines↗
PubMed2000

Reproductive outcome after laparoscopic myomectomy in infertile women.

OBJECTIVE: To assess reproductive outcome after laparoscopic myomectomies for interstitial and/or subserosal myomas in infertile women with or without associated infertility factors. STUDY DESIGN: In this observational study, 91 women with infertility for one year and at least one interstitial and/or subserosal myoma > 20 mm were treated with laparoscopic myomectomy. All patients were mailed questions about fertility and pregnancy outcome. Cumulative pregnancy rates were calculated by the Kaplan-Meier method. The log rank test and Cox's model were used for comparing the spontaneous pregnancy rate in patients with and without associated infertility factors. RESULTS: The mean age of the patients was 35 +/- 4 years. The mean duration of infertility was 44 +/- 33 months. Twenty-five patients (27.5%) had no associated infertility factors, and 66 (72.5%) had one or more. The mean size of the largest myomas was 45 +/- 19 mm. The mean number of myomas removed was 2.0 +/- 1.4. Eighty-six patients had laparoscopic myomectomy (94.5%), and five had laparoscopically assisted myomectomy (5.5%). There were no conversions to laparotomy. Ten patients were lost to follow-up (11.0%). Among the 91 patients treated surgically, 81 (89.0%) of them were evaluated. Forty-three (53.1%) conceived, resulting in a total of 51 pregnancies. The two-year overall cumulative conception rate was 51.2% (95% confidence interval [CI], 39.2-63.2%). The two-year spontaneous pregnancy rate was 43.9% (95% CI, 32.1-55.7%). This rate was 69.9% (95% CI, 50.3-89.5%) for patients with no associated factors and 31.5% (95% CI, 18.4-44.6%) for patients with associated factors (P < .001). This result was not affected by adjusting for age or duration of infertility. CONCLUSION: Laparoscopic myomectomy seems to be a good procedure for patients with myomas and no other infertility factors. In cases with associated infertility factors, the need for myomectomy has to be studied.

Adult↗