PubMed Health⌕ Search

Biomedical subjects

C Chapron

Publications and source records attributed to C Chapron.

At least 109 records · Page 6Linked to original sources
PubMed1996

Salpingectomy - the laparoscopic surgical choice for ectopic pregnancy.

The aim of this study was to assess the fertility outcome after ectopic pregnancy (EP) treated by laparoscopic salpingectomy. Among the 375 patients who underwent this operation between January 1983 and December 1993, there were 145 patients who desired pregnancy and whose contralateral tube was not obstructed. The overall rate of intrauterine pregnancy (IUP) was 50.3%, with an EP rate of 15.2%. These results were analysed according to the patients' past history together with the condition of the contralateral tube at the time of the laparoscopy. We defined two groups. Group 1 included patients who had no previous history of tubal surgery and whose contralateral tube was normal. Group 2 comprised those patients who had a previous history of tubal surgery and/or those whose tube was pathological, but not obstructed. Postoperative fertility of the patients in group 1 was significantly higher than that of the patients in group 2, with IUP rates of 75 and 36.6% respectively (P < 0.001), and a risk of EP recurrence of 9.6 and 18.3% respectively. In group 1, the actuarial IUP rate at 24 months was significantly higher than that for the patients in group 2 (66.7 versus 36.9%; P < 0.001). The patient's past history and the condition of the contralateral tube were the two major factors related to fertility outcome after laparoscopic salpingectomy for EP. In patients with no past history of tubal surgery or infertility and whose contralateral tube was normal, the fertility results after laparoscopic salpingectomy appeared comparable to those observed after conservative laparoscopic treatment.

Adult↗
PubMed1996

[Radical laparoscopic surgery of ectopic pregnancy: results from a continuous series of 383 interventions].

From January 1983 to December 1993, 375 patients underwent laparoscopic salpingectomy. Six complications (1.5 %) were observed. Among 145 patients with a patent contralateral tube who desired pregnancy, 73 had an intrauterine pregnancy (50.3 %) and 22 had ectopic pregnancy (15.2 %). These results are discussed according to the contralateral tube status and gynecologic past history.

Adolescent↗
PubMed1996

[Laparoscopic surgery and benign diseases of the uterus].

Much progress has been made in gynecological surgery with the advent of laparoscopic techniques. Some benign diseases of the uterus can now be treated with laparoscopic myomectomy or hysterectomy. Patient selection is essential. There as still well-defined indications for the vaginal route and laparotomy.

Adult↗
PubMed1995

Laparoscopic myomectomy and myolysis.

The indications for operative laparoscopy have increased greatly over the past decades as its many advantages over laparotomy have become recognized. Laparoscopic myomectomy as a technique is now clearly described. A monopolar hook is used for the uterine incision. After atraumatic enucleation of the myoma, myometrium and serosa are usually sutured particularly if the incision is deep or more than 2 cm long. Myomas can be removed by posterior colpotomy. However, the development of an electrical cutting device permits an easier and quicker removal of the myoma through the suprapubic puncture site. Only complicated myomas and/or those which give rise to persistent symptoms despite properly prescribed medical treatment, together with those which grow rapidly, require surgery. In our experience of ablation of myomas measuring 5 cm and over the results were satisfactory in all 71 patients with more than one year of follow-up. In two cases (2.7%) we were obliged to convert to laparotomy. We were confronted with no serious per-operative or post-operative complications. These satisfactory results must not mask the fact that the technique is lengthy and difficult and should be carried out by experienced surgeons thoroughly familiar with endoscopic sutures. Under these conditions, laparoscopic myomectomy is possible, for large myomas (5 cm and over) even if they are located completely intramurally. However, there are limits and it is preferable to use laparotomy for myomas measuring over 10 cm and for multiple myomectomy (over 3). Finally, the risk of causing adhesions and the quality of the uterine suture need to be assessed in the near future.

Adult↗
PubMed1995

History of infertility.

Infertility has always been a constant preoccupation. The problems it raises today on medical, social, ethical, political and religious levels bear witness to this emphasis, but also to how complicated infertility is to deal with and understand. This study not only examines the history of infertility and the treatments applied but also the repercussions for infertile women socially. As we look through history, we find that the attitudes of physicians have often reflected the role of the woman and her image in society.

Arab World↗
PubMed1995

Laparoscopic management of asymmetric Mayer-Rokitansky-Kuster-Hauser syndrome.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a partial or complete absence (agenesis) of the uterus with an absent or hypoplastic vagina. Until now, the recommended treatment, when resection of a rudimentary horn was indicated, was laparotomy. We report a case of MRKH syndrome in which the patient benefited from laparoscopic surgery for bilateral resection of rudimentary horns. Laparoscopy is not only useful for diagnosis of uterine malformations but can also be valuable for any treatment required for this type of malformation, this being carried out during the same operative procedure, thus avoiding laparotomy for the patient. The creation of an artificial vagina is performed during a second operation.

Adolescent↗
PubMed1995

Sterilization reversal: fertility results.

Fertility outcome following sterilization reversal by laparotomy was evaluated. We studied all sterilization reversals performed between January 1978 and December 1991; a total of 226 women were treated. Tubal anastomosis was performed according to the rules for microsurgery. The microsurgical technique comprised two main phases: preparation of the healthy tube segments and the anastomosis carried out on two layers. It was possible to study the subsequent fertility of 206 patients in all, as 20 patients were lost to follow-up (8.8%). Cumulative pregnancy rates were evaluated by life-table analysis. The overall intrauterine pregnancy rate, including births and miscarriages, was 69.9% (144 patients) after 2 years. The cumulative intrauterine pregnancy rate was 62% at 18 months. Analysis of the fertility results demonstrated that age was the most significant predictive factor. The cumulative intrauterine pregnancy rate at 2 years was 83.5% (61 cases) for patients < or = 33 years, 70% (35 cases) for patients aged 34-36 years, 62.5% (30 cases) for patients aged 37-39 years, and 51.4% (18 cases) for patients aged > or = 40 years. Even for patients aged approximately 40 years, microsurgical repermeabilization can be retained as the first choice rather than in-vitro fertilization.

Adult↗
PubMed1995

Complications of gynecologic laparoscopic surgery.

The growing impact of laparoscopic surgery must not make us underestimate the existence of complications, some of them severe, with medical-legal implications. Several surveys and case reports of complications following modern gynecologic laparoscopic surgery, some reporting laparoscopic management of visceral injuries, have been published recently. The complication rate depends on the complexity of the surgical procedure; serious complications still arise during performance of laparoscopy. Patients must be informed of the hazards of so-called 'minimally' invasive surgery.

Female↗
PubMed1995

Uterine rupture during pregnancy after laparoscopic myomectomy.

A 31 year old patient presenting with primary infertility underwent an operative laparoscopy for the treatment of bilateral hydrosalpinges, during which a myomectomy was also performed. The uterus was repaired using interrupted sutures. At follow-up laparoscopy seven weeks later, a uterine fistula was diagnosed and was oversewn using a single 'figure of eight' suture. One year later the patient became pregnant through in-vitro fertilization. At 34 weeks gestation, she required an emergency laparotomy for acute abdominal pain and the presence of fetal bradycardia. The operative findings revealed a uterine rupture at the site of the previous myomectomy scar. This was then enlarged with a scalpel and a live baby was delivered. The uterus was repaired in two layers. The postoperative period for both mother and baby was satisfactory. This complication raises the problem of the quality of uterine repair following laparoscopic myomectomy, together with the question of how to prevent this type of life-threatening situation.

Abdominal Pain↗
PubMed1995

[Total hysterectomy for benign pathologies: why is laparoscopy of value?].

The majority of the hysterectomies are performed by laparotomy. With laparoscopic surgery it will be possible to perform only 10 to 20 per cent of the hysterectomies by the abdominal route. Even if laparoscopic hysterectomy is a feasible technique, all the hysterectomies should not be performed by the endoscopic route. Laparoscopic surgery is in no case an alternative to vaginal surgery. Laparoscopic surgery is not indicated for hysterectomy if the operation is feasible quickly and under good conditions via the vaginal route. Laparoscopic surgery is only indicated when vaginal surgery is difficult and/or contra-indicated. In these situations, laparoscopic surgery can be performed according two different modalities: laparoscopically assisted vaginal hysterectomy and total hysterectomy completely performed by laparoscopy.

Decision Trees↗
PubMed1995

[Total hysterectomy for benign pathologies. Conventional celiosurgical technique].

The standard technique for total laparoscopic hysterectomy is characterised by two essential points. The first is that all instruments are reusable and the second is that hemostasis is ensured by bipolar coagulation. It is a safe technique with a cost comparable to that of vaginal or abdominal hysterectomies. The routine use of disposable material and automatic disposable staplers for laparoscopic hysterectomies is debatable, as the considerable increase in cost is not accompanied by benefit for the patient or the community. Although laparoscopic hysterectomy is a feasible technique, all hysterectomies should not be performed by this route. If the operation is feasible quickly and under good conditions via the vaginal route, laparoscopic surgery is not indicated. Laparoscopic surgery is only indicated when vaginal surgery is difficult and/or contra-indicated. The elective indications for total laparoscopic hysterectomy are severe adhesions, deep endometriosis and especially a limited vaginal accessibility associated with a narrow vagina and a fixed or non prolapsed uterus. While a average of three quarters of hysterectomies (excluding cases of uterogenital prolapse) are currently performed via a laparotomy, laparoscopic surgery can reduce this rate to approximately 10 to 20 per cent.

Female↗
PubMed1995

[Complete hysterectomy for benign pathology and laparoscopy: respective indications of laparoscopic preparation and an exclusively laparoscopic approach].

According to whether uterine artery treatment takes place vaginally or laparoscopically, laparoscopy for hysterectomy can be considered according to two modalities: laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). The indications for laparoscopy are defined by the limits and/or contraindications of the vaginal route. LAVH is indicated in the following situations: pelvic pain syndrome where diagnosis and treatment can be made at the same time as hysterectomy; minimal endometriosis; past surgical history favouring adhesions formation; necessity to perform an oophorectomy; existence of an ovarian pathology. The elective indications for TLH are the severe pelvic adhesions, deep endometriosis and especially a limited vaginal accessibility associating with a narrow vagina and a fixed or non prolapsed uterus. Laparoscopy thus allows to reduce the number of laparotomies. When on overage three quarters of the hysterectomies (excluding cases of uterogenital prolapse) were up till now performed abdominally, laparoscopy could reduce this rate to approximately 10%.

Elective Surgical Procedures↗