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Biomedical subjects

C H Nezhat

Publications and source records attributed to C H Nezhat.

At least 37 records · Page 2Linked to original sources
PubMed1995

The incidence of adhesions after prior laparotomy: a laparoscopic appraisal.

OBJECTIVE: To relate the presence of intra-abdominal adhesions after laparotomy to the site of incision, repeat laparotomy, and the clinical indication for prior surgery. METHODS: Three hundred sixty women undergoing operative laparoscopy after a previous laparotomy were assessed for adhesions between the abdominal wall and the underlying omentum and bowel. Complications resulting directly from these adhesions were documented. RESULTS: Patients with prior midline incisions had significantly more adhesions (58 of 102) than those with Pfannenstiel incisions (70 of 258). Patients with midline incisions performed for gynecologic indications had significantly more adhesions (109 of 259) than all types of incisions performed for obstetric indications (12 of 55). The presence of adhesions in patients with previous obstetric surgery was not affected by the type of incision. Adhesions to the bowel were significantly more frequent after midline incisions above the umbilicus. Twenty-one women suffered direct injury to adherent omentum and bowel during the laparoscopic procedure. CONCLUSIONS: Intra-abdominal adhesions between the abdominal scar and underlying viscera are a common consequence of laparotomy. Patients undergoing laparoscopy after a previous laparotomy should be considered at risk for the presence of adhesions between the old scar and the bowel and omentum.

Female↗
PubMed1995

Dysmenorrhea is related to the number of implants in endometriosis patients.

OBJECTIVE: To determine whether the symptoms of endometriosis were related to the number and/or location of endometrial implants and the number and/or location of adhesions. DESIGN: Prospective, double-blind study. PATIENTS: Seventy consecutive female surgical patients undergoing diagnostic and operative laparoscopy for pain, infertility, or both. INTERVENTIONS: Patients completed a self-administered questionnaire one day before laparoscopy. MAIN OUTCOME MEASURES: The number, type, and location of endometrial implants and the number, type, and location of adhesions were evaluated during laparoscopy. These were compared with the type and severity of endometriosis symptoms as reported by patients. RESULTS: The total number of ectopic endometrial implants was associated directly with the intensity of dysmenorrhea experienced by patients in the 60 days before operative laparoscopy (n = 47). Patients with low pain scores had significantly fewer implants than patients with high pain scores. CONCLUSIONS: The intensity of menstrual pain is related to the number of endometrial implants in patients with endometriosis.

Adult↗
PubMed1995

Severe endometriosis and operative laparoscopy.

Laparoscopic surgery offers the most effective form of treatment for women with severe endometriosis. The development of advanced laparoscopic techniques allows complete removal of deeply infiltrating lesions. Implants can be laparoscopically dissected from all anatomical locations, including severe involvement of the ureter, bladder, and colon. When the endometriosis penetrates through the entire depth of the organ wall, complete resection and reanastomosis of the ureter or bowel can be safely performed laparoscopically by the experienced surgeon. However, optimal laparoscopic treatment requires not only surgical skill, but also comprehensive knowledge of pelvic anatomy and a good understanding of endometriosis and its progression.

Endometriosis↗
PubMed1995

Use of hysteroscopy in addition to laparoscopy for evaluating chronic pelvic pain.

This study assessed whether hysteroscopy can provide information concerning the cause of chronic pelvic pain. We prospectively evaluated the findings in 547 consecutive patients who had laparoscopy to evaluate chronic pelvic pain at a large, referral-based clinic and outpatient suite of a suburban hospital. Forty-eight had previous hysterectomies. The remaining 499 had hysteroscopy during the same surgery and met the following qualifications: chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, back pain, pelvic pressure or dyschezia for a duration greater than six months and previous failed medical therapy. When endometriosis was the primary diagnosis at laparoscopy, hysteroscopy revealed abnormalities in 62 (32.5%) of 191 patients. At hysteroscopy, 46 of 105 patients (43.8%) with single or multiple leiomyomas of significant sizes diagnosed laparoscopically were noted to have pathology within the uterine cavity. Ten of 11 patients (90.9%) found to have ovarian cysts underwent hysteroscopy. Four (40%) had uterine abnormalities; the most common was cervical stenosis. Pelvic adhesions were found in 118 patients (21.6%). Eighty-nine underwent hysteroscopy, and 24 (27%) had intrauterine abnormalities. Ninety-six patients (17.5%) who underwent laparoscopic evaluation had endometriosis and pelvic adhesions. Ninety-three of these underwent hysteroscopy, and abnormalities were noted in 26 (28.0%). In eight women (1.5%) no abnormality was found at laparoscopy. Two underwent hysteroscopy, and no abnormality was noted in either woman. Hysteroscopy provides useful, adjunctive information and may improve the diagnosis and treatment of chronic pelvic pain.

Chronic Disease↗
PubMed1995

Complications and results of 361 hysterectomies performed at laparoscopy.

BACKGROUND: Before the appropriate use of laparoscopy in hysterectomy can be determined, it is necessary to evaluate the results, including complications. There must also be an accepted classification system to facilitate accurate comparison to total abdominal hysterectomy. STUDY DESIGN: We retrospectively evaluated the charts of 361 women who underwent hysterectomy for various benign pathologic conditions. Intraoperative and postoperative complication rates for hysterectomy performed at operative laparoscopy were examined. The hysterectomies were classified as one of four types according to the number of steps performed laparoscopically. All women were candidates for total abdominal hysterectomy, but not vaginal hysterectomy. RESULTS: The overall complication rate for hysterectomy performed at operative laparoscopy was 11.1 percent. Most complications were minor, including cystitis (1.66 percent), transient high fever (1.39 percent), abdominal wall ecchymosis (1.12 percent), and pneumonia and bronchitis (1.12 percent). There was no correlation between the type of laparoscopic hysterectomy performed and the complication rate. CONCLUSIONS: Our rate of intraoperative and postoperative complications associated with laparoscopic hysterectomy compares favorably with published complication rates for vaginal and abdominal hysterectomy.

Abdominal Muscles↗
PubMed1994

Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis.

We used a new laparoscopic technique to treat infiltrative symptomatic intestinal endometriosis. Eight women, ages 29-38, with extensive symptomatic pelvic endometriosis were included in this series. All were diagnosed as having severe pelvic endometriosis and had not responded to previous conservative surgical and hormonal therapy. In a 5-18-month postoperative followup, six women have reported complete relief of the symptoms. Two have right lower quadrant pain and menstrual cramping. Second-look laparoscopy was offered to all patients and so far, two have accepted. These procedures were performed 6 weeks postoperatively. At that surgery, we found that the anastomotic site had healed completely with filmy adhesions between the posterior aspect of the uterus and the rectosigmoid colon in one patient. The second woman had undergone extensive adhesiolysis at the first surgery, and these adhesions recurred; however, the anastomotic site had healed completely. One of the two infertility patients has achieved pregnancy. The only complications was one patient with ecchymosis of the anterior abdominal wall. Sigmoidoscopy was performed 6 weeks postoperatively, and has been or will be performed at 6 months postoperatively. To date, all anastomotic sites have healed well with no sign of stricture. Our results with this technique in a small series were positive, and it appears that, in the hands of experienced laparoscopists, it may prove useful in treating symptomatic infiltrative endometriosis.

Adult↗
PubMed1994

Videolaseroscopy and videolaparoscopy.

Laparoscopic surgery is not a new idea, but it has only recently found widespread acceptance. The introduction of technological advances such as improved light sources, lasers and video capability has made laparoscopy a surgical technique that offers many advantages to the patient and the surgeon. Because videolaseroscopy must be performed using a completely different set of skills, the only limit to the expansion of this type of surgery is training enough surgeons to meet the growing demands of the public. We believe that videolaseroscopy will become a larger part of the surgical operations performed in the future as technology becomes available to improve upon the instruments and methods.

Female↗
PubMed1994

Laparoscopic retropubic cystourethropexy.

STUDY OBJECTIVE: To evaluate the efficacy of laparoscopic retropubic urethrovesical suspension. DESIGN: Retrospective review of charts of 62 women over a follow-up period ranging from 8 to 30 months. SETTING: A suburban hospital in a major metropolitan area. PATIENTS: Sixty-two women, age 34 to 69 years, gravidity 0 to 8, and parity 0 to 7, with gynecologic abnormalities requiring surgical intervention and with pure genuine urinary stress incontinence. INTERVENTIONS: Each patient underwent a Burch or Marshall-Marchetti-Krantz procedure, modified to be performed at laparoscopy. MEASUREMENTS AND MAIN RESULTS: Success was measured subjectively and objectively. Subjective success, determined by the lack of need to wear pads, was 100%. Objective success was assessed using several criteria: comparison of preoperative and postoperative symptom diaries; questionnaires; urine characteristics by straight catheter (office dipstick for nitrate, leukocyte estrace, bacteria, and white cell blood count, if suspicious urine culture and sensitivity); postvoid residual volume (<100 ml was considered complete); urethrovesical junction angle as determined by catheter or Q-Tip placement (upward, downward, or straight); bladder support; and negative standing stress test. All women reported satisfactory relief of symptoms, with subjective and objective improvement. None have noted urinary leakage during activities similar to those preoperatively associated with this condition. CONCLUSION: To date, the outcomes have been acceptable, although the limited numbers and relatively short follow-up prohibit any definitive conclusions.

Adult↗
PubMed1994

Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy.

Vasopressin may be associated with systemic hemodynamic changes, including severe myocardial ischemia, even in healthy patients. A 36-year-old woman underwent laparoscopy for the treatment of a uterine leiomyoma. After intravascular injection of vasopressin, she experienced life-threatening hypotension, and the procedure was subsequently aborted. After she recovered, she underwent successful laparoscopy without the use of vasopressin, and no complications occurred. As endogenous vasopressin levels sometimes rise during laparoscopy, patients may become susceptible to the drug's effects, and appropriate precautions must be taken.

Adult↗
PubMed1994

Laparoscopic repair of a vesicovaginal fistula: a case report.

BACKGROUND: Operative laparoscopy was performed for the management of ovarian remnant syndrome involving the bladder, bowel, vagina, and ureters, and requiring extensive dissection. A vesicovaginal fistula developed postoperatively. CASE: Because of the complexity and location of the fistula, a vaginal approach was not appropriate. Using techniques of videolaparoscopy, videocystoscopy, and operative laparoscopy, the fistula was repaired. CONCLUSION: In experienced hands, endoscopic management of complex vesicovaginal fistulas may be an alternative to the traditional abdominal approach.

Female↗
PubMed1994

Hospital cost comparison between abdominal, vaginal, and laparoscopy-assisted vaginal hysterectomies.

OBJECTIVE: To evaluate and compare the hospital charges for total abdominal hysterectomy (TAH), vaginal hysterectomy, and laparoscopy-assisted vaginal hysterectomy performed with the linear stapler. METHODS: Thirty cases of each of the three types of hysterectomies, performed at the same hospital by various surgeons, were selected at random. The authors did not participate in any of the cases evaluated. Operating room, postoperative hospitalization, and pharmacy costs were compared. Independent, two-tailed Student t test analysis was performed. RESULTS: The mean cost of performing laparoscopy-assisted vaginal hysterectomy with the linear stapler ($7161.66) was significantly higher (P < .05) than that of both vaginal hysterectomy ($4868.06) and TAH ($4926.80). The cost of vaginal hysterectomy was nonsignificantly lower (P > .05) than that of TAH. The mean operating room supplies and equipment charge for laparoscopy-assisted vaginal hysterectomy with the linear stapler ($2468.43) was, as expected, significantly higher (P < .05) than those for both abdominal ($716.65) and vaginal ($676.16) procedures. The average operating room time charge for laparoscopy-assisted vaginal hysterectomy ($1264.56) was also significantly higher (P < .05) than for the other two procedures (TAH $642.76, vaginal hysterectomy $955.66). The mean total pharmacy charges were similar for all groups ($1114.27 for laparoscopy-assisted vaginal hysterectomy, $1163.16 for vaginal hysterectomy, and $1098.71 for TAH). Reflecting the longer operating time for laparoscopy-assisted vaginal hysterectomy, the intraoperative pharmacy costs were significantly higher for this type ($417.00) than for the TAH patients ($290.62). The difference, however, was almost erased when postoperative pharmacy charges were included, reflecting the lower cost of a shorter hospital stay in the laparoscopy-assisted vaginal hysterectomy group. Some savings were realized by laparoscopy-assisted vaginal hysterectomy when postoperative hospitalization charges were considered. The average hospitalization time was 2.3 days for laparoscopy-assisted vaginal hysterectomy, 3.0 days for vaginal hysterectomy, and 3.3 for TAH. CONCLUSIONS: The cost savings expected with the advent of laparoscopy-assisted vaginal hysterectomy when performed with the linear stapler have not been realized at present. In most cost categories studied, the use of laparoscopy to perform a hysterectomy was associated with much higher costs. The predicted savings associated with the shorter hospital stay in these patients failed to offset the exorbitant intraoperative costs. However, when bipolar electrocoagulation with the CO2 laser and reusable instruments replace staplers and disposables, respectively, the projected savings are appreciated.

Abdomen↗
PubMed1994

Laparoscopic amputation of a noncommunicating rudimentary horn after a hysteroscopic diagnosis: a case study.

This report describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. This condition was diagnosed by simultaneous laparoscopic and hysteroscopic examinations. The hysteroscopic evaluation was significant in the diagnosis, as the noncommunicating horn was not recognized during a previous laparoscopy. The laparoscopic removal of the horn afforded complete long-term resolution of pain coupled with speedy postoperative recovery.

Adult↗
PubMed1993

Laparoscopic radical hysterectomy and laparoscopically assisted vaginal radical hysterectomy with pelvic and paraaortic node dissection.

Nineteen women underwent laparoscopic radical hysterectomy or laparoscopically assisted vaginal radical hysterectomy, with pelvic node dissection and paraaortic node dissection when indicated. One procedure was converted to laparotomy due to equipment failure (at The University of Puerto Rico). There were two minor postoperative complications. The first, febrile morbidity resulting from a urinary tract infection, responded to medical therapy. The second was incisional bleeding, which was controlled with sutures applied using a local anesthetic. No major postoperative complications were noted, there have been no incidents of recurrence, and the follow-up results are encouraging.

Adult↗
PubMed1993

Adhesion formation after endoscopic posterior colpotomy.

Twenty-two women who had undergone laparoscopic posterior colpotomy at initial operative laparoscopy and later underwent a second laparoscopic procedure were evaluated for adhesion formation. Fifteen women (68%) had myomata removed, 3 (14%) had a dermoid cystectomy, 1 (5%) had a serous cystadenoma removed, and 3 (14%) who had large endometriomata and severe adhesions underwent salpingo-oophorectomy. Although filmy adhesions were noted in nine women, no adhesions were noted in the cul-de-sac. Based on our limited results, it does not appear that tissue removal via laparoscopic colpotomy predisposes reproductive-age women to postoperative adnexal adhesion formation.

Adnexal Diseases↗
PubMedDate not supplied

The role of laparoscopy in the management of gynecologic malignancy.

With the advent of minimally invasive laparoscopic techniques, most gynecologic procedures for benign conditions can be performed in an outpatient setting. However, the role of such techniques in gynecologic oncology is not well defined. By reviewing the literature and presenting some new data, we attempt to elucidate the applications of operative videolaparoscopy in gynecologic oncology. Advanced laparoscopic techniques are utilized for the management of cervical cancer as well as the staging and treatment of endometrial and ovarian cancers. Such techniques are used in performing radical hysterectomy for early stage cervical cancer, pelvic and paraaortic lymphadenectomy, and second look laparoscopy following chemotherapy for ovarian cancer. Even though preliminary data are encouraging, large prospective controlled studies with long-term follow-up are necessary to better define the role and limitations of laparoscopy in the treatment of gynecologic malignancies.

Female↗
PubMedDate not supplied

Laparoscopic management of ovarian dermoid cysts: ten years' experience.

OBJECTIVE: To determine the safety and efficacy of laparoscopic management of ovarian dermoid cysts based upon our ten years' experience. METHODS: Charts of 81 patients who underwent laparoscopic removal of dermoid cysts since March 1988 at Stanford University Medical Center or the Center for Special Pelvic Surgery in Atlanta were reviewed retrospectively. RESULTS: Ninety-three dermoid cysts with a mean diameter of 4.5 cm were removed in 81 patients. Operative techniques used were cystectomy for 70 cysts, salpingooophorectomy for 14, and 9 salpingo-oophorectomy with hysterectomy. Fifty-three cysts were treated via enucleation followed by cystectomy or salpingo-oophorectomy and removal through a trocar sleeve. Twenty-two were treated via enucleation and removal within an impermeable sack. Nine were treated via enucleation and removal by posterior colpotomy. Nine were removed via colpotomy following hysterectomy. We had a total of 39 spillages. Spillage rates varied with removal method: 32 (62%) for trocar removal without an endobag, 3 (13.6%) for removal within an endobag, and 4 (40%) with colpotomy removal. No spillage occurred for the nine patients who had a colpotomy done for hysterectomy. Mean hospital stay after surgery was 0.98 days, and there were no intraoperative complications. In one case, there was a postoperative complication of an incisional infection in the umbilicus. CONCLUSION: Including this and 13 other studies, review of the literature reveals a 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. Thus, we conclude that laparoscopic management of dermoid cysts is a safe and beneficial method in selected patients when performed by an experienced laparoscopic surgeon.

Adolescent↗
PubMedDate not supplied

Laparoscopic adhesiolysis and relief of chronic pelvic pain.

OBJECTIVE: To evaluate the short- and long-term results of laparoscopic enterolysis in patients with chronic pelvic pain following hysterectomy. METHODS: Forty-eight patients were evaluated at time intervals from 2 weeks to 5 years after laparoscopic enterolysis. Patients were asked to rate postoperative relief of their pelvic pain as complete/near complete relief (80-100% pain relief), significant relief (50-80% pain relief), or less than 50% or no pain relief. RESULTS: We found that after 2 to 8 weeks, 39% of patients reported complete/near complete pain relief, 33% reported significant pain relief, and 28% reported less than 50% or no pain relief. Six months to one year postlaparoscopy, 49% of patients reported complete/near complete pain relief, 15% reported significant pain relief, and 36% reported less than 50% or no pain relief. Two to five years after laparoscopic enterolysis, 37% of patients reported complete/near complete pain relief, 30% reported significant pain relief, and 33% reported less than 50% or no pain relief. Some patients required between 1 and 3 subsequent laparoscopic adhesiolysis. A total of 3 enterotomies and 2 cystotomies occurred, all of which were repaired laparoscopically. CONCLUSION: We conclude that laparoscopic enterolysis may offer significant long-term relief of chronic pelvic pain in some patients.

Adult↗