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Biomedical subjects

C J Sutton

Publications and source records attributed to C J Sutton.

At least 19 recordsLinked to original sources
PubMed2000

Laparoscopic management of ovarian endometriomas: a critical review of current practice.

Endometriomas are a common cause of gynaecological morbidity, but their aetiology and management remain controversial This review focuses on identifying the evidence from published literature for the laparoscopic management of ovarian endometriomas. A critical appraisal shows that laparoscopic surgery is equivalent to laparotomy. There is no evidence to suggest that one minimal access surgical technique is clearly superior to another. However, this may be related to the inconsistencies in study design. In view of this we describe and justify our own management strategy for dealing with endometriomas.

Endometriosis↗
PubMed1998

Does transcervical resection of the endometrium for menorrhagia really avoid hysterectomy? Life table analysis of a large series.

STUDY OBJECTIVE: To determine long-term success and complication rates of transcervical resection of endometrium (TCRE) for menorrhagia. DESIGN: Retrospective audit of a continuous case series with a minimum of 2 and a maximum of 5 years' follow-up (Canadian Task Force classification II-2). SETTING: District general hospital and tertiary referral center for gynecologic endoscopy. PATIENTS: Three hundred eighty consecutive women with menorrhagia. INTERVENTION: TCRE performed as a day case or with overnight stay between August 1988 and December 1992. MEASUREMENTS AND MAIN RESULTS: Complications occurred in 6.8% of patients, with a perforation rate of 3.2%. Life table analysis showed a cumulative hysterectomy rate of 12.4% at 1 year, reaching a plateau of 27.4% after 4 years. The rate at 5 years was higher for women under age 45 years (35%) than for those 45 and over (14.9%, p <0.01, Mantel's test x(2)). Women whose operation was performed by a senior surgeon had a lower cumulative hysterectomy rate (12.6%) than those whose surgery was performed at least in part by trainees (38%, p <0.01, Mantel's text x(2)). There was no significant difference in cumulative hysterectomy rates between women who had uterine fibroids and those who did not. Ninety-six percent of hysterectomies were performed in the first 3 years after initial TCRE. CONCLUSION: Although TCRE for menorrhagia did not avoid hysterectomy in all women, for those considering hysterectomy, it was a conservative procedure with low morbidity and high chance of avoiding the need for major surgery, especially when performed in women over age 45, by an experienced surgeon.

Adult↗
PubMed1997

Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis.

OBJECTIVE: To assess the longer term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis and to observe the natural history of the disease at second-look laparoscopy in a control group. DESIGN: One-year follow-up of a prospective, randomized, double-blind controlled trial. SETTING: A referral center for the laparoscopic laser treatment of endometriosis. PATIENT(S): Sixty-three patients with pelvic pain and minimal to moderate endometriosis. INTERVENTION(S): After the 6-month follow-up visit, the randomization code was broken, and follow-up was continued to 1 year. Symptomatic patients were offered second-look laser laparoscopy. MAIN OUTCOME MEASURE(S): Continued symptom relief at 1 year after treatment and findings at second-look laparoscopy in symptomatic controls. RESULT(S): Symptom relief continued at 1 year in 90% of those who initially responded. All symptomatic controls had a second-look procedure, with 7 (29%) showing disease progression, 7 (29%) showing disease regression, and 10 (42%) having static disease. CONCLUSION(S): The benefits of laser laparoscopy for painful pelvic endometriosis are continued in the majority of patients at 1 year. Untreated painful endometriosis will progress or remain static in the majority of patients but will spontaneously improve in others.

Adult↗
PubMed1997

Laser laparoscopic surgery in the treatment of ovarian endometriomas.

STUDY OBJECTIVE: To assess the efficacy of laser laparoscopic photocoagulation of endometriomas (2-18 cm) in patients with pain, infertility, or a combination of the two. DESIGN: Retrospective review of all patients with endometriomas from June 1, 1983, to December 31, 1993. SETTING: Department of gynecology and obstetrics at a district general hospital and national training center in minimal access surgery. PATIENTS: One hundred sixty-five women with large endometriomas present at the time of laser laparoscopy. INTERVENTIONS: Carbon dioxide laser or potassium-titanyl-phosphate laser laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Ninety (74%) of 122 patients reported improvement or resolution of pain; and 30 of 66 achieved a pregnancy, for a cumulative conception rate of 45%. CONCLUSION: Laser laparoscopy is a practical, safe, and effective technique for the management of large ovarian endometriomas.

Adult↗
PubMed1995

Advantages of laparoscopic supra-cervical hysterectomy.

The development of minimally invasive hysterectomy in gynaecology is clearly an exciting one, but these procedures need to be validated in prospective studies. If laparoscopic hysterectomy proves to be safe and more effective than abdominal hysterectomy, then it will definitely become established as a validated procedure in gynaecology. There are an increasing number of surgical options for women with menstrual problems-hysterectomy: abdominal, vaginal, laparoscopic, total, supra-cervical, Doderlein, with or without oophorectomy, or endometrial ablation or resection. One particular approach will not be suitable for all women and the choice needs to be individualized according to the particular clinical situation and to some extent patient choice. The true benefits of the supra-cervical approach are yet to be shown, but this may be the way that laparoscopic hysterectomy will develop in the future.

Female↗
PubMed1994

Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis.

OBJECTIVE: To assess the efficacy of laser laparoscopic surgery in the treatment of pain associated with minimal, mild, and moderate endometriosis. DESIGN: A prospective, randomized, double-blind, and controlled clinical study. SETTING: Royal Surrey County Hospital, Guildford, United Kingdom, a referral center for the laser laparoscopic treatment of endometriosis. PATIENTS: Sixty-three patients with pain (dysmenorrhoea, pelvic pain, or dyspareunia) and minimal to moderate endometriosis. INTERVENTIONS: The patients were randomized at the time of laparoscopy to laser ablation of endometriotic deposits and laparoscopic uterine nerve ablation or expectant management. Pain symptoms were recorded subjectively and by visual analogue scale. The women were unaware of the treatment allocated as was the nurse who assessed them at 3 and 6 months after surgery. MAIN OUTCOME MEASURE: Improvement or resolution of pain symptoms assessed subjectively and by visual analogue score. RESULTS: Laser laparoscopy results in statistically significant pain relief compared with expectant management at 6 months after surgery. Sixty-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6% in the expectant group. Results were poorest for minimal disease and, if patients with mild and moderate disease only are included, 73.7% of patients achieved pain relief. There were no operative or laser complications. CONCLUSIONS: Laser laparoscopy is a safe, simple, and effective treatment in alleviating pain symptoms in women with stages I, II, and III endometriosis.

Adolescent↗
PubMed1994

Initial experience with supracervical laparoscopic hysterectomy and removal of the cervical transformation zone.

OBJECTIVE: To assess the feasibility and outcome of laparoscopic supracervical hysterectomy with removal of the cervical transformation zone. DESIGN: A prospective clinical study. SETTING: The department of Gynaecology, Royal Surrey County Hospital, Guildford. SUBJECTS: Eleven consecutive women who were on the waiting list for abdominal hysterectomy and fulfilled the selection criteria. INTERVENTION: Laparoscopic supracervical hysterectomy using a modification of the classical abdominal supracervical hysterectomy technique with removal of the cervical transformation zone. MAIN OUTCOME MEASURES: Operating time, blood loss, duration of hospital stay, time to full recovery and complications. RESULTS: All 11 procedures were successfully completed laparoscopically. The mean operating time was 111 min, and mean blood loss was 185 ml. The mean duration of hospital stay was three days, and the mean time to full recovery was 20 days. There were no major complications. CONCLUSIONS: Laparoscopic supracervical hysterectomy appears to result in a shorter hospital stay and more rapid recovery than total abdominal hysterectomy. This shortened convalescence is of benefit to the patient. The operation appears to be safe when carried out by surgeons experienced in laparoscopic surgery. A randomised comparative study with total abdominal hysterectomy is currently being undertaken.

Adult↗
PubMed1994

Patients with chronic pelvic pain and/or infertility: psychological differences pre- and post-treatment.

This study investigated the psychological differences between gynecological clinic attenders with either pelvic pain or infertility, or with both pelvic pain and infertility both before and after laparoscopic investigation with concurrent treatment. Given the differing meaning attached to the procedure by these groups, it was hypothesized that infertility patients would be more anxious but with less evidence of psychopathology in comparison with the pain group prior to laparoscopic surgery. Postsurgery and in the short term, pain reduction was expected to be associated with decreased pathology for the pain group. Contrary to the hypotheses, pain patients obtained higher anxiety scores in comparison with the infertility group both pretreatment as well as post-treatment. The latter group's scores were comparable to normative data. Other results were generally in line with the hypotheses, pain reduction for both pain groups being associated with a reduction in psychopathology. Patients with pain plus infertility resembled pain patients at pretreatment, while at post-treatment, they bore a closer resemblance to infertility patients in their psychological profile. This was despite the fact that for both pain groups, pain relief was similar. This reinforces the notion that in the patient groups studied anxiety is associated with pain rather than with infertility.

Adaptation, Psychological↗