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F Narducci

Publications and source records attributed to F Narducci.

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

The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients.

OBJECTIVE: We describe a new surgical technique (the vaginal plastron) for the treatment of cystocele by the vaginal route. The technique is based on bladder support by a vaginal strip (6-8cm in length and 4cm in width), isolated from the anterior colpocele, left attached to the bladder, associated with a suspension of this strip by its fixation to the tendinous arch of the pelvic fascia by six lateral sutures (three on each side of the plastron). The vaginal plastron is then covered by tucking it under the anterior colporraphy. STUDY DESIGN: We evaluated the short-term functional and anatomical results of the first 47 patients to have undergone this treatment between October 1997 and June 1998. The average age of the patients was 69 years. Cystoceles were associated with urinary stress incontinence in 38.3% of cases, with hysterocele or prolapse of the vaginal dome in 87.2% of cases, with an elytrocele in 19.1% of cases and a rectocele in 70.2% of cases. Of the 45 patients having had a hysterectomy combined with the vaginal plastron or in their past history, 44 (99.77%) had a Richter sacro-spino-fixation and 17 (38%) had a Campbell procedure combined with the vaginal plastron. All patients underwent a posterior perineorraphy with myorraphy of the elevators. RESULTS: Average follow-up was 16.4 months with extremes of 6-26 months and concerned 46 patients (one patient was unavailable). Ninety-three percent of the cystoceles were considered treated. One case of imperfect anatomical outcome was noted (persistence of stage 1 cystocele in one patient) together with two other cases of failure of the treatment of cystocele (relapse to stage 2 cystocele). CONCLUSION: Proposed as a curative treatment of cystocele and combined with the Richter fixation, the plastron provides a surgical solution to the problem of cystocele relapse arising after vaginal treatment of prolapse by sacro-spino-fixation alone (10-20% according to Richter). Short-term results are encouraging, however, medium- to long-term results (36-60 months) are necessary in order confirm the usefulness of this surgical technique.

Female↗
PubMed2001

Anatomic study of arcus tendineus fasciae pelvis.

OBJECTIVE: To describe the anatomy of the arcus tendineus fasciae pelvis. MATERIAL AND METHODS: Two fixed female cadaver pelvises (88 and 66 years old) were dissected. RESULTS: The arcus tendineus fasciae pelvis is a 10-cm-long fibrous thickening of the pelvic fascia which is medial to the obturator internus muscle and lateral to the peritoneum. It is inserted on the ischiatic spine and courses downward and anteriorly to the pubovesical ligament. The posterior third of the arcus tendineus fasciae pelvis is fused with the posterior third of the arcus tendineus musculus levatoris ani, forming a curve with upward and anterior concavity. This portion of the arcus tendineus is thick and easy to recognise upon palpation. It is located 1cm slightly above and anterior to the ischiatic spine and 2 cm from of the pudendal vessels, which course around the posterior inferior margin of the ischiatic spine. The superior margin of the median part of the arcus tendineus fasciae pelvis is crossed laterally by vessels for the obturator internus muscle arising from the internal iliac vessels. CONCLUSION: In genital prolapse cure, sutures must be placed through the anterior or median parts of the arcus tendineus fasciae pelvis. In any case, they must remain anterior to the posterior part of the arcus tendineus fasciae pelvis to avoid injury to the pudendal vessels.

Aged↗
PubMed2001

[Cure of cystocele with vaginal patch].

OBJECTIVE: To describe an original technique for transvaginal cystocele repair and to report the anatomical and functional results of the first 47 patients operated by this technique. The operation combines suspension, by six sutures to the tendinous arches of the pelvic fascia, of a vaginal patch measuring 6 to 8 cm long by about 4 cm wide left in contact with the cystocele. The vaginal patch is then buried under the anterior colporraphy suture. Spinal fixation, hysterectomy, levator myorrhaphy or urinary incontinence repair are also performed as necessary. METHODS: Descriptive retrospective study of 47 patients undergoing transvaginal repair of prolapse between October 1997 and June 1998. All patients presented external prolapse with grade III cystocele, associated with urinary incontinence in 38.3% of cases and hysterocele or vaginal prolapse in 87% of cases. The mean age of the patients was 69 years. The uterus was preserved in two cases, but hysterectomy was performed in the other 45 patients, together with Richter spinal fixation in 44 cases An associated levator myorrhaphy was performed in every case. RESULTS: The mean follow-up was 16.4 months (range: 6 to 26 months) in 46 patients. The cystocele was considered to be cured in 93% of patients, one patient had an asymptomatic grade I cystocele and surgery was unsuccessful in two patients who developed recurrent grade II cystocele. CONCLUSION: The technique presented here is a curative treatment for grade III cystocele in menopaused women associated with Richter spinal fixation, and prevents the risk of cystocele described after transvaginal treatment of prolapse by spinal fixation alone (10 to 20%). The short-term results are encouraging, but they need to be confirmed by a follow-up of at least 5 years.

Aged↗
PubMed2001

[Hysterectomy for benign lesions: what remains for the abdominal route?].

OBJECTIVE: We conducted a prospective study to assess what indications remain for abdominal hysterectomy for benign conditions. PATIENTS AND METHODS: Four hundred fifty-three hysterectomies were performed for benign conditions between April 4, 1996 and December 14, 1998 in our unit. Abdominal hysterectomy was chosen for large uteri, when vaginal access was unusable, or in case of suspected post-operative pelvic adhesions. RESULTS: We performed 330 vaginal hysterectomies (72.85%), 71 laparoscopy-assisted vaginal hysterectomies (15.6%) and 52 abdominal hysterectomies (11.4%). In 10 cases, laparoconversion was required when a vaginal or a laparoscopy-assisted hysterectomy was complicated by pelvic adhesions or poor vaginal access. Mean operative time for abdominal hysterectomy was 130 minutes and mean blood loss was 504 ml. Mean uterus weight was 612 g and mean hospital stay 6.4 days. We had 6 complications (11.53%) (one bladder injury, one ilial injury and four cases of intraoperative hemorrhage). DISCUSSION: Our experience showed that the rate of complications is greater with laparoscopic hysterectomy due to patient selection and should be performed by trained surgeons.

Adnexal Diseases↗
PubMed2001

[Ovarian cyst: surgical indications and access].

Laparoscopic treatment of adnexal masses is indicated when all criteria of a benign lesion are present: transvaginal ultrasound demonstrates a mass < 5 cm, with liquid or dermoid content, with less than 3 fine partitions (< 3 mm), a thin wall (< 3 mm), no vegetations, normal Doppler. Laparoscopy is also indicated for "benign" cysts measuring 5 to 10 cm if laparoscopy is feasible. Peroperative exploration is the rule. Since the benign or malignant nature of an ovarian mass cannot be determined macroscopically, precaution must be taken to avoid potential laparoscopic dissemination: use of an extraction pouch, instrument cleaning, cytotoxic agent (chlorexidine or povidone-iodine) for trocar tracts, prevention of gas leakage, 3-plane suture of trocar orifices measuring > 10 mm, short interval between laparoscopic diagnosis of cancer and onset of chemotherapy or complete surgery (1 week). In case of pre- or peroperatively suspected malignancy, cytology examination of the peritoneal fluid and careful peroperative exploration of the abdomen and pelvis with peritoneal biopsy as needed are required. Simple cystectomy or adnexectomy may be performed, depending on the age of the patient, while waiting for the final pathology report. Peroperative intraperitoneal rupture must be avoided, converting to laparotomy if needed. If several suspicious elements are found, median laparotomy is often recommended, particularly in case of suspected cancer with extra-ovarian involvement, or if there is a risk of peroperative rupture. Peroperative pathology of the adnexectomy specimen and peroperative exploration will depend on the operator's experience and the availability of pathology examination in the operating room. First line laparoscopy allows an analysis of the operability and choice of the most appropriate access.

Biopsy↗
PubMed2000

Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas.

BACKGROUND: A pilot study of a new surgical technique for aortic dissection, combining the advantages of extraperitoneal surgery and minimal invasive surgery, was conducted. METHODS: Fifty-three patients underwent infrarenal aortic and common iliac dissection for the staging of bulky or advanced cervical carcinomas. The indication for extended lymph node staging was bulky early stage in 33 patients, International Federation of Gynecology and Obstetrics distal Stage IIB or higher in 14 patients, nonbulky early stage with microscopic positive pelvic lymph nodes in 1 patient, and central recurrence in 5 patients. The lymph node dissection template included the common iliac lymph nodes, the inframesenteric lymph nodes, and the preaortic and lateroaortic infrarenal lymph nodes. The operation was performed using endoscopic techniques with CO(2) insufflation of the extraperitoneal space. RESULTS: The procedure failed in two patients. Nine patients had lymph node biopsy or selective removal of macroscopically positive lymph nodes. For the 42 remaining patients, the average duration of the operation was 125.9 +/- 31.8 minutes and the average number of lymph nodes was 20.7. Overall, 17 patients had positive lymph nodes, in whom disease was macroscopic in 9 patients and microscopic in 8. Overall, the positivity rate was 32%. Five complications occurred, four of them related to the extraperitoneal dissection technique. An intraoperative complication occurred in one patient, in whom a lateral injury to a fixed and dilated ureter was managed by stenting. A postoperative complication occurred in another patient, in whom a retroperitoneal hematoma causing ileus and compression of the upper ureter was managed conservatively. Two symptomatic lymphocysts occurred; one of them required drainage under ultrasound guidance. All patients but one had external radiation therapy tailored according to the aortic lymph node status. After an average follow-up of 18.9 months, 60% of lymph node positive patients and 15% of lymph node negative patients died. Distant recurrence occurred in 53% of lymph node positive patients and 9% of lymph node negative patients. No patient had recurrence in the aortic or common iliac area. Two patients developed radiation enteritis. CONCLUSIONS: This new technique deserves to be used as a tool to identify lymph node positive patients who require extended-field radiation and/or chemotherapy.

Adult↗
PubMed2000

Positive margins after conization and risk of persistent lesion.

OBJECTIVE: The aim of this study was to investigate a method to reduce the frequency of uterine reoperation with no persistent lesion and to identify factors predictive of persistent or recurrent lesions. MATERIALS AND METHODS: Of 505 conizations performed by the same surgeon, 71 had positive margins (average patient age = 35.7 +/- 7.7 years). The patients underwent either immediate reoperation or monitoring with a Pap smear and colposcopy. RESULTS: Histologic assessment of the cervical cone after conization showed positive margins in 14.1% of cases [endocervical and exocervical margins affected in 50 of 505 (9.9%) and 21 of 505 (4.2%) cases, respectively]. Of 59 of these patients (83.1%) who underwent follow-up monitoring over an average of 35.2 months (range: 2.6-180. 8), 12 patients (average age: 40.8 +/- 6.4 years) underwent immediate hysterectomy and 47 (average age 34.0 +/- 7.4 years) benefited from monitoring first [secondary discovery of 19 persistent lesions within 6 months and 9 recurrences within 18 months on average (range: 8.8-48 months)]. Of the 9 patients with recurrent lesions, 7 underwent reintervention and 2 monitoring. Of the 19 patients with persistent lesions, 18 underwent reintervention and 1 monitoring. Normal histology was observed in 29.4% of patients undergoing secondary reoperation for an abnormal smear compared with 66.7% of patients undergoing immediate reoperation (P = 0.04). Severity of lesion and age of patients could not be used to predict the incidence of a persistent or recurring lesion. Seventy-nine percent of conizations had positive endocervical margins in patients with a recurring or persistent lesion compared with 48% in patients with normal follow-up (P = 0.03). CONCLUSION: Cytology and colposcopy follow-up in cases of positive conization margins may help to establish justification for the choice of reoperation, thereby limiting morbidity following repeated surgery.

Adult↗
PubMed2000

Learning curves for transperitoneal laparoscopic and extraperitoneal endoscopic paraaortic lymphadenectomy.

STUDY OBJECTIVE: To compare learning curves for paraaortic lymphadenectomy by extraperitoneal endoscopic approach with those for transperitoneal laparoscopy. DESIGN: Randomized, long-term study (Canadian Task Force classification I). SETTING: Animal laboratory. SUBJECTS: Sixty-six pigs. INTERVENTION: Laparoscopic and endoscopic paraaortic lymphadenectomy, 33 pigs in each group, performed by two surgeons competent in laparoscopic surgery but without experience in endoscopic paraaortic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: The duration of the procedure, number of lymph nodes removed, and number of residual nodes revealed learning curves that stabilized after the tenth procedure for each surgeon and for each approach. Vascular trauma depended on experience, occurring during the first 10 procedures for each surgeon. Efficacy and operative morbidity were comparable for the two procedures. CONCLUSION: Endoscopic extraperitoneal lymphadenectomy has a steep learning curve similar to that for transperitoneal laparoscopy.

Animals↗
PubMed2000

De novo adhesions with extraperitoneal endosurgical para-aortic lymphadenectomy versus transperitoneal laparoscopic para-aortic lymphadenectomy: a randomized experimental study.

OBJECTIVE: The objective of this study was to compare the risk of adhesion formation and the site of postoperative adhesions after transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy. STUDY DESIGN: A prospective study was conducted on 66 pigs, randomly allocated to 2 groups of 33 animals that underwent transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy. RESULTS: No statistically significant difference was observed between the 2 techniques in terms of operating time, number of lymph nodes removed, and intraoperative and postoperative morbidity. More lymphoceles were observed in the extraperitoneal laparoscopy group (P =.0002). The overall adhesion rates were 76% in the transperitoneal group and 43.33% in the extraperitoneal group (P =.04). The adhesion score specific to the operative site was lower in the extraperitoneal group (P =.0005). A stereolocalization study showed that almost all adhesions after transperitoneal laparoscopy were situated in the para-aortic external irradiation field, whereas adhesions after extraperitoneal laparoscopy were predominantly situated outside this field. CONCLUSION: Extraperitoneal laparoscopy generates significantly fewer adhesions in the para-aortic irradiation field.

Animals↗
PubMed2000

[Endoscopic para-aortic dissection by the extraperitoneal approach: clinical study of 37 patients].

OBJECTIVE: To give the preliminary results of a series of 37 operations for a para-aortic endoscopic curage by the extraperitoneal passage. MATERIAL AND METHODS: Thirty-seven patients, with an average age of 45.8 +/- 12 years, were operated on for cervical cancer, with an average tumor diameter of 4.9 +/- 1 cm. The indications were: the tumor's diameter > or = 4 cm (N = 24), one FIGO stage > or = IIb distal (N = 10), N+ pelvic (N = 3). The irradiation was pelvic (if N-) or abdominopelvic (if N+). RESULTS: The operation lasted 125.3 +/- 36.8 min, and the average number of ganglions removed was 21.2 +/- 10.2. The upper limit of the curage was submesenteric for nine patients and subrenal for 28. The immediate postoperatory complications were: a retroperitoneal hematoma, an acute intestinal occlusion treated by laparotomy, and a ureteral wound on a fixed ganglion, treated by an endoprosthesis. The number of N+ was ten in all, of which three were macroscopic: 0/1 for stage Ib1; 2/12 (16.7%) for Ib2; 4/14 (28.6%) for IIb proximal; 4/10 (40%) for IIb distal or more. There were 6/26 (23.1%) N+ microscopic cases for subrenal curages, versus 1/8 (12.5%) for submesenteric. (Excluding 3 N+ microscopic cases). All were given postoperatory radiotherapy except for one, who had a widened hysterectomy (N-). After an average follow-up of 9.5 +/- 5.9 months, there were two pelvic recurrences and six at a distance (of which four died). We had a lymphocele superinfection at six weeks on the diverticular sigmoiditis. There was an enteritis in a patient who had an abdominal irradiation after a laparotomy for acute occlusion. CONCLUSION: Out of 36 patients having postoperatory radiotherapy, para-aortic extraperitoneal curage diagnosed seven N+ microscopic cases, allowing 26 uniquely pelvic irradiations.

Adult↗
PubMed2000

[Comparison of transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy: randomized experimental study].

OBJECTIVES: The objective of this study was to compare the risk of adhesion formation and the site of postoperative adhesions after transperitoneal versus extraperitoneal laparoscopic paraaortic lymphadenectomy. MATERIAL AND METHOD: A prospective randomized trial was conducted on 66 pigs, submitted to transperitoneal (n = 33) or extraperitoneal (n = 33) laparoscopic paraaortic lymphadenectomy. The efficacy and the intra and postoperative morbidity (adhesion score taking into account the number of adhesions and the surface area involved) of each approach were compared. The site of postoperative adhesions in relation to a simulated external irradiation field was determined by a stereo-localization system (Syslav) on 20 pigs. RESULTS: No statistically significant difference was observed between the two techniques in terms of operating time, number of lymph nodes removed, and intra and postoperative morbidity except for lymphoceles and adhesions. No case of lymphocele was observed in the transperitoneal group versus 13 cases (43.33%) in the extraperitoneal group (P = 0.0002). Final total adhesion score was 76% (n = 22) in the transperitoneal group versus 63.33% (n = 19) in the extraperitoneal group. Adhesion score specific to the operative site was 76% (n = 21) in the transperitoneal group versus 43.33% (n = 13) in the extraperitoneal group (P = 0.04). A statistically significant difference was observed between the two approaches in terms of final total adhesion score (P = 0.008) or adhesion score specific to the operative site (P = 0.0005). The stereolocalization study showed that almost all adhesions were situated in the paraaortic external irradiation field after transperitoneal laparoscopy, while adhesions were predominantly situated outside this field after extraperitoneal laparoscopy. CONCLUSIONS: Extraperitoneal laparoscopy generates significantly fewer adhesions in the paraaortic irradiation field and should have a risk of radiation enteritis less important than transperitoneal laparoscopy.

Animals↗
PubMed2000

[Arcus tendineus fascia pelvis: anatomical study].

OBJECTIVE: To reveal the anatomy of arcus tendineus fascia pelvis. MATERIAL: and methods. 2 fixed female cadaver pelvises (88 and 66 years old) were dissected. RESULTS: The arcus tendineus fascia pelvis is a fibrous recess of the pelvic fascia which is 10 cm long, laterally to the obturator internus muscle and medially to the peritoneum. It reaches the ischial spine lower and anteriorly to the pubo-vesical ligament. The third posterior part of the arcus tendineus of the pelvic fascia is commun with the posterior part of the arcus tendineus of the levator ani. This third posterior part is like a curve concave anteriorly. This curve is thick and easy to recognize by the palpation. This third posterior curve is 1cm in front of the ischial spine and 2cm in front of the pudendal vessel which took place behind the ischial spine. The vessels of the obturator internus muscle originated from the internal iliac vessel and crossed laterally the median part of the arcus tendineus of the pelvic fascia. CONCLUSION: Sutures must be placed through the anterior and median part of the arcus tendineus fascia pelvis, in front of the posterior part of the arcus tendineus fascia pelvis to avoid any injury to the pudendal vessels.

Aged↗
PubMed2000

[Laparoscopic sacral colpopexy: short-term results and complications in 83 patients].

We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with two strips of synthetic mesh. Five patients had previously undergone hysterectomy and 4 others had experienced failure of surgery for prolapse of the uterus. Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All other 77 patients underwent laparoscopic sacropexy using anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was associated in 60 cases, laparoscopic Burch colposuspension in 74 and levator myorraphy using the vaginal approach in 55. Operative time decreased from 292 to 180 minutes as the surgeon gained experience. The main operative complications were one rectal and two bladder injuries. Three patients required reoperations for haematoma or hemorrhage. One patient complained of chronic inflammation of the cervix and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow up was 343 days. Three other patients required reoperation: one for a 3(rd) degree cystocele and two for recurrent stress incontinence. The conclusion of this study is that laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long term assessment is required to confirm the results of this procedure.

Adult↗
PubMed1999

[Abdominal colposacroplexy for the treatment of vaginal vault prolapse with or without urinary stress incontinence].

OBJECTIVE: The aim of this study was to assess the factors of success in abdominal colposacropexy (CSP) procedures. PATIENTS AND METHODS: We performed 271 consecutive CSP between 1986 and 1997 (mean age: 48.8 years +/- 11.1). We reviewed 217 patients (80.1%). Mean duration of follow-up was 5.5 years (1-136 months). We performed: 18 CSP with Goretex mesh, 3 with resorbable mesh and 196 with Mersilene; 179 CSP with posterior colporraphy and 38 without; 208 CSP with culdoplasty (Moschowitz's procedure) and 9 without; 182 CSP with anterior and posterior meshes, 26 with posterior mesh only and 9 with anterior mesh only. RESULTS: 97.7% (212/217) of patients were cured for prolapse. 58% (125/217) had urinary stress incontinence totally cured and 82% (178/217) had urinary stress incontinence improved. Rejected grafts were 16.7% (3/18) with Goretex mesh and 1.1% with Mersilene mesh (p = 0.004). Recurrent prolapses were 1.1% (2/196) with CSP with posterior colporrhaphy and 7.9% (3/38) in CSP without (p = 0.009; OR = 0.14, CI = 0.02-0.86); 4/208 with CSP with culdoplasty and 1/9 with CSP without (p = 0.04; OR = 0.17, CI = 0.02-1.58). Recurrent stress incontinence was observed in 4/9 cases with CSP with anterior mesh only and 28/182 with CSP with anterior and posterior meshes (p = 0.03; OR = 0.34, CI = 0.12-0.97). CONCLUSION: CSP must use anterior and posterior Mersilene mesh. The CSP must be systematically combined with posterior colporraphy and culdoplasty (Moschcowitz's procedure).

Adult↗
PubMed1998

[Maternal and congenital syphilis].

Testing for syphilis during pregnancy reveals a positive serologic status in 0.02% of cases. However, a 66% rate of stillbirths is noted in women who are infected and who have not benefited from any treatment. Routine screening is at present performed during the early stages of pregnancy but a second serologic test during the third trimester is useful in the diagnosis of a late infection especially in drug users or HIV (human immunodeficiency virus) positive patients. Congenital syphilis is diagnosed in utero when a positive maternal serologic status is associated with ultrasound images showing fetal abnormalities; these include hepatosplenomegaly, hyperechogenic bowel, signs of bowel obstruction or fetal hydrops. Maternal syphilis is treated by delayed action penicillin and is indicated even for patients allergic to the antibiotic which in this particular case is delivered after desensitization. First line therapy by intravenous penicillin is indicated when confronted with the following high risk factors of congenital syphilis: an elevated titre of VDRL (venereal disease research laboratory) at the time of diagnosis or delivery, unknown date of the precise onset of the infection, the appearance of a rash or of a chancre during pregnancy, ultrasound fetal abnormalities or late therapy during the third trimester. Treatment of the new-born child will depend on the results of clinical, serologic and X-ray evaluation. Long term follow-up for at least a year is mandatory.

Aftercare↗