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Biomedical subjects

H Manhes

Publications and source records attributed to H Manhes.

At least 19 recordsLinked to original sources
PubMed1992

Results of conservative laparoscopic treatment of isthmic ectopic pregnancies: a 26 case study.

Twenty-six ectopic pregnancies located strictly within the isthmus were treated surgically using conservative laparoscopic techniques. In each and every case, the Triton monopolar electrode was used to perform salpingostomy which was followed by aspiration of the trophoblast. This therapeutic approach is very reliable since only one failure was observed (3.9%), requiring a further operation during which salpingectomy was carried out by laparoscopy. It was possible to evaluate subsequent fertility for 11 patients, seven of whom (63.6%) obtained an intrauterine pregnancy and only one patient (9.1%) had a recurrence. This highly satisfactory prognosis is perfectly comparable with that obtained with treatment via laparotomy with segmental resection of the isthmic portion of the tube and immediate or delayed anastomosis. These very encouraging results mean that conservative laparoscopic treatment presents an advantageous alternative to classic surgical treatment for isthmic ectopic pregnancies, in that the patients are spared a laparotomy.

Female↗
PubMed1992

Fertility following laparoscopic management of benign adnexal cysts.

Fertility following laparoscopic treatment of benign adnexal cysts without ovarian suture was studied retrospectively. Patients with endometriomas or who were previously infertile were excluded. Thirty-eight patients treated conservatively were included, 10 after partial resection of functional cysts, 23 after an ovarian cystectomy and six after treatment of a paraovarian cyst. One patient had two cysts. The overall intrauterine pregnancy rate was 92%; one patient had an ectopic pregnancy (2.6%). From these results, we conclude that fertility following laparoscopic treatment of adnexal cysts appears to be normal. Technical guidelines to improve laparoscopic cystectomy are proposed.

Adnexal Diseases↗
PubMed1992

[Recurrence after conservative celioscopic treatment of a first ectopic pregnancy].

Conservative laparoscopic treatment by salpingotomy was performed on 192 patients who presented with a first ectopic pregnancy (EP). The overall fertility results show that 139 patients (72.4%) obtained an Intra Uterine Pregnancy (IUP), whereas only 18 patients (9.4%) suffered a recurrence. The risk of ipsilateral recurrence is 66.7% (12 cases). For the 14 patients presented with two patent tubes after conservative laparoscopic treatment of a first EP, the ipsilateral recurrence rate is 57.1% (8 cases). The side of the recurrence is directly influenced by the patient's previous history. While 88.9% (8 cases) of recurrence are ipsilateral for patients presenting previous tubal history, this rate is only 44.4% (4 cases) when tubal factors are absent (p less than 0.05). This prompts us to recommend laparoscopic salpingectomy for patients with a serious past tubal history. In these patients recurrence is ipsilateral in more than three out of four cases. On the other hand, for patients with no or few tubal factors the treatment has to be conservative.

Evaluation Studies as Topic↗
PubMed1991

[Ectopic pregnancy. Techniques and results of celioscopic treatment].

As in laparotomy the laparoscopic treatment of ectopic (EP) can be either conservative or radical. After conservative laparoscopic treatment, the risk of failure is comparable to what has been observed after the same treatment by laparotomy and the post-EP fertility results are better than those observed after treatment by laparotomy. These results, associated with the advantages of endoscopy over laparotomy, enable us to say that the laparoscopic treatment is nowdays the best surgical treatment of EP. The post-EP fertility is determined by previous patient's history, whereas the characteristics of the EP do not affect or only slightly affect fertility. A multifactorial analysis enabled us to quantify the pejorative impact on fertility of each of the factors which significantly affect the fertility results. We thus propose a therapeutic scoring system of EP designed to choose the treatment which will better preserve the fertility of the patients who wish to become pregnant.

Female↗
PubMed1991

Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients.

OBJECTIVES: To lay down the criteria to clearly define whether conservative or radical laparoscopic treatment should be adopted in cases of ectopic pregnancies (EP). DESIGN: Retrospective, noncomparative. SETTING: At the University Hospital of Clermont Ferrand and the La Pergola Clinic at Vichy from July 1974 to December 1987. PATIENTS: This study was carried out in 223 patients who had been treated laparoscopically for EP and who desired future childbearing and who were not lost to follow-up. MAIN OUTCOME MEASURES: The measures chosen to achieve the objective included age, parity, size of hematosalpinx, volume of hemoperitoneum, tubal rupture, location, intrauterine device, ipsilateral and contralateral adhesions, and patient's previous history of salpingitis, EP, solitary tube, and tubal infertility. RESULTS: The general intrauterine pregnancy rate was 67% (149 patients) and the recurrence rate 12% (27 patients). The results according to the studied factors demonstrated that age, parity, and the type of the EP have no influence on the postectopic fertility. The history of the patient, ipsilateral adhesions, or contralateral tubal status significantly reduce the future fertility prognosis and risk of recurrence. CONCLUSIONS: From a multivariable analysis, the authors propose a scoring system to choose the most suitable treatment to preserve fertility and to reduce the risk of recurrence ranging from laparoscopic conservative treatment to laparoscopic salpingectomy with contralateral sterilization.

Abdomen↗
PubMed1991

Laparoscopic distal tuboplasty: report of 87 cases and a 4-year experience.

OBJECTIVE: To evaluate fertility results after laparoscopic distal tuboplasty and to compare these results with those obtained previously with microsurgery. DESIGN: Retrospective, nonrandomized. SETTING: Department of Obstetrics and Gynecology at the University Hospital of Clermont-Ferrand, France. PATIENTS: All the distal tuboplasties performed between October 1985 and June 1989 were included. Adnexal damage was assessed using tubal and adhesions scoring systems described previously. Tuboplasty was carried out bilaterally except when one tube was absent or severely damaged (tubal stage III or IV and/or with severe adhesions). Patients with bilateral severe adnexal damages were treated only if they refused to undergo in vitro fertilization. Laparoscopic tuboplasty was performed either with the CO2 laser or with conventional instruments. MAIN OUTCOME MEASURE: Fertility after laparoscopic treatment was evaluated using simple and cumulative pregnancy rates (PRs) according to the adnexal damage and compared with the microsurgical results using PRs according to the adnexal damage. RESULTS: The overall intrauterine and extrauterine PRs were 33.3% and 6.9%, respectively. Twenty-six of the 29 intrauterine pregnancies were obtained within the 1st postoperative year. According to tubal and adhesion stages, the results of laparoscopic distal tuboplasty are similar to those obtained using microsurgery. CONCLUSION: We conclude that laparoscopic distal tuboplasty, when performed by experienced surgical laparoscopists, represents an effective alternative to microsurgery.

Adult↗
PubMed1991

Subsequent fertility for patients presenting with an ectopic pregnancy and having an intra-uterine device in situ.

Of 503 ectopic pregnancies (EP) dealt with surgically using conservative laparoscopic techniques, 153 (30.4%) occurred in patients with an intra-uterine device (IUD) in situ. Examination of the characteristics of the EP revealed that the fimbrial location was more frequent among patients with an IUD whereas a significantly higher proportion were located in the isthmus in the group of patients without an IUD. Whereas the condition of the tubal wall did not differ according to the presence or absence of an IUD, adhesions and obstructed or non-existent contralateral tubes were significantly less frequent among patients with an IUD in situ. Two hundred and twenty three patients desired pregnancy, 30 of whom had an IUD in situ when the EP was diagnosed. The subsequent fertility for these 30 patients with an IUD was shown by rates for intrauterine pregnancy (IUP), recurrent EP and infertility of 96.7, 3.3 and 0% respectively. These results were significantly better than those for women who had no IUD, the figures for this group being 59, 13.4 and 27.4%, respectively. The favourable prognosis was due solely to the fact that women with an IUD had far fewer negative antecedents and that the EP probably occurred due to impaired ciliary action which is reversible when the IUD is removed.

Adult↗
PubMed1991

[Contribution of celioscopy in the early diagnosis of ovarian cancers].

Four hundred and eighty-one patients with an ovarian cyst considered to be benign on the basis of clinical and ultrasonographic findings underwent diagnostic laparoscopy. All malignant tumours (9 cases) were recognized by diagnostic laparoscopy and were treated immediately via laparotomy. When a cyst was identified as being benign on laparoscopy, the diagnosis was always confirmed by histological examination. Sixty one patients (64 cysts) were treated via laparotomy immediately after laparoscopy for the following reasons: malignant or suspicious lesions (19 cases) dense adhesions or anatomical conditions making laparoscopic surgery difficult (42 cases). 420 patients (444 cysts) were treated by laparoscopic surgery with either intraperitoneal cystectomy or transparietal cystectomy. The postoperative course following laparoscopic surgery for annexal cysts was uneventful in 417 cases (3 patients developed a complication).

Cysts↗
PubMed1991

[Conservative celioscopic treatment of isthmic ectopic pregnancies].

Twenty-six ectopic pregnancies located strictly within the isthmus were treated surgically using conservative laparoscopic techniques. In each and every case the Triton's monopolar electrode was used to perform salpingostomy which was followed by the aspiration of the trophoblast. This therapeutic approach is very reliable since only one failure was observed (3.9%), requiring a further operation during which salpingectomy was carried out by laparoscopy. It was possible to evaluate subsequent fertility for 11 patients. 7 of whom (63.6%) obtained an intra-uterine pregnancy and only one patient (9.1%) had a recurrence. This highly satisfactory prognosis is perfectly comparable with that obtained with treatment via laparotomy with segmental resection of the isthmic portion of the tube and immediate or delayed anastomosis. These very encouraging results mean that laparoscopic treatment presents a very advantageous alternative to classic surgical treatment for isthmic ectopic pregnancies, in that the patients are spared a laparotomy.

Adult↗
PubMed1991

[Ectopic pregnancies with intrauterine devices. Characteristics and subsequent fertility].

Out of the 503 ectopic pregnancies (EP) dealt with surgically using conservative laparoscopic techniques, 153 (30.42%) occurred in patients with an intrauterine device (IUD) in situ. Examination of the characteristics of the EP reveals that there is a significantly higher proportion located in the isthmus in the group of patients without an IUD, whereas the fimbrial location is more frequent among patients with an IUD. Whereas tube wall condition does not differ according to the presence or absence of an IUD, adhesions and obstructed or not existent contralateral tubes are significantly less frequent among patients with an IUD in situ. 223 patients desired pregnancy, 30 of which had an IUD in situ when the EP was diagnosed. The subsequent fertility for these 30 patients with an IUD resulted in rates for intrauterine pregnancy (IUP), recurrent EP an infertility of 96.7%, 3.3%, and 0% respectively. These results are significantly better than those for women who had no IUD, the figures for their group being 59%, 13.4%, and 27.4% respectively. The favorable prognosis is due solely to the fact that women with an IUD have far less negative antecedents and that the EP probably occurred due to impaired ciliary action, reversible when the IUD is removed.

Female↗
PubMed1990

Laparoscopic management of unicornuate uterus with rudimentary horn and unilateral extensive endometriosis: case report.

One case of unicornuate uterus with a cavitary rudimentary horn and unilateral extensive endometriosis was treated by laparoscopy, after three months of treatment with GnRH analogues. The rudimentary horn and the corresponding tube were removed. The post-operative course was uneventful. Laparoscopic radical management of this malformation reduces both peritoneal damage and economic cost.

Adult↗
PubMed1990

[CO2 laser in operative laparoscopy. Techniques. Indications. Results].

The authors share their experience in the use of the CO2 laser, over 10 years. Three main indications for the CO2 laser in operative laparoscopy are examined: adhesiolysis, neosalpingostomy and endometriosis. The CO2 laser presents a number of advantages for each of these indications. For adhesiolysis it is possible to eliminate type C adhesions without any major damage to the peritoneum, and to remove adhesions on the surface of the ovary by vaporization. For neostomy, the tube can be sectioned without any bleeding, and the surgeon can work both quickly and accurately. Finally, for endometriosis the CO2 laser proves an ideal tool, being suitable for treating all aspects of this pathology. Thus, the CO2 laser is particularly well-suited for use in operative laparoscopy as it enables results to be obtained comparable to those of traditional surgical techniques, avoiding laparotomy for the patient.

Endometriosis↗