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Biomedical subjects

J B Dubuisson

Publications and source records attributed to J B Dubuisson.

At least 19 recordsLinked to original sources
PubMed1992

Transcervical tubal cannulation and falloposcopy for the management of tubal pregnancy.

This is the first report of transcervical salpingoscopic visualization of tubal pregnancy in two patients. The falloposcope was introduced through a catheter used routinely for transcervical tubal cannulation, guided by tactile impression. We have previously demonstrated that it is possible to diagnose and treat tubal pregnancies via a transcervical intra-Fallopian cannula. Falloposcopy could help select appropriate patients for transcervical intra-Fallopian therapy by verifying the site of implantation and the characteristics of the ectopic pregnancy.

Adult↗
PubMed1992

[Complications of gynecologic laparoscopy. Multicentric study of 7,604 laparoscopies].

In a series of 7,604 laparoscopic procedures, the authors report one death and a rate of 2.76 per thousand (21 cases) for complications requiring laparotomy. When exclusively diagnostic laparoscopic procedures are considered (1,191 cases) this rate drops to 1.67 per thousand. The likelihood of laparotomy being required is directly related to the degree of importance of the laparoscopic surgical procedure. For major laparoscopic surgery the rate of laparotomy is 4.46 per thousand (18 cases), whereas it is only 0.42 per thousand (1 case) for minor laparoscopic surgery (p less than 0.01). Intestinal injuries represent 52.4% (11 out of 21) of cases requiring laparotomy. The main problem with this type of accident is to recognize them, because in almost half the cases (42.8%; 3 out of 7) the intestinal injury went unseen during the laparoscopic procedure and gave rise to peritonitis. Vascular complications are less frequent and required laparotomy in only 8 cases (38%; 8 out of 21). This low level of complications is yet further proof that laparoscopic surgery is a reliable technique and does not involve a high risk of laparotomy, provided that the surgeon has received specific training.

Female↗
PubMed1992

Role of gonadotrophin-releasing hormone agonists in the treatment of external genital endometriosis: review of 77 cases.

Peritoneal and ovarian endometriosis are anatomically highly polymorphous and can give rise to pain and sterility. Endometriosis can be recognized and evaluated by means of laparoscopy and an appropriate therapeutic strategy determined. Surgical laparoscopy using lasers (CO2, KTP and argon) produces excellent results. More than 80% of cases can be treated by coelioscopy, bearing in mind that severe endometriosis can require classic surgery and remains difficult to perform. However, one basic idea should not be forgotten, ie, that endometriosis is a progressive disease. Restoration of anatomic pelvic integrity (with free pouch of Douglas, mobility of appendages and functional ovaries) is the only guarantee of good fertility, achievable by interruption of progression of the disease. Following therapeutic trials with danazol, norsteroidal progestagens, gonadotrophin-releasing hormone agonists have opened up wide perspectives for use and we use them in combination with coeliac surgery. Our experience has paralleled that of Donnez and Bruhat, with almost identical results.

Combined Modality Therapy↗
PubMed1992

Gonadotrophin-releasing hormone agonist and laparoscopic myomectomy.

The indications for operative laparoscopy have expanded greatly over the past decades, as its many advantages over laparotomy have been recognized. We report our techniques and short-term results concerning myomectomy by laparoscopy. From January 1, 1990 to October 1, 1991, 147 intraperitoneal myomectomies were performed in 70 patients: 46 of 70 were treated preoperatively with a depot gonadotrophin-releasing hormone agonist. No complications were observed. In selected cases, with the advantages of laparoscopic surgery, laparoscopic myomectomy appears to be a safe technique.

Anti-Bacterial Agents↗
PubMed1991

[Tuboperitoneal sterility. Indications, operative techniques and results of adhesiolysis and distal tuboplasties].

Major advances in the field of laparoscopic surgery have made it possible to perform most of the adnexal repair procedures by this route. The most common operation is adhesiolysis, i.e. the excision, usually with scissors, of peritubal and ovarian adhesions. This is a rapid, simple and non-traumatic technique. In salpingostomy, the hydrosalpinx is opened at its terminal end and the gauntlet cuff eversion of the newly created infundibulum is maintained by means of defocalized CO2 laser shots or electrocoagulation. The results of laparoscopic adhesiolysis and salpingostomy are very similar to those obtained with the conventional laparotomy and microsurgery techniques. These results, plus the advantages of laparoscopy (comfort of the patient, shorter stay in hospital, absence of scars), explain why operative laparoscopy is increasingly used in the treatment of operable adhesions and distal tubal lesions. In severe lesion, there is no alternative to in vitro fertilization.

Fallopian Tube Diseases↗
PubMed1991

Risk factors for ectopic pregnancy in 556 pregnancies after in vitro fertilization: implications for preventive management.

OBJECTIVE: To analyze risk factors for ectopic pregnancy (EP) after in vitro fertilization (IVF). DESIGN: A retrospective study of IVF pregnancies was performed between November 1983 and December 1989. SETTING: This study was conducted in a tertiary care center, the Port-Royal University Hospital. PATIENTS: Patients' records were reviewed for 48 EP and 508 intrauterine pregnancies obtained by IVF. INTERVENTIONS: Forty-six salpingectomies were performed for EP after IVF. MAIN OUTCOME MEASURE: We evaluated the impact on the ectopic rate of tubal status, the type of ovarian stimulation and luteal phase support, and the number of embryos transferred. RESULTS: Forty-three of 48 EP occurred in patients with tubal infertility. The rate of EP was significantly higher when the indication was tubal (11.1%) than when it was endometriosis (2.1%) or unexplained infertility (3.4%). Pathological findings revealed tubal lesions in all 46 salpingectomies. CONCLUSIONS: Ectopic pregnancy after IVF appears related to pre-existing tubal pathology. However, routine prophylactic salpingectomy to prevent the risk of EP does not appear justified.

Adult↗
PubMed1991

Myomectomy by laparoscopy: a preliminary report of 43 cases.

OBJECTIVE: To evaluate the technique and short-term results of intraperitoneal (IP) myomectomies. DESIGN: From January 1, 1990, to March 1, 1991, IP myomectomies were performed in all cases in which it appeared feasible. SETTING: This study was conducted in a tertiary care center, the Port-Royal University Hospital. PATIENTS, PARTICIPANTS: Among 49 consecutive patients with interstitial or subserous myomas, 6 patients with voluminous, multiple myomas had laparotomies. Intraperitoneal myomectomy was performed in 43 patients. The indication for laparoscopy was a pelvic mass in 29 cases, infertility in 13, and severe endometriosis in 1 case. INTERVENTIONS: Thermocoagulation or monopolar coagulation was used for the uterine incision. Myometrium and serosa were sutured in 23 of 43 patients. Myomas were removed through the suprapubic puncture site after fragmentation of large myomas. MAIN OUTCOME MEASURE(S): We evaluated the length of the procedures, blood loss, and postoperative course. RESULTS: Ninety-two myomas were removed laparoscopically. No complication was observed. CONCLUSIONS: In selected cases, IP myomectomy appears to be a safe technique with the advantages of laparoscopic surgery.

Adult↗
PubMed1990

[Surgical treatment of endometriosis].

The surgical treatment of endometriosis, which used to be performed by laparotomy, is now in most cases performed by coelioscopy. The purpose of surgery is to destroy or remove as much as possible of the endometriotic lesions and to treat their sequelae, usually adhesions. In the majority of patients, the coelioscopic treatment can be carried out at the same as the initial diagnostic coelioscopy, the stay in hospital not exceeding 48 hours. The pregnancy rate obtained is similar to that reported with laparotomy, but the operator must have a long experience of operative coelioscopy.

Endometriosis↗
PubMed1990

Reproductive outcome after laparoscopic salpingectomy for tubal pregnancy.

Since 1983, we have performed laparoscopic salpingectomy as a routine procedure for ectopic pregnancy (EP) in cases where conservative management is impossible or contraindicated. The main indications are a ruptured tubal gestation, a pathological tube, a history of tuboplasty, and an ipsilateral recurrence. This technique is simple, quick, and safe. Reproductive outcome after laparoscopic total salpingectomy for EP was evaluated in 125 cases between January 1983 and December 1987. The pregnancy rate was 33.6%. In our population, there was a high proportion of patients with a pathological or absent contralateral tube (74.4%). In patients with a normal contralateral tube (32 cases), the live birth rate (46.9%) was greater but not significantly than in patients (39 cases) with a patent but pathological tube (25.6%). In vitro fertilization (IVF) was performed in 59 patients; clinical pregnancy was obtained in 40.7% of cases. These encouraging results lead us rapidly to consider IVF in patients with a pathological contralateral tube.

Fallopian Tubes↗
PubMed1990

Terminal tuboplasties by laparoscopy: 65 consecutive cases.

A series of 65 consecutive laparoscopic distal tuboplasties, performed from May 1986 to May 1988 is reported. Thirty-one were fimbrioplasties and 34 were neosalpingostomies. Outcome was evaluated at 18 months postoperatively. Twenty-two patients obtained pregnancies (33.8%), of which 18 were intrauterine (27.7%). The intrauterine pregnancy rate was 25.8% after fimbrioplasty and 29.4% after neosalpingostomy. These results are comparable with those obtained after microsurgery. Progress in operative laparoscopy may be attributed to the development of an appropriate atraumatic instrumentation and the CO2 laser. The major advantage of laparoscopic techniques is their availability at the time of diagnostic laparoscopy. Immediate opening of hydrosalpinges allows for precise evaluation of the tubal mucosa, thereby establishing prognosis. In cases with a severely altered mucosa, in vitro fertilization may be considered immediately. When the mucosa is satisfactory, laparoscopic fimbrioplasty or neosalpingostomy may be performed. Within 1 year after one of these procedures, a pregnancy is generally achieved in 1 of 3 patients.

Adult↗
PubMed1990

Diagnosis and treatment of ectopic pregnancy by retrograde selective salpingography and intraluminal methotrexate injection: work in progress.

Selective retrograde trans-cervical salpingography was carried out in four patients in whom ectopic pregnancy was suspected. The Fallopian tube was catheterized using a catheter set designed in our centre. The 6F catheter was placed in the cornua and an inner coaxial catheter was easily introduced into the proximal portion of the Fallopian tube, guided by tactile impression. Contrast medium was then injected and a round haloed mass was seen. Thereafter, the Fallopian tube was catheterized using a metallic guidewire until its tip was adjacent to the ectopic pregnancy. The coaxial catheter was then advanced along the guidewire and after removal of the latter, 5-35 mg of methotrexate was injected into the Fallopian tube. This new procedure was simple, well tolerated and had no side effects. A tubal pregnancy was demonstrated and surgery was avoided in all cases.

Adult↗
PubMed1990

[Laparoscopic surgery of ovarian cysts. Indications and limits as found in a series of 169 cysts].

The new laparoscopic surgical techniques which have been adapted for treating ovarian cysts fulfil a double purpose; to reduce the need for traditional surgical treatment while at the same time being sure to remove the whole of the cyst wall. They make it possible in this way to avoid unnecessary laparotomies for many patients. They forestall recurrences of the cyst while at the same time lessening the risk of adhesion formation. We present a series of 169 adnexal masses of which 158 were treated successfully using these techniques. This experience has made it possible for us to work out an exact operative protocol for transparietal and intra-peritoneal cystectomies and for transparietal oophorectomies. All histological kinds of ovarian cysts that are benign can be treated laparoscopically, but endometriomas and dermoid cysts made it fail in 18.1% and 5.7% of cases respectively. Only in a few cases ultrasound guided punctures of the cysts could be carried out and that only in ovarian cysts with clear fluid in women of reproductive age. Apart from this limited group, from now on laparoscopy should be the treatment for most adnexal cystic masses. Laparoscopy is the only way after looking carefully at the whole of the pelvis, to work out whether it is possible to operate on them through the laparoscope and this now allows a varied attitude to treatment to be adapted and changing according to each case.

Adolescent↗
PubMed1990

[Celioscopy and ectopic pregnancy].

The most frequent indication is the treatment of ectopic pregnancy. Salpingotomy with tubal preservation, the procedure of choice for young women wanting to become pregnant, has been used in 88 cases. However, tubal preservation is not always possible (rupture of the ovarian tube, hemosalpinx), and sometimes not even advisable (inflammatory lesions, homolateral recurrence) and salpingectomy was necessary in 294 cases. Another indication for salpingectomy is painful chronic salpingitis, resulting from an undetected or ill-treated Chlamydia trachomatis infection: 84 cases.

Adult↗
PubMed1990

[Tuboperitoneal infertility and operative celioscopy (endometriosis excluded)].

The great progress made in surgical celioscopy now allows most surgery for the repair of the adnexa to be performed through such an approach. The exeresis of adhesions with scissors is the safest, fastest and least traumatic technique. For salpingostomy, the eversion of the cuff is maintained by a defocused CO2 laser shot on the distal tubal serosa, or more simply, by the contact of the serosa with the bipolar pliers or with the tip of the thermocoagulation device. The results of the lysis of adhesions are satisfactory, with 53% intrauterine pregnancies in our 49-patient series. The results of distal plasty, with 27.7% intrauterine pregnancies in our 65-case series, they are quite comparable to those of microsurgical laparotomy. These results, along with the advantages of surgical celioscopy, caused us to give up microsurgical laparotomy for the treatment of operable adhesions and distal tubal lesions, even more so as in vitro fertilization must be contemplated at once for severe lesions.

Fallopian Tubes↗
PubMed1990

[Celiosurgery of the ovary].

Ovarian cysts can also be explored with celioscopy and, when no signs of malignancy are detected, cystectomy can be performed in this way (115 cases). In addition, an ovariectomy was performed in 15 cases and an adnexectomy in 2 cases.

Fallopian Tubes↗