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J B Dubuisson

Publications and source records attributed to J B Dubuisson.

At least 127 records · Page 7Linked to original sources
PubMed1994

Failure of laparoscopic treatment for peritoneal trophoblastic implants.

We report on two cases of peritoneal trophoblastic tissue implants, one after salpingostomy, and one after salpingectomy for ectopic pregnancy. During each secondary laparoscopy, simple excision of implants with laparoscopic biopsy forceps resulted in persistent elevated beta-human chorionic gonadotrophin (beta-HCG) levels. Methotrexate therapy was used. Removal of all trophoblastic tissues present and avoidance of trophoblastic spillage during the laparoscopic procedure should prevent such an uncommon complication.

Adult↗
PubMed1994

Total laparoscopic hysterectomy: preliminary results.

Total hysterectomy carried out entirely via laparoscopy benefited 31 patients. In all cases the operation was carried out using conventional, re-usable instruments (grasping forceps, laparoscopic scissors, bipolar coagulation). The mean duration of the operation was 171 min. No serious peri- or post-operative complications were encountered and no transfusion was required. The mean drop in haemoglobin was 1.3 g/100 ml and the average length of hospital stay was 4 days. In one case (3.26%) we converted to laparotomy because a lateral myoma made it impossible to achieve haemostasis of the uterine pedicle under suitably safe conditions. These results confirm that total hysterectomy via laparoscopy is a safe, feasible and reproducible technique. Future work will establish the exact place and methods for laparoscopic surgery for hysterectomy; it can be suggested, however, that laparoscopic surgery is only indicated when vaginal hysterectomy is contra-indicated or impossible. So, laparoscopic hysterectomy constitutes an alternative to laparotomy rather than to vaginal hysterectomy. The combination of an immobile uterus and poor vaginal accessibility is the prime indication for total hysterectomy via laparoscopy.

Adult↗
PubMed1994

Laparoscopic salpingostomy: fertility results according to the tubal mucosal appearance.

Prognostic factors for fertility outcome following laparoscopic salpingostomy were evaluated. We studied all distal tuboplasties performed between May 1986 and June 1991. Ninety infertile women were treated. Tuboplasty was carried out bilaterally except when one tube was absent or when bifocal lesions were present. Salpingostomy was performed using either scissors and thermocoagulation for eversion, or the CO2 laser. Cumulative pregnancy rates were evaluated by life-table analysis, according to the tubal classification and the mucosal status. The 18 months estimated cumulative pregnancy rate with normal delivery was 28.7%. Pregnancy rates were significantly higher in patients classified in grades I and II versus grade III and IV (severely damaged tubes) according to the distal tubal scoring system, and in patients with normal or lightly atrophic mucosa versus alveolar or absent mucosa. Operative laparoscopy is effective for treatment of hydrosalpinges. Fertility outcome is related to the tubal damage. Our results demonstrate that the prognosis value of the mucosal status seems to be as predictive as the distal tubal scoring system.

Adult↗
PubMed1994

Pregnancy after laparoscopic partial cystectomy for bladder endometriosis.

We report a case of partial laparoscopic cystectomy in a 31-year-old infertile patient presenting vesical endometriosis. This patient had suffered severe dysmenorrhoea for 10 years previously together with repeated episodes of urinary infection, mostly occurring during the menstrual period. A diagnostic laparoscopy performed in another centre diagnosed a stage IV endometriosis. Gonadotrophin-releasing hormone agonists were prescribed for 9 months. After failure of this treatment, the patient came to consult us. A solid mass in the left supratrigone was detected by pelvic ultrasonography and confirmed by cystoscopy. Transurethral resection was carried out. A recurrence of the symptoms 9 months later prompted operative laparoscopy under cystoscopic control. This confirmed recurrence of a 3.5 cm endometriotic nodule. Laparoscopic partial cystectomy was performed using the monopolar electrode. The bladder was then sutured via laparoscopy. No complications occurred. No postoperative treatment was given. Second-look cystoscopy 2 months later revealed that healing was perfect. Eight months later, the patient is well and has a normal intra-uterine pregnancy.

Adult↗
PubMed1994

[Celiosurgery in gynecology. Indications, benefits and risks].

Initially used exclusively for diagnosis, laparoscopy is now a surgical method in gynecology but also in many other specialties. In gynecology, the results of laparoscopic surgery are comparable to those obtained by laparotomy in many indications: ectopic pregnancy, ovarian cysts, endometriosis, tubo-peritoneal sterility... Because of the advantages of laparoscopic surgery over traditional surgical treatment by laparotomy, operative laparoscopy is, in these indications, now recognized to be the best choice of surgical treatment. The most important advantages of operative laparoscopy are the following: less esthetic drawbacks, minimal risk of parietal and infectious complications, lower risk of post operative adhesions, more comfortable post operative course and lower cost due to considerably shortened hospital stay and recovery period. The risk of complications is directly correlated to the surgeon's experience and the importance of the surgery performed.

Endometriosis↗
PubMed1993

[Is it necessary to operate on every ovarian cyst?].

In the absence of a prospective study comparing the complications in a series of patients with operated and non-operated ovarian cyst, all ovarian tumours must be operated and examined histologically. Apart from ultrasound-guided aspiration, which may be proposed as sole treatment under very strictly defined conditions, laparoscopic surgery has transformed the treatment of ovarian cysts. The first difficulty is to eliminate malignant or borderline lesions which require classical treatment via laparotomy. The second difficulty consists of avoiding any peritoneal and parietal dissemination. Dissection of the closed cyst, occasionally ovariectomy, and extraction via a sac have been proposed as solutions to this problem.

Biopsy, Needle↗
PubMed1993

[Laparoscopic myomectomy. 102 cases].

Myomectomy was performed by laparoscopy in 102 patients, according to a precise technique using the monopolar hook for the uterine incision and intraperitoneal sutures. Myomes were mostly removed through the suprapubic puncture site after fragmentation or by colpotomy. A laparotomy during the laparoscopic procedures was necessary in 2 cases. No complications were observed. A second-look laparoscopy or a cesarean section was performed in 24 cases. Post-operative adhesions were noted in 3 cases. In our experience, operative laparoscopy has several advantages over laparotomy and the risks of complications is low in selected cases.

Adult↗
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↗