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L Marpeau

Publications and source records attributed to L Marpeau.

At least 19 recordsLinked to original sources
PubMed2007

[Treating severe endometriosis by pregnancy: a risky business].

We report the case of a young woman presenting with painful deep and rectal endometriosis. This condition had started long ago while the diagnosis had been delayed. Brutal colon occlusion followed the discontinuation of oral contraception. Left colectomy with terminal colostomy was carried out in emergency. The conservative surgical management of deep endometriosis was performed three months later. In women presenting deep endometriosis, the discontinuation of hormonal treatment in order to attempt a spontaneous pregnancy should not be recommended before undertaking a thorough endometriosis and fertility status investigation.

Adult↗
PubMed2006

Magnesium sulphate given before very-preterm birth to protect infant brain: the randomised controlled PREMAG trial*.

OBJECTIVE: To evaluate whether magnesium sulphate (MgSO(4)) given to women at risk of very-preterm birth would be neuroprotective in preterm newborns and would prevent neonatal mortality and severe white-matter injury (WMI). DESIGN: A randomised study. SETTING: Eighteen French tertiary hospitals. Population Women with fetuses of gestational age < 33 weeks whose birth was planned or expected within 24 hours were enrolled from July 1997 to July 2003 with follow up of infants until hospital discharge. METHODS Five hundred and seventy-three mothers were randomly assigned to receive a single 40-ml infusion of 0.1 g/ml of MgSO(4) (4 g) solution or isotonic 0.9% saline (placebo) over 30 minutes. This study is registered as an International Standard Randomised Controlled Trial, number 00120588. MAIN OUTCOME MEASURES: The primary endpoints were rates of severe WMI or total mortality before hospital discharge, and their combined outcome. Analyses were based on intention to treat. RESULTS: After 6 years of enrolment, the trial was stopped. Data from 688 infants were analysed. Comparing infants who received MgSO(4) or placebo, respectively, total mortality (9.4 versus 10.4%; OR: 0.79, 95% CI 0.44-1.44), severe WMI (10.0 versus 11.7%; OR: 0.78, 95% CI 0.47-1.31) and their combined outcomes (16.5 versus 17.9%; OR: 0.86, 95% CI 0.55-1.34) were less frequent for the former, but these differences were not statistically significant. No major maternal adverse effects were observed in the MgSO(4) group. CONCLUSION: Although our results are inconclusive, improvements of neonatal outcome obtained with MgSO(4) are of potential clinical significance. More research is needed to assess the protective effect of MgSO(4) alone or in combination with other neuroprotective molecules.

Adult↗
PubMed2006

[Uterine rupture following operative hysteroscopy].

The aim of this study was to attempt to identify factors predictive of uterine rupture following operative hysteroscopy. A MEDLINE and EMBASE search (1980 to April 2006) using the keywords "hysteroscopy", "uterine rupture" and "pregnancy" was performed with no limitations of languages. 18 cases of uterine rupture following operative hysteroscopy were retrieved. Hysteroscopic metroplasty (uterine septa and synechiae) was involved in 16 (89%) cases. Hysteroscopic resection was performed with monopolar current cutting, rigid scissors and laser in respectively 14 (78%), 3 (16.5%) and 1 (5.5%) cases. Uterine perforation occurred in 10 (55.5%) cases. The interval between hysteroscopy and subsequent pregnancies varied from 1 month to 5 years with an average delay of 16 months. Uterine rupture occurred between 19 and 41 weeks, with no labour in 12 (66.5%) cases. Four fetal and one maternal deaths followed uterine rupture. Hysteroscopic metroplasty may expose patients to an increased risk of uterine rupture in subsequent pregnancy. Uterine perforation and/or the use of current monopolar section during operative hysteroscopy increase this risk. Uncomplicated hysteroscopic resection of submucous myomas and endometrial polyps do not alter obstetrical outcome. Considering hysteroscopic metroplasty, the use of coaxial bipolar electrode should be preferred.

Female↗
PubMed2006

[Three-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence with low urethral closure pressure].

OBJECTIVE: The aim of this study was to assess, with long-term outcome, the effectiveness of TVT for stress urinary incontinence (SUI) with low maximum urethral closure pressure (MUCP) and to identify predicting factors for failure in this case. PATIENTS AND METHODS: This is a bicentric retrospective study including women who underwent a TVT procedure for grade 3-SUI according to the Ingelman-Sundberg's scale. All patients had a low MCUP defined by PCUM < 30 or by the formula 110-the age+/-20% cmH2O. Urethral hypermobility was defined on physical examination and urodynamic investigations. TVT was the only operation performed. Patients were assessed at three months then at longer term with an average follow-up of three years and ever less than one year. RESULTS: A total of 60 women 30 to 78 years old (mean age 55) were so operated. More than third of them (38%) had already been operated for incontinence. Thirty-eight percent had SUI without urethral hypermobility. Thirty percent presented bladder overactivity. The short-term evaluation found that, out of 58 patients, 70,6% cured, 10,3% improved and 18,9% classified as failure. The long-term evaluation, concerning 44 patients, found that 57% remained cured, 16% improved and 27% were classified as failure. Bladder overactivity was cured or improved in more than half of the cases (60%). Ten percent of de novo urgencies were noted, all of which persisted later on. For all that, as much as two thirds of these patients were satisfied with the TVT. Mean age of patients classified as failure, was higher (65 years). Previous SUI surgery did not modify the results. When the MUCP was < 20 cmH2O, success was present only one time out of two. The absence of urethral hypermobility decreased to a significant degree the probability of cure (38 vs. 82,6%, P < 0.01), and more still when bladder overactivity was associated (16,6 vs. 66,6%, P < 0.01). Postoperative voiding troubles constituted a pejorative factor for success of surgery. DISCUSSION AND CONCLUSION: Even if results of TVT with low MCUP are worse, they do not remain less appreciable. When we confront the benefits awaited with this technique compared to the usually described complications, TVT must represent the first treatment of this indication.

Adult↗
PubMed2006

[Posthysterectomy posterior compartment prolapse: Preliminary results of a novel transvaginal surgical procedure using polypropylene mesh via the low transobturator route].

OBJECTIVE: The aim of this study is the description and anatomical and functional outcome assessment of a novel surgical procedure, based on rectovaginal fascia defect repair with polypropylene mesh using the tension-free transobturator and infracoccygeal route based on the integral theory developed by Petros. MATERIALS AND METHOD: Prospective, consecutive and single centre study performed between February 2003 and April 2005. Inclusion criteria were symptomatic posthysterectomy stage three to four regarding posterior compartment prolapse according to the Baden and Walker classification, with no anterior and/or apical prolapse. Principles and description of this new surgical procedure are described. RESULTS: Fourteen patients, with a mean age of 63.5 years and a mean body mass index of 29.2, were included in the study. All the patients had previous hysterectomy, 64.3% reported at least one previous surgery for pelvic organ prolapse, 44.5% reported at least one reoperation. All patients complained of rectocele and/or enterocele stage three. No perioperative or postoperative complication occurred. With a median follow-up of 13 months (range 3-32.9), no recurrence and no anterior or apical compartment prolapse occurred. No vaginal erosion an infection of the mesh was observed. The mean level of subjective satisfaction was 9.23 on a visual analogical scale (0-very disappointed, 10-very satisfied). CONCLUSION: This new surgical procedure is effective and safe for the repair of posthysterectomy large posterior compartment prolapse. A long-term follow-up is required to confirm these promising results.

Aged↗
PubMed2006

[Cystocele and stress urinary incontinence: assessment of a total treatment by monoprosthesis].

OBJECTIVES: The aim of this study is to evaluate the effectiveness and the potential complications in the short and medium terms of the transobturator and infracoccygeal hammock, a surgical technique suggested to treat in one sole operating time, by vaginal way, cystocele and stress urinary incontinence. PATIENTS AND METHODS: From February 2002 till August 2004, 45 patients aged 66+/-11 years on average, presenting a stage 3 or stage 4 cystocele associated with stress urinary incontinence (proven for 40 of them and masked by the prolapse itself for the other five) benefited from this new surgical procedure. RESULTS: With a mean follow-up of 31+/-9 months, the success rate of the technique is estimated at 98% on the anatomical aspect (one single failure) and at 91% on the urinary aspect (73% of the patients were cured, 18% improved and 9% in failure). No patient presented urinary retention except one with an infected pelvic hematoma requiring its evacuation and the partial ablation of the prosthesis. Postvoid residual volume at discharge was 83 ml. Two patients developed de novo bladder overactivity. Unfortunately we had to regret nearly 18% of exposed prosthesis. This result should be improved by the exclusive use of polypropylene monofilament prosthesis with broad meshes, weak weights and by reduced vaginal scars. DISCUSSION AND CONCLUSION: Total treatment by monoprosthesis of cystoceles with associated stress urinary incontinence constitutes an interesting prospect for some high-risk genital urinary prolapses for anatomical repetition or post-operative dysvoiding. Patients with recurrent failures of prolapse surgical cure, those with a large cystocele or by extension with a complete prolapse of the three floors, and even those with a post-hysterectomy prolapse have perhaps found a durable solution with their problem.

Adult↗
PubMed2006

[Ideas to make the TVT progress].

Because of the bladder injuries risk and subsequent increase of the intervention time due to the bladder integrity checking, many surgeons have abandoned TVT. Based on a demonstrative clinical case, we report a simple, fast and effective method meant to minimize the risk of bladder injuries and to wonder about the mandatory bladder checking by cystoscopy during the TVT sling installation. An infiltration of 1% Xylocaïne half diluted is carried out in the area laterally to the urethra and the bladder, through vaginal and pubic ways. A 360 ml blue of methylene solution bladder filling may show quickly and safely a bladder injuries occurrence, either a true transfixion or an under mucous route. Using this procedure, TVT technique could be no more dangerous or longer than the TOT technique.

Cystoscopy↗
PubMed2006

[Place of surgery in the management of gestational trophoblastic tumors].

Gestational trophoblastic tumors are authentic malignant tumors of the conception. They are mostly chemosensitive. For young women, the place of the surgery seems now restricted and more and more codified. Hysterectomy keeps a certain interest for women who do not wish to preserve their fertility. Hysterectomy limits then the complications of chemotherapy. It optimizes the chances of recovery without recurrence. If chemotherapy must nevertheless be carried out, hysterectomy decreases the necessary number of cures to obtain complete remission of the disease. Surgery is also indispensable to chemoresistant tumors. It allows exeresis of localized residual sites or isolated metastases. Other indications for surgery include uncontrollable vaginal or intra-abdominal bleedings and placental site trophoblastic tumors.

Adult↗
PubMed2006

[Malignant transformation of abdominal wall endometriosis: a new case report].

Cancer arising in abdominal wall endometriosis is a rare event, hindering diagnosis and making management uncertain. A cesarean section scar is generally at the origin of the disease. We report the case of a 45-year-old woman, with a past medical history of cesarean deliveries, complaining of a repeat abdominal wall endometriosis which transformed into a clear-cell carcinoma. Outcome was rapidly fatal. Compared with endometriosis-associated ovarian carcinoma, the prognosis of this abdominal scar complication is poor. In the literature, survival rate reaches only 57% after a short follow-up of 20 months. Clear-cell carcinoma is the most common histological subtype, followed by endometrioid carcinoma. Radical surgery is the main treatment. Good technique and proper care during cesarean section may help in preventing this endometriosis complication.

Abdominal Neoplasms↗
PubMed2006

[Late post-conization hemorrhage and false aneurysm of the uterine pedicle].

We report a case of delayed post-conization hemorrhage induced by the rupture of a uterine artery false aneurysm. Cold knife conization of the cervix was the main cause of the false aneurysm. To our knowledge, this is the first case reported. Angiography enabled the diagnosis and the treatment by embolization of the lesion. A less aggressive technique than a scalpel, perhaps with a diathermic loop, could help to prevent this type of complication.

Adult↗
PubMed2006

[Episiotomy techniques].

OBJECTIVES: To describe the different types of episiotomy and to define the methods of repair. METHODS: A systematic review on Medline and Cochrane Database between 1980 and August 2005 was performed. RESULTS: Aseptic prevention and specific material may be used in order to reduce the risk of surgical wound infection (grade C). Episiotomy and perineal repair may be associated with considerable pain. In contrast, there has been little evaluation of the effectiveness of analgesia provided to women undergoing this procedure. The mediolateral episiotomy is a 6 cm incision at a 45 degrees angle from the inferior portion of the hymeneal ring (professional agreement). However, shorter length and lower angled episiotomies are also currently reported for routine practice (grade C). There are no data to recommend preferential use of an absorbable synthetic material (acid polyglycolic versus polyglactin 910). The use for the more rapid polylactin 910 suture material was associated with less need to remove sutures but with more wound gapping in comparison with the standard polyglactin 910 material (grade A). The continuous subcuticular technique of perineal repair may be associated with less pain in the immediate postpartum period than the interrupted technique (grade A). CONCLUSION: Mediolateral episiotomy is the method of choice in France. However, the procedure for this technique should be studied more. Subcuticular technique with an absorbable synthetic material may be the optimal method of repair.

Adult↗
PubMed2005

[Surgical management of intractable postpartum haemorrhages].

Surgical management of an intractable postpartum haemorrhage after failure of medical and obstetric measures is not limited to the emergency peripartum hysterectomy. Uterine atony and abnormal placental insertions are the major causes of primary postpartum haemorrhages. Involving mostly young women, having few or no child, before with a healthy uterus, in first intention conservative option is recommended. The simplest methods must be known and be applied. It will be essentially progressive uterine arteries' ligation, which can be adapted to the majority of situations. Internal iliac arteries' ligation is a little less effective and technically more difficult to carry out. It remains interesting in obstetrical traumatic hurts, which do not concern the uterus. New and easier surgical methods, such as uterine compression or hemostatic suturing techniques have been described for which we lack experience. The quality of the result depends of the length of intervention and the cause of the bleeding. Nevertheless the main cause of failure with conservative treatments is placenta accreta. In case of failure of a conservative treatment, it would be dangerous to multiply techniques. Emergency peripartum hysterectomy then should remain the choice procedure.

Female↗