Biomedical subjects

MA Pelosi

Publications and source records attributed to MA Pelosi.

5 recordsLinked to original sources

PubMed1998

Simplified cesarean section: a strategic surgical approach to minimize postoperative infectious morbidity.

Objective: A simplified method of cesarean delivery aimed at minimizing postoperative morbidity is illustrated.Methods: Two hundred consecutive cesarean deliveries were performed by the authors' simplified cesarean technique. Mean patient age was 27 years (range 17-46), and mean weight was 169 pounds (range 112-414). Indications for cesarean delivery included dystocia or failure to progress in labor (38%), repeat cesarean (32%), malpresentation (11.5%), fetal distress (9.5%), and other (9%).Results: Simplified cesarean delivery was successfully completed in all cases. Mean operating time was 16 minutes (range 9-33), mean blood loss was 460 mL (range 100-1150), and mean postsurgical hospitalization time was 72 hours (range 36-120). No bowel, bladder, or vascular injuries occurred. Postoperative febrile morbidity occurred in one patient (0.5%), ileus occurred in one patient (0.5%), and blood transfusion was administered to one patient (0.5%). No cases of wound infection, wound dehiscence, hematoma, or incisional hernia occurred. All patients were ambulatory on the first postoperative day. All but one patient (99.5%) tolerated a regular diet on the first postoperative day.Conclusions: The authors' technique of cesarean section appears to be a safe and efficient method for cesarean delivery associated with minimal postoperative infectious morbidity and rapid resumption of bowel and ambulatory function.

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PubMed1998

Cesarean hysterectomy for placenta previa accreta, increta, and percreta: a strategic approach to minimize surgical hemorrhage.

Objective: A new approach to cesarean hysterectomy aimed at minimizing surgical hemorrhage in difficult cases of placenta previa accreta is introduced.Methods: Diagnoses of placenta percreta with bladder invasion, and of placenta increta, respectively, were made by magnetic resonance imaging in two third-trimester patients with multiple previous cesarean deliveries and symptomatic placenta previa. Elective cesarean hysterectomy was planned in both cases. A novel approach to mobilization of the bladder and lower uterine segment at cesarean hysterectomy was applied in both cases.Results: Cesarean hysterectomy by a modified approach was accomplished uneventfully in both cases. Blood loss was 900 mL and 1,100 mL respectively. Neither patient required blood component therapy.Conclusions: A novel approach to cesarean hysterectomy result was associated with limited blood loss and without the need for blood component therapy in two patients at risk for surgical hemorrhage.

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PubMed1994

Laparoscopic Assisted Vaginal Metroplasty

This presentation describes for the first time the successful performance of a laparoscopic-assisted vaginal metroplasty in a habitual aborter patient with a bicornuate uterus. A combined single puncture laparoscopy and operative colpotomy approach was used. Most symptomatic septate uteri can be treated by operative hysteroscopy. However, the correction of a symptomatic bicornuate uterus still requires abdominal metroplasty. The patient was 24 years old with four early midtrimester miscarriages. Habitual abortion work-up was normal except for a bicornuate uterus. A septate uterus with two distinct cavities, one uterine corpus and an indentation in the mid-fundal area was diagnosed by hysterosalpingogram and laparoscopy. The operating time was 2 hours and blood loss 150 ml. The patient was discharged at 48 hours and had an uneventful postoperative period. She is currently 28 weeks pregnant. This case presentation indicates that assisted vaginal metroplasty is an attractive minimally invasive surgical alternative to traditional laparotomy.

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PubMed1994

Single Puncture Laparoscopic Sling Procedure

The sling procedure has become the procedure of choice for women with recurrent stress incontinence with a poorly mobile, fibrotic urethra and for women with primary incontinence and very low urethral closure pressures consistent with inadequate intrinsic urethral tone. In addition to the increased risk of graft infection or postoperative rejection associated with the use of synthetic materials, the technical drawback of traditional sling procedures is that the placement of the graft through the space of Retzius is carried out blindly, increasing the risk of bladder and urethral injury, hemorrhage, infection and nerve trauma. We had the opportunity to perform the first successful laparoscopic sling procedure using a single puncture technique in a 43 year-old woman at the time of laparoscopic hysterectomy for large symptomatic leiomyomata. In addition to her gynecologic problem, the patient had very low proximal urethral pressure. The procedure was performed under direct laparoscopic view, avoiding the blind placement of the sling under the proximal urethra and bladder neck and avoiding injury to the bladder and urethra. The procedure was almost bloodless. The patient was discharged 24 hours postoperatively. The Foley catheter was removed on the third postoperative day. No voiding difficulties occurred. Her postoperative course was uneventful. Postoperative evaluation 6 months after surgery demonstrated normal urethral closure pressure, urinary continence, and absence of reaction to the sling graft material. This singular experience appears to demonstrate that laparoscopy may play an important role in improving the surgical performance and outcome of the sling procedure.

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PubMed1994

Successful Laparoscopic Removal of an Interstitial Ectopic Pregnancy

This presentation describes the successful laparoscopic removal of an interstitial ectopic pregnancy. Interstitial pregnancy is rare (2%-4% of tubal pregnancies). Due to its location, rupture usually results in hemorrhagic shock. Current treatments include cornual resection, hysterectomy, local injection of potassium chloride or methotrexate, and systemic methotrexate. The laparoscopic treatment of interstitial pregnancy has not been reported with the exception of Reich et al (1988). A 38 year-old gravida 4 para 3 underwent cornual resection, while preserving the tube, for a right interstitial 9-week pregnancy using the single umbilical puncture approach. The operating time was 45 minutes and blood loss 50 ml. The patient was discharged at 24 hours and had an uneventful postoperative course.

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