PubMed Health⌕ Search

Biomedical subjects

V Gomel

Publications and source records attributed to V Gomel.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up.

BACKGROUND: The objective of the study is to evaluate the short- and long-term efficacy of complete laparoscopic excision of deep endometriosis, without rectum involvement, with the opening and partial excision of the posterior vaginal fornix. METHODS: Thirty-one patients were included in the study with symptomatic extensive disease including involvement of the cul-de-sac, rectovaginal space and posterior vaginal fornix without rectum involvement. Endoscopic surgery was performed with complete separation of rectovaginal space and in-block resection of the diseased tissue, opening and partial excision of the posterior vaginal fornix and vaginal closure either by laparoscopic or by vaginal route. Patients filled in questionnaires on pain before and 12, 24, 36, 48 and 60 months after surgical treatment. RESULTS: No intraoperative complications were observed; 65% were free of analgesic on post-operative day 2, 38% had total remission of chronic pain and 22% were improved; 38% had total remission of dysmenorrhoea and 22% were improved; 45% had total remission of dyspareunia and 25% were improved. Follow-up improvement of symptoms was statistically significant and was maintained for 5 years without recurrence of the disease or repeated surgery (P < 0.001). CONCLUSION: Complete surgical resection of deep infiltrative endometriosis with excision of the adjacent tissue of the posterior vaginal fornix improves quality of life with persistence of results for long time in patients not responsive to medical treatment.

Adult↗
PubMed2005

Reproductive surgery.

The aim of this review is to try and answer the following questions. What is the importance of reproductive surgery? What does the field encompass? What are the deleterious effects of postoperative adhesions in reproductive age women? Is there a relationship between the mode of surgical access, laparoscopy versus laparotomy, and the degree of postoperative adhesions? What is microsurgery and what is its place in reproductive surgery? Does training in microsurgery provide benefits to the gynecologist and his/her patients? At present, when assisted reproductive techniques have recorded enormous progress and the technology has been industrialized, what is the place of reconstructive tubal surgery in the treatment of tubal infertility?

Embryo Transfer↗
PubMed2002

C-reactive protein should accelerate the diagnosis of bowel injury after gynecologic surgery.

STUDY OBJECTIVE: To search for a marker that could aid in earlier diagnosis of bowel injury after gynecologic surgery. DESIGN: Retrospective case study with prospective controls (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Fourteen women with bowel injuries and 50 controls with no postoperative complications. MEASUREMENTS AND MAIN RESULTS: Bowel injury occurred in 14 (2.4/1000) of 5901 gynecologic procedures. Of these, eight were recognized intraoperatively and treated immediately. In six women C-reactive protein levels were markedly increased (>100 mg/L) relative to control patients (p <0.0001). CONCLUSION: Systematic postoperative assessment of C-reactive protein in patients at high risk for bowel injury may help identify this complication earlier in the postoperative period.

Adult↗
PubMed2001

Cross-linked hyaluronate hydrogel prevents adhesion formation and reformation in mouse uterine horn model.

The aim of this study was to evaluate the efficacy of cross-linked hyaluronate hydrogel (HA gel) as an adjuvant for postoperative adhesion prevention, in a mouse uterine horn model. In experiment 1 uterine horns were abrased with iodine. HA gel was applied to the injured surface before closure in the treatment group. In experiment 2, after injuring the uterine horns, three stitches were placed at equal distances around the uterine horns to appose the injured medial surfaces of the two horns during healing. HA gel was inserted between the uterine horns in the treatment group. In experiment 3 prevention of adhesion reformation was assessed. After lysis of adhesions that were induced as in experiment 2, HA gel was introduced between the serosal surfaces of apposing uterine horns. Untreated animals served as controls in each experiment. Statistical analysis was carried out using Student's t-test. The adhesion score was significantly lower in the HA gel group on the 14th day compared with controls in all the experiments: in experiment 1, 0.3 +/- 0.4 versus 1.7 +/- 1.2; in experiment 2, 0.9 +/- 1.0 versus 2.6 +/- 0.5; and in experiment 3, 1.5 +/- 0.9 versus 2.2 +/- 0.6 respectively. Cross-linked HA gel significantly reduced de-novo adhesions (P< 0.03) and adhesion reformation (P < 0.03).

Animals↗
PubMed2001

Hysteroscopic resection of submucosal myomas in patients with infertility.

BACKGROUND: Submucosal myomas are associated with infertility, and may be treated by hysteroscopic resection. Improvement of the menstrual pattern after surgery has been examined and compared with pregnancy rate in a group of menorrhagic women with primary (n = 24) and secondary (n = 35) infertility. METHODS: The entire patient group (n = 59) was managed between January 1990 and September 1998. The submucosal myomas were intracavitary (n = 15), intramural class 1 (n = 34) and intramural class 2 (n = 10), and none was multiple submucosal myoma. The mean (+/- SD) age was 36.6 +/- 4.6 years; mean myoma size was 24.5 +/- 13.3 mm; mean duration of the procedure was 40 +/- 23 min; and mean follow-up was 26 +/- 18.8 months. Thirty-five patients had one or more associated infertility factors. RESULTS: An improvement in clinical symptoms was observed in 62% of patients. Sixteen patients (27%) conceived, and of these only six (10%) delivered at term. The pregnancy rate was significantly better when myoma was the exclusive aetiology of infertility (41.6%), and when the lesion was >/=50 mm in size (57.1%). CONCLUSIONS: Hysteroscopic myomectomy appears safe, and is effective in the control of menstrual disorders. However, the effect on infertility seems limited, particularly in terms of delivery rate. The advanced age of the patients may partly explain these results.

Abortion, Spontaneous↗
PubMed2000

Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion.

OBJECTIVE: To determine the frequency of peritoneal and visceral adhesions to the umbilical region according to past surgical history and to estimate the risk of bowel injury with blind insertion of the principal trocar-cannula. DESIGN: Prospective, unicentric study by a single operator. SETTING: Clinique Saint-Sernin and Polyclinique de Bordeaux, Bordeaux, France. PATIENT(S): Eight hundred fourteen patients undergoing diagnostic or operative laparoscopy were classified into four groups based on their history of abdominal surgery: group I (n = 469), no previous abdominal surgery; group II (n = 125), prior laparoscopic surgery; group III (n = 131), previous laparotomy with a horizontal supra-pubic incision; group IV (n = 89), previous laparotomy with a midline incision. INTERVENTION(S): Initial microlaparoscopy performed through the left upper quadrant of the abdomen, inspection of the anterior abdominal wall and particularly the umbilical area for the presence of adhesions. Patients who had adhesions were assessed as to whether or not they were at significant risk of injury from blind insertion of the principal trocar. MAIN OUTCOME MEASURE(S): Incidence of umbilical adhesions and the potential risk of bowel injury with blind insertion of the umbilical (principal) trocar. RESULT(S): Umbilical adhesions were found in 9.82% of the 814 cases. The rates of umbilical adhesions were as follows: group I, 0.68%; group II, 1.6%; group III, 19.8%; and group IV, 51.7%. Severe adhesions with potential risk of bowel injury with blind insertion of the umbilical trocar in the four groups were 0.42%, 0.80%, 6.87%, and 31.46%, respectively. CONCLUSION(S): Women with previous laparotomy have a higher incidence of umbilical adhesions, especially in case of midline incision. Preliminary inspection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended for patients at risk for adhesions to reduce complications associated with insertion of the principal (umbilical) trocar.

Adolescent↗
PubMed2000

Laparoscopic uterine suspension using three-stitch technique.

We conducted a prospective, longitudinal study to assess the efficacy of a new laparoscopic hysteropexy technique in alleviating pelvic pain. Subjects were 50 women of reproductive age with chronic pelvic pain or dyspareunia in whom the only clinical finding was uterine retroversion who underwent laparoscopic uterine suspension using three-stitch technique. There were no intraoperative complications. The only postoperative complication was abdominal pain in one woman. The technique was effective in relieving symptoms in these patients. Of the 22 women who had associated infertility for longer than 3 years, 10 became pregnant within 1 year after surgery. This benefit, however, is likely due to couples' improved sex life rather than change in surgical axis of the uterus.

Adult↗
PubMed1999

Thermal balloon ablation versus endometrial resection for the treatment of abnormal uterine bleeding.

This study compares the clinical efficacy and safety of a thermal uterine balloon system with hysteroscopic endometrial resection in the treatment of dysfunctional uterine bleeding. In all, 147 women were treated by two experienced gynaecological surgeons: one performed 73 thermal balloon ablations and the other 74 endometrial resections between November 1994 and April 1998. The inclusion criteria were similar in both groups. The operative time was reduced significantly with the uterine balloon technique. There were no intra-operative complications in either group and postoperative morbidities were minimal and not statistically different. Multivariate analysis noted two prognostic factors associated with failures: retroverted uterus with thermal balloon ablation and age under 43 years with endometrial resection. The overall success rate did not differ significantly between the two groups 83.0 +/- 5% for balloon ablation and 76.3 +/- 6% for endometrial resection. Uterine balloon ablation appears to be as efficacious as endometrial resection. The former is much easier to perform, making the technique readily reproducible, especially by those with limited expertise in hysteroscopic surgery, and thus more widely applicable and safer.

Adult↗
PubMed1998

Complex uterine surgery: a cooperative role for interventional radiology with hysteroscopic surgery.

OBJECTIVE: To describe the value of concurrent interventional radiology with hysteroscopy for the management of complex intrauterine abnormalities. DESIGN: A new descriptive technique. SETTING: Tertiary care center. PATIENT(S): Three case reports. INTERVENTION(S): Interventional radiology with the placement of guidewires and/or dilatation of resistant structures may assist with hysteroscopic management of complex intrauterine abnormalities or may be a primary therapeutic option. MAIN OUTCOME MEASURE(S): Resolution of dysmenorrhea and restoration of fertility. RESULT(S): The placement of a guidewire into an occluded portion of the intrauterine cavity provides direction and safety for hysteroscopic resolution of the underlying problem. In the last case, placement of the guidewire and passing dilators over the guidewire provided complete treatment. CONCLUSION(S): The uterine cavity or a smaller segment of it may be blocked by occlusive fibrous tissue that is not amenable to standard hysteroscopic dissection. Combining radiologic imaging with hysteroscopic surgery allows visual access to instrumentation and the hidden structures or organs throughout the entire procedure. It adds complexity to the surgery but may allow restoration of function to an organ or structure that is otherwise inaccessible.

Adolescent↗
PubMed1998

A comparative study of the effects of thrombin and electrodesiccation used for haemostasis on inflammation and adhesion formation.

Electrodesiccation or chemical agents, such as thrombin and fibrin sealant, may be used to control oozing in the peritoneal cavity. Electrodesiccation is time consuming and associated with adjacent thermal damage. Adhesion formation remains a concern with the use of thrombin and fibrin sealant. In this study, adhesion formation and various histological parameters of inflammation were evaluated following haemostasis with electromicrodesiccation or thrombin in the rabbit model (n = 36). Following laparotomy, the right uterine horn was subjected to a measured injury producing sufficient oozing. After the injury was effected, the animals were randomized to haemostasis with electromicrodesiccation (n = 18) or thrombin (n = 18). In the first phase of the study, the histological parameters of acute injury and haemostasis with either modality were evaluated in two animals in each group. In the second phase, one, two and 10 animals, in each group, were submitted to second-look laparotomy on post-operative days 2, 7, and 15, respectively and the type and extent of adhesions were quantified. Histological parameters of inflammation as well as the type and extent of adhesions were comparable between the two groups. We conclude that local application of thrombin is not associated with a statistically greater degree of post-operative adhesions when compared to electromicrodesiccation.

Animals↗
PubMed1997

The role of laparoscopy in the management of pelvic pain in women of reproductive age.

OBJECTIVE: To review the diagnostic and therapeutic roles of laparoscopy in women of reproductive age with acute and chronic pelvic pain. DATA IDENTIFICATION: Studies relating to the use of laparoscopy in women with acute and chronic pelvic pain were identified through the literature and MEDLINE searches. CONCLUSION(S): Laparoscopy has an important place in the management of conditions that cause acute pelvic pain in women of reproductive age, including ectopic pregnancy, pelvic inflammatory disease, tubo-ovarian abscess, and adnexal torsion. The procedure frequently facilitates the diagnosis and provides the necessary access for surgical treatment. Prompt diagnosis and effective management prevent complications and help preserve fertility. The role of laparoscopy in women with chronic pelvic pain is more controversial and limited, but abnormal laparoscopic findings are detected in approximately 60% of those who have undergone a multidisciplinary investigation and received a tentative clinical diagnosis. The access provided by laparoscopy permits the effective surgical treatment of many of the conditions encountered, including endometriosis, pelvic adhesions, ovarian lesions, and symptomatic uterine retroversion.

Adnexal Diseases↗
PubMed1996

A new type of CO2 laser avoids power density loss due to absorption and the blooming effect by the CO2 gas environment.

The aim of this study was to compare the acute tissue effects of a standard CO2 laser (Ultrapulse 5000) with a new design (Ultrapulse 5000L) that utilizes a different carbon isotope (C13) in the rat uterine horn model. Following laparotomy, measured laser injuries were effected with the Ultrapulse 5000 or Ultrapulse 5000L lasers via a laparoscope using CO2 or air for insufflation. Serial sections of the lesions were, thereafter, obtained to evaluate depth and width of total injury, width of defect and thermal damage zone. When CO2 was used as the insufflating gas, Ultrapulse 5000L laser was associated with significantly deeper lesions compared to the Ultrapulse 5000 system for the two tested pulsed energy levels (P < 0.0001). The width of total injury and thermal damage zone were significantly less with the former laser compared to the latter. The width of the defect was, however, significantly larger with the Ultrapulse 5000L laser for the 200 millijoule pulsed energy level, whereas it was comparable for the 75 millijoule level. When air was used as the insufflation gas, all four parameters of tissue injury were comparable between the two types of laser (P > 0.05). The adverse effects on the CO2 laser beam and the resultant altered tissue effects that occur in a regular CO2 environment are avoided by the use of the Ultrapulse 5000L or an air environment.

Air↗
PubMed1996

Pathophysiology of adhesion formation and strategies for prevention.

OBJECTIVE: To review the mechanism of adhesion formation and to briefly discuss the possible sites of action of various preventive measures and adjuvants. STUDY DESIGN: Literature review. RESULTS: Although good surgical technique, designed to minimize trauma, is a crucial part of adhesion prevention, technique alone cannot effectively eliminate de novo formation and especially reformation of adhesions. CONCLUSION: To date, no adjuvant has proven uniformly effective in preventing postoperative adhesions. Nonreactive barriers show promise in selected situations, especially in the presence of apposing, injured peritoneal surfaces. Development of new and more effective compounds and advances in molecular cell biology may provide a more definitive answer to this perplexing problem, which has eluded surgeons for so long.

Humans↗
PubMed1995

Laparoscopic treatment of interstitial pregnancy.

The conventional treatment of interstitial pregnancy has been cornual resection of hysterectomy by laparotomy. We have used a laparoscopic approach to treatment of interstitial pregnancy, consisting of cornual excision in four patients and salpingotomy incision via the myometrium in another. In all five cases, the procedure was associated with minimal bleeding and no complications.

Electrocoagulation↗
PubMed1995

Endometrial ablation: indications and preliminary diagnostic hysteroscopy.

Endometrial ablation is indicated when a woman with excessive uterine bleeding has, completed childbearing, been shown to suffer from dysfunctional bleeding, has exhausted all reasonable nonsurgical alternatives and would previously have been offered a hysterectomy. Diagnostic hysteroscopy is an integral part of the investigation of such a patient. Its primary function is to identify intrauterine lesions which might, if treated alleviate the need for ablation, or if untreatable, constitute contraindications to ablation. This chapter describes in detail the indications for and contraindications to, ablation. A short description of the medical management of dysfunctional bleeding is given. The instruments, technique and hysteroscopic findings which may be encountered are discussed.

Catheter Ablation↗
PubMed1995

For tubal pregnancy, surgical treatment is usually best.

Laparoscopic treatment of tubal pregnancy is safe and effective. It permits performance of both radical and conservative procedures. Irrespective of the mode of access, conservative procedures carry the risk of retention of trophoblastic tissue. Systemic methotrexate administration is effective in the treatment of retained trophoblastic tissue, especially if the diagnosis is made early, preferably within the first postoperative week. The subsequent reproductive outcome appears to be the same, irrespective of the mode of access (laparotomy or laparoscopy) by which the procedure is done.

Female↗