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At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

Laparoscopic management of bleeding after laparoscopic or vaginal hysterectomy.

OBJECTIVE: To assess the results and contributions of laparoscopy in the management of postoperative bleeding following laparoscopic (LH) or vaginal hysterectomy (VH). METHODS: A retrospective study of a 5-year period was carried out on 1167 women who underwent laparoscopic or vaginal hysterectomy. Ten women with postoperative bleeding following laparoscopic or vaginal hysterectomy were identified. RESULTS: The overall incidence of bleeding after laparoscopic or vaginal hysterectomy was 0.85% (10 of 1167). Over the 5-year study period, the incidence fluctuated between 1.1% and 0.4%. Surgical revision was primarily vaginal in 1 woman, followed by laparoscopic control. In 6 patients, laparoscopy was performed immediately. The patients profited from the prompt laparoscopic treatment, because intraabdominal hemorrhage was found and stopped. Of 6 cases of intraperitoneal bleeding, 1 resulted from a blood disorder. The collagen-fibrin agent TachoComb was applied locally, and the patient was postoperatively treated with blood products and coagulation factors. Only bipolar coagulation, TachoComb, and Foley catheter were used to achieve local hemostasis during laparoscopy. The remaining 3 cases where the vaginal cuff was bleeding were managed by vaginal repair and packing without laparoscopy. CONCLUSION: The laparoscopic approach to postoperative bleeding following laparoscopic or vaginal hysterectomy is an attractive alternative to the abdominal surgical approach. Bleeding following laparoscopic or vaginal hysterectomy can be managed by laparoscopy in the majority of patients. Because the abdominal incision is avoided, the recovery time is reduced.

Electrocoagulation↗
PubMed1995

Avoidance of complications of laparoscopic hysterectomy.

The laparoscopic approach to hysterectomy offers the patient very considerable advantages over the open surgical approach. Claims that operations can 'always be done vaginally' are false. Such claims are based on inappropriate patient selection. Comparisons between vaginal hysterectomy and the laparoscopic approach betray illogical thinking: they are two different operations for very different patients. For safe practice, the surgeon must be properly trained and experienced before attempting advanced laparoscopic surgery, including hysterectomy, and patients must be carefully selected for their suitability to undergo such operations. There are a number of specific precautions and manoeuvres detailed here which may greatly enhance the safety of laparoscopic hysterectomy and reduce complications to an absolute minimum in the hands of the trained laparoscopic surgeon.

Blood Vessels↗
PubMed1999

[Vaginal delivery after two previous cesarean sections].

We report on a patient, who, after two previous caesarean sections, normally delivered vaginally without complications. The obstetric approach to, or better, the management of a vaginal delivery after caesarean section, our experience in other vaginal deliveries after previous caesarean section is discussed. This case report shows that, after two previous caesarean sections, the next child can normally be delivered vaginally without complications.

Adult↗
PubMed1991

Sacrospinous fixation--should this be performed at the time of vaginal hysterectomy?

A sensible individualized approach should be applied to every patient undergoing transvaginal surgery for benign disease. This approach should attempt to correct every defect present in the pelvic supports. Uterovaginal prolapse is the result rather than the cause of genital prolapse. Not every vaginal hysterectomy should be treated like a cystocele-rectocele repair. Instead, every defect of the endopelvic fascial support should be evaluated in a patient both before and during surgery. As a result of these evaluations, more than just a hysterectomy and an anterior and posterior colporrhaphy may be performed. In a case in which a patient is found to have more than one defect at the time of examination, sacrospinous fixation of the vaginal apex at the time of transvaginal hysterectomy may be indicated. In the office, the patient can be examined in the supine and standing positions, both with and without Valsalva's maneuver, to determine if moderate to severe uterovaginal prolapse exists. Sacrospinous fixation should be performed in those cases as an adjunct to other steps taken to prevent postthysterectomy prolapse.

Female↗
PubMed1992

[A uterus with two scars: can we allow vaginal delivery?].

This study gives the results of a year in which the active conduct of a trial of labour was carried out on uteruses that had scars in them. This approach allowed 22% of women to deliver vaginally out of a total of 41 patients. Of 17 patients (41.4%) that were put down for a tentative trial delivery, 9 (53%) did deliver vaginally. This approach seems to have been reasonable and beneficial so long as proper precautions were taken. The prognosis is better if there has been a previous vaginal delivery.

Cesarean Section↗
PubMed2005

Pediatric radical abdominal trachelectomy for cervical clear cell carcinoma: a novel surgical approach.

INTRODUCTION: Clear cell carcinoma of the cervix and vagina is rare in the pediatric population. Many of these tumors are associated with prior intrauterine diethylstilbestrol (DES) exposure. All DES-associated tumors are believed to contain microsatellite instability (MI). Historically, the recommended treatment is radical hysterectomy and pelvic lymphadenectomy, which result in infertility in all cases. Radical abdominal or vaginal trachelectomy and pelvic lymph node dissection is a new technique utilized in adult women with early cervical cancer who wish to retain fertility. This novel approach is also pertinent to the pediatric patient and is described in this report. A molecular analysis is also performed to determine if these are DES-associated tumors. METHODS: Due to the narrow vaginal anatomy in pediatric patients, a vaginal approach is not possible, and an abdominal approach is performed. The resection includes the cervix, upper vagina, parametrium, and paracolpos. Pelvic lymphadenectomy is performed in a similar manner to the adult patient. Matched pairs of normal and tumor DNA from both cases were examined for evidence of MI using a consensus panel of microsatellite markers. RESULTS: Two girls aged 6 and 8 years and without history of DES exposure presented with vaginal bleeding. Vaginoscopy revealed cervical polyp in both cases. Biopsies demonstrated clear cell cancer stage IB1 in both patients. They underwent radical abdominal trachelectomy and bilateral pelvic lymph node dissection along with anastomosis of uterine isthmus to upper vagina. Intraoperative frozen-section analysis confirmed negative uterine and vaginal margins. No adjuvant treatment was given and both girls remain disease free. Neither tumor showed evidence for MI, confirming that these are not DES-associated tumors. CONCLUSION: To our knowledge, this is the first report of radical abdominal trachelectomy in the pediatric age group and it is likely to include the youngest patient with clear cell carcinoma of the uterine cervix not associated with DES exposure. This novel approach is feasible and appears safe in the pediatric age group.

Adenocarcinoma, Clear Cell↗
PubMed1981

[Conservative treatment of malignant vulvo-vaginal tumors (in childhood, by multi-disciplinary approach (clear cell carcinomas excluded) (author's transl)].

Malignant vulvovaginal tumors in 24 children were treated at the Institut Gustave-Roussy between 1970 and 1979 (16 embryonal rhabdomyosarcomas and 8 yolk sac tumors), with conservative treatment: chemotherapy, curietherapy and partial surgery according to each case. After a mean follow-up period of three years, 20 patients had been cured, while only 4 patients had moderate sequelae.

Antineoplastic Agents↗
PubMed1991

Repair of severe anterior vaginal wall prolapse (grade IV cystourethrocele).

The classical approach for the repair of severe anterior vaginal wall prolapse is the use of transvaginal colporrhaphy or, more recently, an abdominal paravaginal repair. Severe cystoceles develop from weaknesses of the levator sling and pubocervical fasciae resulting in 2 main anatomical changes: a central defect between the pubocervical fasciae, and a sliding herniation of the bladder and urethra (paravaginal defect). We developed a new transvaginal technique for the repair of large cystoceles (grade IV) extending outside of the introitus at rest, which includes repair of the central defect by anterior colporrhaphy, and repair of the paravaginal herniation of the bladder base and bladder neck by a needle suspension of these structures. We report our experience within a 5-year period in the treatment of 51 cases of severe bladder prolapse (grade IV cystoceles), 46 of which required this combined procedure regardless of preoperative stress urinary incontinence status. Five patients underwent anterior colporrhaphy as the only procedure, since they were continent and demonstrated a well supported bladder neck from a previous suspension operation. Other vaginal abnormalities should be repaired simultaneously to provide adequate pelvic floor support.

Adult↗
PubMed2001

Modified Granada Agar Medium for the detection of group B Streptococcus carriage in pregnant women.

OBJECTIVES: To improve the detection rate of group B streptococci (GBS) in pregnant women, aiming at the prevention of early-onset septicemia in the newborn. METHODS: The yield from culturing two sites, vaginal and anorectal, on a Modified Granada Medium (MGM) was compared with our standard approach of culturing a vaginal swab on blood agar (BA). RESULTS: Samples were processed from 430 consecutive pregnant women. GBS was isolated from the vagina in 11.6% with BA, and in 13.7% with MGM. In 17.0% of anorectal samples, GBS was identified with MGM. The combination of both sites and media had a yield of 20.0%. MGM identified all but six (2%) of 310 GBS strains after aerobic incubation, with use of a cover slide, and missed only three strains (1%) after anaerobic incubation. CONCLUSIONS: Separate culture of vaginal and anorectal samples using the same MGM agar plate resulted in an increase in detection rate for GBS of 76% as compared to BA alone. The technique is simple and results are available after overnight incubation. MGM was confirmed as a specific medium for the identification of GBS, with a sensitivity of 98-99%.

Anal Canal↗
PubMed2004

Sacral colpopexy using mersilene mesh in the treatment of vaginal vault prolapse.

We report the efficacy and safety of abdominal sacral colpopexy using Mersilene mesh to treat vaginal vault prolapse. A total of 61 patients underwent sacral colpopexy to treat vaginal vault prolapse of whom 58 were available for evaluation. The procedure utilizes an abdominal approach to expose the vaginal vault and the anterior surface of the first and second sacral vertebrae. A Mersilene mesh is fastened to the anterior and posterior vaginal walls then anchored to the sacrum without tension. Hysterectomy and posterior colporrhaphy were performed as indicated. Concomitant anti-incontinence surgery was performed in 52 patients: 41 underwent Burch colposuspension, and 11 had pubovaginal sling placement. To assess long-term subjective and clinical efficacy, patients completed a questionnaire and underwent pelvic examination at least 1 year following surgery. The resolution of symptoms, objective restoration of normal pelvic support, and urinary continence defined surgical success. Median patient age at operation was 62 years. Previous operations included 29 hysterectomy procedures, five failed sacrospinous fixation, and 12 failed anti-incontinence procedures. The total complication rate was 15%. With a median follow-up of 26 months, complete correction of vaginal prolapse was found in 91% of patients. Vaginal symptoms were relieved in 90% of patients and 88% of patients had resolution of their urinary incontinence. Ninety percent of patients were satisfied with the surgery and would recommend it to others. Sacral colpopexy using Mersilene mesh relieves vaginal vault symptoms, restores vaginal function, and provides durable pelvic support.

Colpotomy↗
PubMed1994

[New pharmacological approach to therapy of perimenopausal meno-metrorrhagia. Vaginal use of progesterone].

The authors evaluate the effectiveness of a therapy based on natural progesterone to be employed as a vaginal cream in the treatment of meno-metrorrhagia in peri-menopause in 40 patients who were not prepared to consider surgery as a solution for their problems. In the polycentric out-patient study this new preparation has proved to be efficacious and to induce a regression of the endometrial hyperplasia in more than 90% of patients subject to five months' treatment.

Adult↗
PubMedDate not supplied

Intravaginal slingplasty: short term results.

BACKGROUND: Numerous surgical techniques have been described for the treatment of vaginal vault prolapses. In 1997, a new minimally invasive procedure was introduced by Petros: the infracoccygeal sacropexy, also known as Intravaginal Slingplasty (IVS). This technique is used to place a mesh in the recto-vaginal fascia and to reinforce the uterosacral ligament by placing a polypropylene tape between the perineum and the vaginal vault. Since July 2002, we have changed our approach to the treatment of vaginal vault prolapses and now perform IVS. The aim of this study was to report our early experience and short-term results with IVS. METHODS: Prospective single-institution non-randomized trial of patients who underwent IVS. Indications, intra- and post-operative complications were recorded as well as early post-operative results. RESULTS: 34 patients with a mean age of 60+/-13 years, were operated during a 12-month period. Surgical indications included rectoceles (n = 27), enteroceles (n = 26), cystoceles (n = 15) and hysteroceles (n = 9). 85% of the patients (n = 29) had more than one prolapse. Mean operative time was 63+/-19 minutes, with a 0% intra-operative complication rate. Post-operative complication rate was 2.9%: bleeding from an internal haemorrhoid required surgical haemostasis. Median post-operative stay was 3 days (range: 2-7 days). There was also one post operative complication (2.9%, a mesh erosion). Recurrence rate was 8.8% (two cystoceles and one rectocele recurred after surgery). CONCLUSION: Posterior IVS provides a safe and efficacious treatment for posterior vaginal vault prolapses. Long-term results are required to assess the functional results and recurrence rate of the technique.

Adult↗
PubMed2005

Laparoscopic techniques for the repair of vaginal vault prolapse: determining if less is more.

Repair of vaginal vault prolapse remains a surgical challenge. Abdominal, vaginal, and combined procedures have been described. The ideal operation remains elusive with regard to outcomes, morbidity, and economics. As an extension of the abdominal approach, laparoscopy continues to gain favor as an access method and as a surgical advancement. Recent studies highlight a number of laparoscopic techniques for restoration of apical support that demonstrate feasibility and encouraging results. Further study is necessary to determine if the minimally invasive nature of laparoscopy can duplicate or surpass standard abdominal and vaginal approaches to the repair of pelvic organ prolapse.

Female↗
PubMed1997

Voiding dysfunction following incontinence surgery: diagnosis and treatment with retropubic or vaginal urethrolysis.

PURPOSE: A retrospective analysis was done of women undergoing urethrolysis for post-cystourethropexy voiding dysfunction to identify possible predictors of outcome. MATERIALS AND METHODS: The charts of 51 sequential women who underwent 54 urethrolysis procedures between 1986 and 1996 were reviewed. The most common presenting symptoms were irritative in 38 patients, obstructive in 31, de novo urge incontinence in 28 and persistent retention in 12. Onset was immediate after suspension in 84% of the patients. Median time from last cystourethropexy or sling to urethrolysis was 15 months (range 4 to 268). Initial evaluation consisted of multichannel video urodynamics and cystoscopy in all women. The techniques of urethrolysis were retropubic in 35 cases, vaginal in 15 or infrapubic in 4, with simultaneous repeat suspensions performed in 63%. RESULTS: A successful outcome with complete resolution of symptoms or significant improvement was achieved in 86% (retropubic), 73% (vaginal) and 25% (infrapubic) of the cases with a median followup of 10 months. No parameter examined, namely urodynamic variables, number of previous suspensions, time from suspension to urethrolysis or surgical approach, was a statistically significant predictor of outcome. CONCLUSIONS: Urodynamics may not show classic obstructive voiding in women who benefit from urethrolysis. Our only absolute selection criterion for offering urethrolysis is a clear temporal relationship of symptoms to cystourethropexy. Retropubic and vaginal techniques for urethrolysis provide similar results but morbidity is seemingly less with the vaginal approach. Omental or Martius fat pad interposition may be of benefit.

Adult↗
PubMed1993

Female sterilization by the vaginal route: a positive reassessment and comparison of 4 tubal occlusion methods.

Over the last 15 years female sterilization by the vaginal route has been abandoned in favour of the abdominal approach via a laparoscope or a suprapubic incision. This was justified when the vaginal route was used for a fimbriectomy or a Pomeroy type of sterilization. The use of tubal occlusion methods designed for the laparoscope has simplified the technique of vaginal sterilization and lowered the morbidity. Four hundred and ninety consecutive cases over an 18-year period are reviewed. Four hundred and eighty five were completed vaginally. The methods used were Pomeroy with catgut, Falope ring, Hulka and Filshie clips. The Filshie clip was the most satisfactory. Vaginal sterilization is suitable for day care. The readmission rate was 1%. There was no case of pelvic infection in 177 clip cases but 5 in 173 where the Pomeroy technique was used. The pregnancy rate was highest with the Hulka clip. The overall rate was 1%. With clip methods strong analgesics were only required in 6% postoperatively and only 14% took any analgesic after returning home; consequently return to normal activities was rapid. The patient's weight was not related to operative difficulty when clips were used so the vaginal route may prove to be the method of choice in the obese. Filshie clip sterilization via the posterior fornix of the vagina could be the most cost-effective method of sterilization available at present. The vaginal route needs reappraisal using contemporary methods of tubal occlusion.

Adult↗