1
|
A New Laparoscopic Entry Point in Patients With Previous Laparotomy: A Prospective Comparative Study. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:420-424. [PMID: 35882018 DOI: 10.1097/sle.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intraperitoneal access and establishing pneumoperitoneum for laparoscopy is a critical step especially in patients who underwent previous laparotomy due to the higher risk of visceral or vascular injuries. In this study, we propose a new entry point for safe laparoscopic access in cases having previous laparotomy. MATERIALS AND METHODS This is a prospective controlled randomized trial conducted between January 2016 and January 2022 in Ain Shams University Hospitals. It included 232 patients who underwent laparoscopic procedures after previous laparotomy. They were randomly divided into 2 equal groups. In group 1, laparoscopic access was carried out by an optical trocar through the new point situated in the subxiphoid region 1 cm below the costal margin and centered 2.5 cm from the midline on either side. In group 2, laparoscopic access was performed by an optical subumbilical trocar after Verres needle insufflation in Palmer point. The primary end points were success and safety of entry, measured by the number of entry attempts and the incidence of bowel and vascular injuries. The secondary end point was the entry time. RESULTS In group 1, safe entry into the abdomen was achieved without visceral or vascular injury. In the 3 cases, minor liver injuries occurred. In group 2, 2 major vascular injuries and 5 bowel injuries occurred. There was a significant difference in procedure time (55±7.2 s in group 1 vs. 192±11.6 s in group 2). CONCLUSION The suggested entry point is fast, safe, and reliable in patients having previous laparotomy.
Collapse
|
2
|
Exploring perioperative complications of anterior lumber interbody fusion in patients with a history of prior abdominal surgery: A retrospective cohort study. Spine J 2020; 20:1037-1043. [PMID: 32200118 DOI: 10.1016/j.spinee.2020.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior lumbar interbody fusion (ALIF) exposes the anterior aspect of the spine through a retroperitoneal approach. Access to the anterior spine requires mobilization of intra-abdominal viscera/vasculature, which can become complicated as scarring and/or adhesions develop from prior abdominal surgical interventions, increasing risk of intraoperative complications. The literature suggests that "significant prior abdominal surgery" is a relative contraindication of ALIF surgery; however, there is no consensus within the literature as to what defines "major/significant" abdominal surgeries. Additionally, the association between the number of prior abdominal surgeries and perioperative complications in ALIF surgery has not been explored within the literature. PURPOSE This study seeks to explore the association between perioperative complications of ALIF surgery and the type (major and/or minor) and number of prior abdominal surgeries. DESIGN A retrospective cohort study was performed to examine perioperative complications in ALIF patients with or without prior history of abdominal surgery. PATIENT SAMPLE All consecutive patients undergoing ALIF with or without a history of prior abdominal surgery from 2008 to 2018 at a single tertiary center were evaluated. Patients under the age of 18, patients with spinal malignancy, or patients who had ALIF above L3 were excluded. OUTCOME MEASURES Perioperative complications included intraoperative complications during ALIF surgery and postoperative complications within 90 days of ALIF surgery. Intraoperative complications include vascular injury, ureter injury, retroperitoneal hematoma, etc. Postoperative complications include urinary tract infection, revision of abdominal scar, ileus, deep vein thrombosis, pulmonary embolism, etc. Other outcome measures include readmission within 90 days, length of ALIF surgery, and length of hospital stay. METHODS Electronic medical records of 660 patients who underwent ALIF between 2008 and 2018 were retrospectively reviewed. Patient demographics, Charleston Comorbidity Index (CCI), level of fusion, past abdominal surgical history, use of access surgeon during exposure, intraoperative, and postoperative complications were collected. Predictors of intraoperative and postoperative complications were analyzed using simple and multivariable logistic regression. Statistical analysis was performed using JMP 14.0 (SAS, Cary, NC, USA) software. RESULTS After controlling for age, length of ALIF, gender, multilevel ALIF, and the use of an access surgeon, there was no significant association between the type of prior abdominal surgery (major and/or minor) and intraoperative complications on multivariable logistic regression analysis (Minor: odds ratio [OR]=1.68; 95% confidence interval [CI]: 0.58-4.86 & Major: OR=1.99; 95% CI: 0.80-4.91). On multivariable logistic regression, the odds of developing an intraoperative complication increases by 52% for each additional prior abdominal surgery after adjusting for age, length of ALIF, gender, multilevel ALIF, and the use of an access surgeon (OR=1.52, 95% CI: 1.10-2.11). Iliac vein laceration was the most common intraoperative complication (n=27, 4%). Neither the type (major and/or minor) nor the number of prior abdominal surgeries were significant predictors of postoperative complications (Minor: OR=1.29; 95% CI: .72-2.31, Major: OR=1.24; 95% CI: 0.77-2.00, & Number: OR=1.03; 95% CI: .84-1.26). CONCLUSION With each additional prior abdominal surgery, accumulation of scarring and adhesions can likely obscure anatomical landmarks and increase the risk of developing an intraoperative complication. Therefore, the number of prior abdominal surgeries should be taken into consideration during planning and operative exposure of the anterior spine via a retroperitoneal approach.
Collapse
|
3
|
Kim HJ, Kang H, Kim MK, Han SS. The Effects of Barrier Agents in Postoperative Pelvic Adhesion Formation: A Comparative Study of a Temperature-Sensitive Poloxamer-Based Solution/Gel and a Hyaluronic Acid-Based Solution in a Rat Uterine Horn Model. J Laparoendosc Adv Surg Tech A 2018; 28:134-139. [DOI: 10.1089/lap.2017.0404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hyeon-Ji Kim
- Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi-Kyung Kim
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung-Su Han
- Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Is robot-assisted laparoscopic myomectomy limited in multiple myomas?: a feasibility for ten or more myomas. Obstet Gynecol Sci 2018; 61:135-141. [PMID: 29372160 PMCID: PMC5780308 DOI: 10.5468/ogs.2018.61.1.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/24/2017] [Accepted: 08/05/2017] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the feasibility of robot-assisted laparoscopic myomectomy in multiple myomas over 10. Methods A retrospective study was conducted for 662 patients who underwent robot-assisted laparoscopic myomectomy and open myomectomy by a single operator in a tertiary university hospital. Results A total of 30 women underwent removal of 10 or more uterine myomas by robotics and 13 patients were selected for this study. The average number of myomas removed was 13.7 (range 10-20). The maximum diameter of the myomas was 6.8 cm (range 5.0-10.0 cm). The sum of the diameters of each myoma was 34.7 cm (range 20.0-54.5 cm) and the mass of resected myomas for each case was 229.1 g (range 106.8-437.9 g). In no case was the robotic procedure converted into conventional laparoscopy or laparotomy, and all patients recovered without any major complications. In comparison with 13 cases of open myomectomy during the same period, robotic surgery took longer time than open surgery (360.5 vs. 183.8 minutes; P=0.001) but had shorter postoperative hospital days after surgery (mean 2.5 vs. 3.5 days; P=0.003). Conclusion Robot-assisted laparoscopic myomectomy could be an alternative to laparotomic myomectomy for numerous myomas over 10 in number.
Collapse
|
5
|
Effect of remote cesarean delivery on complications during hysterectomy: a cohort study. Am J Obstet Gynecol 2017; 217:564.e1-564.e8. [PMID: 28735704 DOI: 10.1016/j.ajog.2017.07.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cesarean delivery is performed frequently worldwide, and follow-up studies that report complications at subsequent surgery are warranted. OBJECTIVES The aim of the study was to investigate the association between a previous abdominal delivery and complications during a subsequent hysterectomy and to estimate the fraction of complications that are driven by the presence of adhesions. STUDY DESIGN This was a longitudinal population-based register study of 25354 women who underwent a benign hysterectomy at 46 hospital units in Sweden 2000-2014. RESULTS Adhesions were found in 45% of the women with a history of cesarean delivery. Organ injury affected 2.2% of the women. The risk of organ injury (adjusted odds ratio, 1.74; 95% confidence interval, 1.41-2.15) and postoperative infection (adjusted odds ratio, 1.26; 95% confidence interval, 1.15-1.39) was increased with previous cesarean delivery, irrespective of whether adhesions were present or not. The direct effect on organ injury by a personal history of cesarean delivery was estimated to 73%, and only 27% was mediated by the presence of adhesions. Previous cesarean delivery was a predictor of bladder injury (adjusted odds ratio, 1.86; 95% confidence interval, 1.40-2.47) and bowel injury (adjusted odds ratio, 1.83; 95% confidence interval, 1.10-3.03), but not ureter injury. A personal history of other abdominal surgeries was associated with bowel injury (adjusted odds ratio, 2.27; 95% confidence interval, 1.37-3.78), and the presence of endometriosis increased the risk of ureter injury (adjusted odds ratio, 2.15; 95% confidence interval, 1.34-3.44). CONCLUSION Previous cesarean delivery is associated with an increased risk of complications during a subsequent hysterectomy, but the risk is only partly attributable to the presence of adhesions. Previous cesarean delivery and presence of endometriosis were major predisposing factors of organ injury at the time of the hysterectomy, whereas background and perioperative characteristics were of minor importance.
Collapse
|
6
|
Randall D, Joosten F, Ten Broek RP, Gillott R, Bardhan KD, Strik C, Prins W, van Goor H, Fenner JW. A novel diagnostic aid for intra-abdominal adhesion detection in cine-MRI: pilot study and initial diagnostic impressions. Br J Radiol 2017; 90:20170158. [PMID: 28707532 DOI: 10.1259/bjr.20170158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE A non-invasive diagnostic technique for abdominal adhesions is not currently available. Capture of abdominal motion due to respiration in cine-MRI has shown promise, but is difficult to interpret. This article explores the value of a complimentary diagnostic aid to facilitate the non-invasive detection of abdominal adhesions using cine-MRI. METHOD An image processing technique was developed to quantify the amount of sliding that occurs between the organs of the abdomen and the abdominal wall in sagittal cine-MRI slices. The technique produces a "sheargram" which depicts the amount of sliding which has occurred over 1-3 respiratory cycles. A retrospective cohort of 52 patients, scanned for suspected adhesions, made 281 cine-MRI sagittal slices available for processing. The resulting sheargrams were reported by two operators and compared with expert clinical judgment of the cine-MRI scans. RESULTS The sheargram matched clinical judgment in 84% of all sagittal slices and 93-96% of positive adhesions were identified on the sheargram. The sheargram displayed a slight skew towards sensitivity over specificity, with a high positive adhesion detection rate but at the expense of false positives. CONCLUSION Good correlation between sheargram and absence/presence of inferred adhesions indicates quantification of sliding motion has potential to aid adhesion detection in cine-MRI. ADVANCES IN KNOWLEDGE This is the first attempt to clinically evaluate a novel image processing technique quantifying the sliding motion of the abdominal contents against the abdominal wall. The results of this pilot study reveal its potential as a diagnostic aid for detection of abdominal adhesions.
Collapse
Affiliation(s)
- David Randall
- Medical Physics, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | | | | | | | - Chema Strik
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Wiesje Prins
- Radiologie, Rijnstate Hospital, Arnhem, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - John Wesley Fenner
- Medical Physics, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| |
Collapse
|
7
|
Siufi Neto J, Santos Siufi DF, Magrina JF. Trocar in conventional laparoscopic and robotic-assisted surgery as a major cause of iatrogenic trauma to the patient. Best Pract Res Clin Obstet Gynaecol 2016; 35:13-9. [PMID: 26723474 DOI: 10.1016/j.bpobgyn.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/08/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022]
Abstract
All laparoscopic procedures, laparoscopic or robotic-assisted, start with a trocar entry. Unfortunately unknown to most, this is an extremely important part of the surgery, as 80% of major vascular injuries and 50% of intestinal injuries occur during this procedure. Laparoscopic first entry is often delegated to trainees with little experience, wrongly assuming that laparoscopic entry is similar to incisional entry at laparotomy. This may result in patient death (mortality of major vascular injuries is 11% and unrecognized intestinal injuries is 5%) or significant temporary or permanent morbidity.
Collapse
Affiliation(s)
- Joao Siufi Neto
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA; Surgical Oncologist, Sírio - Libanês Hospital, São Paulo, SP 01308-050, Brazil.
| | - Daniela Freitas Santos Siufi
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA; Surgical Oncologist, Sírio - Libanês Hospital, São Paulo, SP 01308-050, Brazil
| | - Javier F Magrina
- Department of Gynecologic Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA
| |
Collapse
|
8
|
Peña-Fernández M, Solar-Vilariño I, Rodríguez-Álvarez MX, Zapardiel I, Estévez F, Gayoso-Diz P. Assessment of morbidity in gynaecologic oncology laparoscopy and identification of possible risk factors. Ecancermedicalscience 2015; 9:606. [PMID: 26715943 PMCID: PMC4679209 DOI: 10.3332/ecancer.2015.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study was to ascertain the incidence of and the risk factors associated with morbidity in laparoscopy performed on patients with cervical cancer and endometrial cancer. Methods This was an observational study of a cohort of 128 women, 89 with endometrial cancer and 39 with cervical cancer from January 2000 to December 2011. We used the Student’s t-test or the Mann-Whitney U test for continuous variables, and the Chi-square or Fisher’s exact test for categorical variables. Results Complications were found in 44 patients (34.4%). After a multivariate analysis, among the risk factors associated with the presence of complications as the only type of surgery was found to be statistically significant (p = 0.043), more frequent in the most complex procedures such as Wertheim operation, trachelectomy, and para-aortic lymphadenectomy. Type of surgery (p = 0.003) and tumour type (p = 0.003) were risk factors associated with conversion to laparotomy. It was more frequent among the most complex procedures and cervical cancer cases. Regarding the need for transfusion, significant differences were observed in terms of surgery duration (p < 0.001), more frequent in longer surgery. Conclusion Morbidity in laparoscopic surgical oncology is related to the surgery complexity, where the basal characteristics of the patient are not a factor of influence in the development of complications.
Collapse
Affiliation(s)
- Maite Peña-Fernández
- Department of Gynecology and Obstetrics, Santiago de Compostela University Clinical Teaching Hospital, Spain
| | - Inés Solar-Vilariño
- Department of Gynecology and Obstetrics, Santiago de Compostela University Clinical Teaching Hospital, Spain
| | - María Xosé Rodríguez-Álvarez
- Clinical Epidemiology and Biostatistics Unit, Santiago de Compostela University Clinical Teaching Hospital and Santiago Health Research Institute, Spain
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Francisco Estévez
- Department of Gynecology and Obstetrics, POVISA Hospital, Vigo, Spain
| | - Pilar Gayoso-Diz
- Clinical Epidemiology and Biostatistics Unit, Santiago de Compostela University Clinical Teaching Hospital and Santiago Health Research Institute, Spain
| |
Collapse
|
9
|
Hur HC, King LP, Klebanoff MJ, Hur C, Ricciotti HA. Fibroid morcellation: a shared clinical decision tool for mode of hysterectomy. Eur J Obstet Gynecol Reprod Biol 2015; 195:122-127. [DOI: 10.1016/j.ejogrb.2015.09.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
|
10
|
Adhesions are the major cause of complications in operative gynecology. Best Pract Res Clin Obstet Gynaecol 2015; 35:71-83. [PMID: 26586540 DOI: 10.1016/j.bpobgyn.2015.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 12/29/2022]
Abstract
Adhesion formation has been found to be highly prevalent in patients with a history of operations or inflammatory peritoneal processes. These patients are at a high risk of serious intraoperative complications during a subsequent operation if adhesiolysis is performed. These complications include bowel perforation, ureteral or bladder injury, and vascular injury. In order to minimize the risk of these complications, adhesiolysis should only be performed by experienced surgeons, and intraoperative strategies must be adopted. The reduction of the overall incidence of adhesions is essential for subsequent surgical treatments. Anti-adhesion strategies must be adopted for preventing the reoccurrence of adhesions after abdominopelvic operations. The strategies employed to reduce the risk and the overall incidence of adhesions have been elucidated in this article.
Collapse
|
11
|
Sherlock CE, Lott-Ellis K, Bergren A, Withers JM, Fews D, Mair TS. Granulosa cell tumours in the mare: A review of 52 cases. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - K. Lott-Ellis
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens Georgia USA
| | - A. Bergren
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens Georgia USA
| | - J. M. Withers
- Weipers Centre Equine Hospital; University of Glasgow; Glasgow UK
| | - D. Fews
- Department of Clinical Veterinary Science; University of Bristol; Bristol UK
| | - T. S. Mair
- Bell Equine Veterinary Clinic; Maidstone Kent UK
| |
Collapse
|
12
|
Asmar J, Even M, Carbonnel M, Goetgheluck J, Revaux A, Ayoubi JM. Myomectomy by Robotically Assisted Laparoscopic Surgery: Results at Foch Hospital, Paris. Front Surg 2015; 2:40. [PMID: 26347871 PMCID: PMC4542131 DOI: 10.3389/fsurg.2015.00040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022] Open
Abstract
We reported an observational, retrospective chart review of 36 women who underwent robotic myomectomy at the Department of Obstetrics and Gynecology, Foch Hospital. Short- and long-term results were analyzed. We compared our results with literature data. Potential advantages and limits of robotic surgery in myomectomy are discussed.
Collapse
|
13
|
Floss K, Garcia-Rocha GJ, Kundu S, von Kaisenberg CS, Hillemanns P, Schippert C. Fertility and Pregnancy Outcome after Myoma Enucleation by Minilaparotomy under Microsurgical Conditions in Pronounced Uterus Myomatosus. Geburtshilfe Frauenheilkd 2015; 75:56-63. [PMID: 25684787 PMCID: PMC4318730 DOI: 10.1055/s-0034-1396163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 02/05/2023] Open
Abstract
Introduction: Besides the typical complaints and symptoms, myomas can cause sterility, infertility and complications during pregnancy. Laparoscopic interventions reach their limits with regard to organ preservation and the simultaneous desire to have children in the removal of multiple and larger intramural myoma nodes. The aim of this study is to examine fertility status and pregnancy outcome after myoma removal by minilaparotomy (skin incision maximal 8 cm) in women with pronounced uterus myomatosus. Materials and Methods: This retrospective study makes use of the data from 160 patients with an average age of 34.6 years. Factors analysed include number, size and localisation of the myomas, complaints due to the myoma, pre- and postoperative gravidity, mode of delivery, and complications of birth. Results: Indications for organ-sparing myoma enucleation were the desire to have children (72.5 %), bleeding disorders (60 %) and pressure discomfort (36.5 %). On average 4.95 (SD ± 0.41), maximally 46 myomas were removed. The largest myoma had a diameter of 6.64 cm (SD ± 2.74). 82.5 % of the patients had transmural myomas, in 17.5 % the uterine cavity was inadvertently opened. On average the operating time was 163 minutes (SD ± 45.47), the blood loss 1.59 g/dL (SD ± 0.955). 60.3 % of the patients with the desire to have children became pregnant postoperatively. 75.3 % of the pregnancies were on average carried through to the 38th week (28.4 % vaginal deliveries, 71.6 % Caesarean sections). In the postoperative period there was one case of uterine rupture in the vicinity of a previous scar. Discussion: By means of the microsurgical "mini-laparotomy" even extensive myomatous uterine changes can, in the majority of cases, be operated in an organ-sparing manner with retention of the ability to conceive and to carry a pregnancy through to maturity of the infant. The risk for a postoperative uterine rupture in a subsequent pregnancy and during delivery is minimal.
Collapse
Affiliation(s)
- K. Floss
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
| | | | - S. Kundu
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
| | | | - P. Hillemanns
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
| | - C. Schippert
- Obstetrics and Gynecology, Medical School of Hannover (MHH), Hannover
| |
Collapse
|
14
|
[Post-cesarean parietal scar characteristics are predictive of pelvic adhesions. A prospective cohort study]. ACTA ACUST UNITED AC 2014; 44:621-31. [PMID: 25304098 DOI: 10.1016/j.jgyn.2014.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/07/2014] [Accepted: 08/28/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate whether abdominal scar characteristics could predict the incidence and severity of intra-abdominal adhesions found at repeat cesarean delivery. PATIENTS AND METHODS Prospective cohort study including 151pregnant women with at least one previous cesarean delivery and who delivered abdominally in the department of obstetrics and gynaecology of Farhat Hached teaching hospital-Sousse-Tunisia, during 6 months. Abdominal scar characteristics were studied. The main outcome measure(s) were the incidence and severity of intra-abdominal adhesions. Statistical analysis was performed using SPSS 18.0. RESULTS Of 151 women enrolled into this trial, 111 (73.5%) had adhesions, 57 (37.8%) had dense adhesions. Of all the abdominal scar characteristics studied, a depressed scar was associated with an increased incidence of both dense and filmy intra-abdominal adhesions and frozen pelvis if compared of women who did not have a depressed scar (P<10(-4) ; RR=7.6; IC=2.98-19.45). A number of previous cesarean section equal or more than 2 was also correlated with an increased incidence of severe intra-abdominal adhesions and frozen pelvis if compared with women who had only one previous cesarean section (P=0.002; RR=2.53; IC=1.16-5.56). DISCUSSION AND CONCLUSION A depressed abdominal scar of a previous cesarean delivery and a number of previous cesarean sections are significantly correlated with the incidence and severity of intra-abdominal adhesions.
Collapse
|
15
|
Kumakiri J, Kikuchi I, Kitade M, Jinushi M, Shinjyo A, Takeda S. Potential risk of port-site adhesions in patients after laparoscopic myomectomy using radially expanding trocars. Int J Gynaecol Obstet 2014; 128:5-9. [PMID: 25282402 DOI: 10.1016/j.ijgo.2014.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/26/2014] [Accepted: 09/11/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the incidence of port-site adhesions following use of radially expanding trocars (RETs) at laparoscopic myomectomy by observation via second-look laparoscopy (SLL). METHODS In a retrospective study, data from patients who underwent SLL after laparoscopic myomectomy between January 2007 and June 2012 at Juntendo University Hospital, Tokyo, were assessed for the incidence of port-site adhesions forming below RET incisional scars when fascial and peritoneal defects had not been closed. RESULTS During the study period, 554 patients underwent SLL, and 2176 incisional scars were examined. Adhesions were detected in 15 patients (2.8%); thus, the incidence of port-site adhesions under scars was 0.7% (15/2176). Among these 15 patients, the wounds with adhesions were located as follows: 6 (1.1%) under the umbilical scar, 5 (0.9%) under the right lower abdominal scar, 2 (0.4%) under the left upper abdominal scar, and 2 (0.4%) under the left lower abdominal scar. According to multiple regression analysis, the duration of laparoscopic myomectomy was positively associated with port-site adhesions (odds ratio, 1.79; 95% confidence interval, 1.09-2.94; P=0.02). CONCLUSION The present data suggest that the incidence of port-site hernias and adhesions under RET incisional scars is low despite the non-closure of fascial and peritoneal defects.
Collapse
Affiliation(s)
- Jun Kumakiri
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Makoto Jinushi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Azusa Shinjyo
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
16
|
Robot-assisted laparoscopy for infertility treatment: current views. Fertil Steril 2014; 101:621-6. [DOI: 10.1016/j.fertnstert.2014.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 12/22/2022]
|
17
|
Chang SJ, Kuo SM, You JL, Wu YR, Chen SY, Lee MW. Physical and biological effects of gellan gum on decreasing postoperative adhesion in a rat model. J BIOACT COMPAT POL 2013. [DOI: 10.1177/0883911513475942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An antiadhesion membrane made from gellan gum was fabricated and characterized. A 12-µm-thick membrane of gellan gum was prepared and reacted with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide to obtain a cross-linked membrane (G/A70) with 87% gel content and a tensile strength of 46.5 MPa. In vivo, the G/A70 membrane had 90% less tissue adhesion. Inflammation-related and extracellular matrix protein gene expression in a rat model of abdominal surgery was found by real-time quantitative reverse transcription polymerase chain reaction analysis. On day 3, after surgery, the gene expression of ceruloplasmin and type V collagen in the G/A70-treated group was 1.9 and 0.3 times that of the control group, respectively. The G/A70 membrane elicited mild inflammation but suppressed type V collagen synthesis and reduced the occurrence of tissue adhesion. These findings provide insights into the properties of gellan gum antiadhesion membranes and help to overcome problems involving tissue adhesions in surgical procedures.
Collapse
Affiliation(s)
- Shwu-Jen Chang
- Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Shyh-Ming Kuo
- Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jhen-Lin You
- Department of Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Rong Wu
- Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Ying Chen
- Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Wei Lee
- Department of Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| |
Collapse
|
18
|
Mettler L, Sammur W, Schollmeyer T, Alkatout I. Cross-linked sodium hyaluronate, an anti-adhesion barrier gel in gynaecological endoscopic surgery. MINIM INVASIV THER 2013; 22:260-5. [PMID: 23289513 DOI: 10.3109/13645706.2012.751034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In the context of common adhesion prevention in laparotomic, laparoscopic and hysteroscopic surgery this article details the effects of a cross-linked sodium hyaluronate anti-adhesion barrier gel. The observed adhesion score is expressed in the following three measurements: Severity, extent and incidents of adhesions. MATERIAL AND METHODS From a total of 85 patients treated by laparoscopy and hysteroscopy, a second look endoscopic procedure could be performed in 35 cases. RESULTS Our preliminary, short evaluation of 35 patients submitted to a second look laparoscopy or hysteroscopy revealed the beneficial effect of the applied HYAcorp endo gel, showing only a minimal amount of adhesions at the second look observation. CONCLUSION Cross-linked sodium hyaluronate is highly effective in the prevention of adhesions at laparoscopic and hysteroscopic surgery.
Collapse
Affiliation(s)
- Liselotte Mettler
- Department of Obstetrics & Gynecology, University Hospitals Schleswig-Holstein , Campus Kiel , Germany
| | | | | | | |
Collapse
|
19
|
|
20
|
Mettler L, Schollmeyer T, Alkatout I. Adhesions during and after Surgical Procedures, their Prevention and Impact on Women'S Health. WOMENS HEALTH 2012; 8:495-8. [DOI: 10.2217/whe.12.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Liselotte Mettler
- Department of Gynaecology & Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, House 24, 24105 Kiel, Germany
| | - Thoralf Schollmeyer
- Department of Gynaecology & Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, House 24, 24105 Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynaecology & Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, House 24, 24105 Kiel, Germany
| |
Collapse
|
21
|
Hirschelmann A, Wallwiener CW, Wallwiener M, Weyhe D, Tchartchian G, Hackethal A, De Wilde RL. Is Patient Education About Adhesions a Requirement in Abdominopelvic Surgery? Geburtshilfe Frauenheilkd 2012; 72:299-304. [PMID: 25284835 DOI: 10.1055/s-0031-1298425] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/17/2012] [Accepted: 02/28/2012] [Indexed: 12/14/2022] Open
Abstract
Background: Over the past decades, our knowledge and understanding of adhesions and adhesion-related complications has increasingly grown and it has become evident that adhesions have significant implications for patients, physicians and the healthcare system. The question arises whether this has resulted in greater awareness of adhesion-related problems among practicing physicians and appropriate patient education on this topic in daily practice. The following article provides a brief overview of the important subject of adhesions, discusses current awareness of adhesions among patients and doctors and addresses the consequences of failure to provide patient education and consent from a medical perspective. Methods: Selective literature searches were conducted in PubMed and the Cochrane Library. A patient information and consent form was developed based on several years' experience and expertise in the field of adhesions. Results: Adhesions are the most common type of complication in abdominopelvic surgery today, with devastating consequences for some patients. Surveys investigating the awareness of adhesions among physicians and patients clearly showed that even well-informed physicians fail to educate their patients adequately. Such failure could potentially lead to successful medical malpractice lawsuits against doctors. Conclusion: Considering their clear clinical impact, adhesions and related consequences should always be discussed with patients preoperatively. A newly developed consent form that specifically addresses adhesion formation may serve to thoroughly educate patients preoperatively and to adequately document the process of doing so.
Collapse
Affiliation(s)
- A Hirschelmann
- Department of Gynaecology, Obstetrics and Gynaecological Oncology, Pius-Hospital, Oldenburg
| | - C W Wallwiener
- Division of Gynaecological Surgery, Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen
| | - M Wallwiener
- Department of Obstetrics and Gynaecology, University of Heidelberg, Heidelberg
| | - D Weyhe
- Department of General and Visceral Surgery, Pius-Hospital, Oldenburg
| | - G Tchartchian
- Clinic for Minimal Invasive Surgery, Berlin-Zehlendorf
| | - A Hackethal
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Herston, Queensland, Austria
| | - R L De Wilde
- Department of Gynaecology, Obstetrics and Gynaecological Oncology, Pius-Hospital, Oldenburg
| |
Collapse
|
22
|
Pouly JL, Darai E, Yazbeck C, Benifla JL, Dechaud H, Wattiez A, Crowe A, Audebert A. [Postoperative abdominal adhesions and their prevention in gynaecological surgery: II. How can they be prevented?]. ACTA ACUST UNITED AC 2011; 40:419-28. [PMID: 22137338 DOI: 10.1016/j.gyobfe.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 09/02/2011] [Indexed: 01/07/2023]
Abstract
This paper is the second of a two-part publication. The initial paper provided a comprehensive overview of the evidence on adhesions to allow gynaecological surgeons to be best informed on adhesions, their development, impact on patients, health systems and surgical outcomes. There is rising evidence that surgeons can take important steps to reduce the burden of adhesions. In this second paper, we review the various strategies to reduce the impact of adhesions, improve surgical outcomes and provide some practical proposals for action on adhesions. As well as improvements in surgical technique, developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving outcomes for patients. They should be considered for use particularly in high-risk surgery and in patients with adhesiogenic conditions. Further research into new strategies to prevent adhesions more effectively through an improved surgical environment, new and combination devices and pharmacological agents should be encouraged. Formal recommendations would ensure better prioritisation of adhesion-reduction within the French health system. Patients should also be better informed of the risks of adhesions.
Collapse
Affiliation(s)
- J-L Pouly
- Unité de FIV, pôle gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1 place Lucie-Aubrac, Clermont-Ferrand, France.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Delling U, Stoebe S, Brehm W. Hand-assisted laparoscopic adhesiolysis of extensive small intestinal adhesions in a mare after breeding injury. EQUINE VET EDUC 2011. [DOI: 10.1111/j.2042-3292.2011.00333.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
24
|
Hackethal A, Sick C, Szalay G, Puntambekar S, Joseph K, Langde S, Oehmke F, Tinneberg HR, Muenstedt K. Intra-abdominal adhesion formation: does surgical approach matter? Questionnaire survey of South Asian surgeons and literature review. J Obstet Gynaecol Res 2011; 37:1382-90. [PMID: 21599803 DOI: 10.1111/j.1447-0756.2011.01543.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM The impact of postsurgical intra-abdominal adhesions, which represent a considerable burden for patients and health services, is often underestimated. Various factors influence adhesion formation, including the surgical approach. This study aimed to further understand the condition by investigating surgeons' perceptions of adhesion formation, particularly differences after laparoscopic and open surgery, and by performing a selective literature review. MATERIALS AND METHODS South Asian surgeons attending endoscopy symposia in India and in Germany completed Likert-scale-based questionnaires on awareness of adhesion formation and associated consequences in gynecology. MEDLINE and PubMed were searched for articles published in 2000-2010 comparing laparoscopy and laparotomy in relation to adhesion formation. The results of the questionnaire study were then considered in view of findings from this review. RESULTS In total, 43.1% (97/225) of questionnaires were completed. Respondents considered that laparoscopy caused fewer adhesions than laparotomy for all gynecological procedures. Although they believed their knowledge of adhesion formation was satisfactory, they widely underestimated the risk, giving estimated rates of 12.5% after laparoscopy and 36.3% after laparotomy. Twenty-eight studies were identified in the review. Most concluded that laparoscopy was less likely to cause adhesions than laparotomy but further statistical analysis was precluded because so many different definitions and classifications of adhesions had been used. CONCLUSIONS The risk of adhesion formation was widely underestimated in the study group. Both the questionnaire study and the review concluded that laparoscopy results in less adhesion than laparotomy but further statistical comparison necessitates the development of standard definitions and classifications of adhesions.
Collapse
Affiliation(s)
- Andreas Hackethal
- Department of Obstetrics and Gynaecology, Justus-Liebig-University of Giessen, Giessen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Brummer THI, Jalkanen J, Fraser J, Heikkinen AM, Kauko M, Mäkinen J, Seppälä T, Sjöberg J, Tomás E, Härkki P. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod 2011; 26:1741-51. [PMID: 21540244 DOI: 10.1093/humrep/der116] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hysterectomy guidelines highlight an increase in urinary tract injuries with laparoscopic hysterectomy (LH). This national survey analyses complications of LH, abdominal hysterectomy (AH) and vaginal hysterectomy (VH). METHODS A prospective cohort undergoing hysterectomy for benign indications during 2006 was drawn from 53 hospitals in Finland; all communal hospitals participated. Detailed questionnaires covered surgical data and intra- and post-operative major and minor complications, for which risk factors were analysed by a multivariate logistic regression model adjusted for surgical data and patient characteristics. RESULTS Major complications rates in AH (n= 1255, 24%), LH (1679, 32%) and VH (2345, 44%) were 4.0, 4.3 and 2.6%, and total complications rates were 19.2, 15.4 and 11.7%, respectively. Logistic regression showed no statistically significant differences between approaches for any organ injuries or other major complications. Most bladder and bowel injuries (88 and 83%), but not ureter injuries (10%), were recognized intra-operatively. The ureter injury rate was low after LH (0.3%), as it was after other types of hysterectomy. Compared with LH, AH increased the odds of wound infection, and was an independent risk factor for urinary infections and febrile events. Compared with AH, LH and VH both presented a higher risk for pelvic infection; surgically treated equally often regardless of the type of hysterectomy. No differences in complications emerged between LH and VH. Obesity was a risk factor for many infections. Surgical adhesiolysis [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.38-4.21] was the strongest single risk factor for major complications as a whole. Bladder injury was associated with a history of caesarean section (OR 4.01, 95% CI 2.06-7.83) and with a large uterus ≥500 g (OR 2.88, 95% CI 1.05-7.90), while bowel injury was associated with adhesiolysis (OR 29.07, 95% CI 7.17-117.88). CONCLUSIONS FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive.
Collapse
Affiliation(s)
- Tea H I Brummer
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|