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Traweek R, Phan V, Griesbach C, Hall C. General Surgery During Pregnancy and Gynecologic Emergencies. Surg Clin North Am 2023; 103:1217-1229. [PMID: 37838464 DOI: 10.1016/j.suc.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Nonobstetrical surgical emergencies can occur throughout pregnancy but are often difficult to diagnose due to the physiologic and anatomical changes that occur during pregnancy. Medical providers should have insight into these changes and be familiar with options for the diagnosis and management of common nonobstetrical surgical emergencies, such as appendicitis, cholecystitis, and small bowel obstruction. Surgeons should also be aware of obstetrical emergencies, such as ectopic pregnancy and severe vaginal bleeding, which may be life threatening to mother and the fetus. Intraoperatively, surgeons should be familiar with minimally invasive approaches for surgical diseases and special anesthetic considerations for pregnant patients.
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Affiliation(s)
- Raymond Traweek
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Vivy Phan
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Griesbach
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Hall
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA.
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2
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Cusimano MC, Liu J, Azizi P, Zipursky J, Sajewycz K, Sussman J, Kishibe T, Wong E, Ferguson SE, D'Souza R, Baxter NN. Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy: A Systematic Review and Meta-analysis. Ann Surg 2023; 278:e147-e157. [PMID: 34966066 DOI: 10.1097/sla.0000000000005362] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy. SUMMARY BACKGROUND DATA Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking. METHODS We systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link. RESULTS We identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimesters (fetal loss 2.9%, preterm birth 5.6%). CONCLUSIONS Absolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jessica Liu
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
| | - Paymon Azizi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
| | - Jonathan Zipursky
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katrina Sajewycz
- School of Medicine, Faculty ofHealth Sciences, Queen's University, Kingston, ON, Canada
| | - Jess Sussman
- School of Medicine, Faculty ofMedicine, University of Toronto, Toronto, ON, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Health Sciences Library, St. Michael's Hospital, Toronto, ON, Canada
| | - Eric Wong
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/Sinai Health Systems, Toronto, ON, Canada
| | - Rohan D'Souza
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Maternal Fetal Medicine, Mount Sinai Hospital/Sinai Health Systems, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne ViC, Australia
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3
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Takeda A, Hayashi S. Gasless laparoendoscopic single-site assisted extracorporeal ovarian cystectomy through the umbilicus for the management of ovarian torsion at 33 weeks of gestation: A case report with literature review. Case Rep Womens Health 2023; 38:e00517. [PMID: 37324931 PMCID: PMC10267531 DOI: 10.1016/j.crwh.2023.e00517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Ovarian torsion in the third trimester of pregnancy is a rare but potentially dangerous non-obstetric complication for both mother and fetus and presents a diagnostic and therapeutic challenge for the treating physicians. A 39-year-old woman (gravida 2, para 1) presented at 7 weeks of gestation. Asymptomatic bilateral small ovarian cysts were diagnosed at the initial presentation. Progesterone was intramuscularly administered every 2 weeks after 28 weeks of gestation because of uterine cervical length shortening. Sudden onset of right lateral abdominal pain was reported at 33 weeks and 2 days of gestation. Emergency laparoendoscopic single-site (LESS) surgery was performed through the umbilicus under strong suspicion of right adnexal torsion with ovarian cyst, as indicated by magnetic resonance imaging a day after admission. Isolated right ovarian torsion without fallopian tube involvement was identified under laparoscopic view. The contents of the right ovarian cyst were aspirated after confirming resumption of color tone of the right ovary after detorsion. Then, the right adnexal tissue was grasped through the umbilicus, followed by a successful ovarian cystectomy under direct vision. Tocolysis was postoperatively attempted by intravenous ritodorine hydrochloride and magnesium sulfate administration, which was continued through to 36 weeks and 4 days of gestation, because of increased uterine contraction frequency. The next day, spontaneous labor occurred, followed by the vaginal delivery of a healthy 2108-g female infant. The postnatal course was uneventful. Transumbilical LESS-assisted extracorporeal ovarian cystectomy is a feasible and minimally invasive option for ovarian torsion management in the third trimester of pregnancy.
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Affiliation(s)
- Akihiro Takeda
- Corresponding author at: Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan.
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Didar H, Najafiarab H, Keyvanfar A, Hajikhani B, Ghotbi E, Kazemi SN. Adnexal torsion in pregnancy: A systematic review of case reports and case series. Am J Emerg Med 2023; 65:43-52. [PMID: 36584539 DOI: 10.1016/j.ajem.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study aimed to investigate clinical presentations, surgical procedures and findings, complications, and predisposing factors of adnexal torsion in pregnant women. METHODS We searched PubMed/Medline, Embase, and Web of Science from January 2000 to March 2022. All case reports and case series with full-text English language reporting adnexal torsion in pregnant women were included. Medical history, clinical presentations, surgical procedures and findings, complications related to adnexal torsion, and predisposing factors were independently extracted by two investigators. RESULTS A total of 182 articles reporting 662 pregnant women with adnexal torsion were included. Most of the adnexal torsions occurred during the first trimester (54.63%), while others occurred during the second (26.36%) and third (19.00%) trimesters. The most common symptom of adnexal torsion was sudden-onset pain (80.60%). Enlargement of the adnexa was the most prevalent ultrasound finding in a twisted adnexa (95.20%). Additionally, about half of the patients had decreased blood flow in Doppler ultrasound (53.80%). Laparoscopic surgery was the favorite option (56.88%), while cystectomy and detorsion were the most commonly performed procedure (29.06%). Expectant management was reported in only 2.99% of the patients. In addition, the most common complications were preterm labor (27.58%) and emergent cesarean sections (25.28%). CONCLUSIONS Clinicians should think of adnexal torsion when pregnant women complain of sudden-onset pain. Then, using ultrasound, adnexal enlargement or masses should be explored seriously. They should take invasive and urgent therapy to preserve ovaries and prevent complications.
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Affiliation(s)
- Hamidreza Didar
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Najafiarab
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Keyvanfar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elena Ghotbi
- Department of Obstetrics and Gynecology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Neda Kazemi
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran.
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Jo JY, Cho IA, Shin JK, Lee SA, Choi WJ. Laparoscopic surgery for fallopian tube torsion due to benign tumour in the third trimester of pregnancy: a case report and literature review. J OBSTET GYNAECOL 2022; 42:2566-2572. [PMID: 35929982 DOI: 10.1080/01443615.2022.2107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Isolated fallopian tubal torsion is rare among women of reproductive age, and it is even rarer during pregnancy. Despite its rare incidence, it is important to consider this diagnosis to facilitate prompt and effective intervention. We present the case of a pregnant woman in her third trimester who presented with acute right abdominal pain. A 32-year-old primigravida woman at 29 weeks and four days of gestation visited the emergency department with acute right flank and abdominal pain. Sonography and MRI revealed the presence of a right adnexal cystic mass. Exploratory laparoscopy revealed isolated right tubal torsion and a normal ovary. To avoid torsion recurrence, we performed laparoscopic right salpingectomy. The remainder of her gestation was uneventful. Histopathological examination revealed serous cystadenoma with haemorrhagic infarction. We reviewed the literature for cases of isolated tubal torsion in the past 11 years. Twenty-three case reports were included in this study, and the average time from presentation to surgical intervention was 35.6 hours. In these cases, most of the patients underwent laparotomy and had good pregnancy outcomes. Although the approach may vary depending on the situation, the laparoscopic approach should be preferred to laparotomy in the third trimester of pregnancy.
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Affiliation(s)
- Jae Yoon Jo
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - In Ae Cho
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Jeong Kyu Shin
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Soon Ae Lee
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Won Jun Choi
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Abstract
Acute appendicitis is the most common surgical pathology during pregnancy. It occurs in about 1 in 500 to 1 in 635 pregnancies per year,[1] and appendectomy is the gold standard in the treatment approach.[2] However, its diagnosis represents a challenge to both surgeons and obstetrician-gynecologists. In addition, the role of laparoscopy remains controversial. This study discusses the diagnostic approach and reviews the appropriate surgical approach while evaluating the part of laparoscopy. This is a retrospective descriptive analysis reviewing 36 patients who underwent surgery for acute appendicitis during pregnancy at the "Surgery Department of Jendouba Hospital from January 1, 2005 to December 31, 2019. Data include age, comorbidities, previous abdominal surgery, symptoms, physical examination findings, complementary exams results, operative treatment details, the emergency status of the procedure, associated medical treatment, antibiotics and tocolysis, the pathology reports, and follow-up. The mean age of patients was 27 years. Twenty-one patients (58, 33%) were in the second trimester of pregnancy, 6 patients (16, 66 %) were in the first trimester, and 9 (25%) in the third one. The physical examination reported a right iliac fossa tenderness in 27 patients (75%). The abdominal ultrasound was performed in all cases and guided the diagnosis in 24 cases (66, 66%). 18 patients (50%) underwent laparoscopy, 12 patients (33, 33%) underwent laparotomy. The remaining 6 patients (16, 66%) required a conversion from laparoscopic to open surgery. The clinical presentation of appendicitis in pregnancy is often misguiding. Therefore, an abdominal ultrasound should be performed for all pregnant patients having abdominal pain. The difficulty of operating under laparoscopy increases with the pregnancy term, leading to a higher risk of conversion, which increases the operating time and the doses of anesthetics, causing a maternal and fetal risk.
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Affiliation(s)
- Atef Mejri
- Tunis El Manar University, Tunisia
- Department of General Surgery, Jendouba Hospital, Tunisia
| | - Khaoula Arfaoui
- Tunis El Manar University, Tunisia
- Department of General Surgery, Jendouba Hospital, Tunisia
- *Correspondence: Khaoula, Arfaoui, (e-mail: )
| | - Emna Trigui
- Tunis El Manar University, Tunisia
- Department of Obstetrics and Gynecology, Jendouba Hospital, Tunisia
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Ekici H, Okmen F, Imamoglu M, Hortu I, Akdemir A. Perioperative Outcomes in Pregnant Women Who Underwent Surgery for Adnexal Torsion. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:336-342. [PMID: 35139568 PMCID: PMC9948234 DOI: 10.1055/s-0042-1742403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate clinical characteristics, maternal and fetal outcomes in pregnant women who underwent surgery for adnexal torsion (AT). METHODS All patients, who underwent surgical operation due to AT during pregnancy at the Department of Obstetrics and Gynecology, School of Medicine, Ege University between 2005 and 2020 were retrospectively investigated. Main clinical and perioperative outcomes were evaluated. RESULTS A total of 21 patients who underwent surgery due to AT during pregnancy were included. Of all patients, 61.9% underwent laparoscopy and the remaining 38.1% underwent laparotomy. The most common surgical procedure was adnexal detorsion in both groups (48%). Mean gestational age at the time of diagnosis, duration of surgery and hospitalization were significantly lower in the laparoscopy group, when compared with the laparotomy group (p = 0.006, p = 0.001, and p = 0.001, respectively.) One of the patients had an infection during the postoperative period. Spontaneous abortion was only observed in one case. CONCLUSION It can be concluded that the surgical intervention implemented for the exact diagnosis and treatment of AT (laparotomy or laparoscopy) did not have an unfavorable effect on pregnancy outcomes such as abortion, preterm delivery, and fetal anomaly. However, laparoscopy may be superior to laparotomy in terms of advantages.
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Affiliation(s)
- Huseyin Ekici
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Fırat Okmen
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Metehan Imamoglu
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey.,Department of Obstetrics and Gynecology, School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey.,Department of Stem Cell, Institute of Health Sciences, Ege University, Izmir, Turkey.,Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey.,Department of Stem Cell, Institute of Health Sciences, Ege University, Izmir, Turkey
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Analysis of 190 Female Patients after Appendectomy. Obstet Gynecol Int 2021; 2021:8036970. [PMID: 34873404 PMCID: PMC8643258 DOI: 10.1155/2021/8036970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/16/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
This study is a retrospective cohort review carried out at a single, private tertiary center. We included 190 female patients who underwent surgery for acute appendicitis between January 2016 and December 2018. Two groups of patients were analyzed based on the pregnancy. The main outcome measures were complication rate and risk of abortion during or after surgery. Out of 190 female patients, eight of them were pregnant (4.2%). The pregnant group more significantly underwent ultrasound investigation compared to the nonpregnant group. Complicated appendicitis present in two pregnant patients at advanced gestational age was not statistically significant from nonpregnant. Laparoscopic appendectomy was performed in 6/8 (75%) of pregnant compared to 158/182 (87%) in nonpregnant (p = 0.415). Compared to the nonpregnant, the pregnant group has a more fecolith, positive peritoneal fluid culture, and wound infection, with E. coli more frequently isolated in 25%. None of the pregnant patients had an abortion, preterm labor, or mortality during or after surgery. In conclusion, laparoscopic appendectomy is a low-risk operation for pregnant with acute appendicitis.
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Deleuze S, Brotcorne F, Polet R, Soma G, Rigaux G, Giraud G, Cloutier F, Poncin P, Wandia N, Huynen MC. Tubectomy of Pregnant and Non-pregnant Female Balinese Macaques ( Macaca Fascicularis) With Post-operative Monitoring. Front Vet Sci 2021; 8:688656. [PMID: 34568470 PMCID: PMC8458650 DOI: 10.3389/fvets.2021.688656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Worldwide, primates, and humans increasingly share habitats and often enter in conflict when primates thrive in human-dominated environments, calling for special management measures. Reproductive control is increasingly used to manage population growth but very few monitoring data are available. Therefore, the efficiency and implications of such programs require a careful examination. In the context of a contraception program in wild female long-tailed macaques in Ubud, Bali, conducted over four successive campaigns between 2017 and 2019, including 140 females (i.e., 41.9% of the reproductive females of the population in 2019), modifications of an endoscopic tubectomy procedure, a permanent sterilization method, clinical evaluation of this method, and the post-operative monitoring results of the neutered females after release are described. This surgical approach was applicable for pregnant females: 28.6% of the treated females were pregnant at the time of the surgery. The procedure used a single lateral port to reach and cauterize both oviducts in non-pregnant as well as in early to mid-term pregnant females. Pregnant females nearer to term required a second lateral port to access both oviducts masked by the size of the gravid uterus. Moreover, bipolar thermocauterization was utilized successfully without resection to realize the tubectomy. The average duration of the laparoscopic surgery was 14 min for non-pregnant females and 22 min for pregnant females. Animals were released 3 h 22 min in average following their capture. This short holding time, recommended for free-ranging primates, was made possible by the minimal invasiveness of the sterilization approach. A laparoscopic post-operative evaluation conducted on two patients during the following campaign confirmed that the oviducts were definitely disrupted and no longer patent. Moreover, no new pregnancies in sterilized females were recorded during the 3-year observation period. The survival rate of the treated females 6 months after sterilization was high (96.3%) with no major post-operative complications clinically recorded. Among females that were pregnant during surgery, 81.1% were confirmed to experience term delivery. This study demonstrates the safety and efficiency of endoscopic tubectomy, even for pregnant females, as a mean of wild macaques' population control.
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Affiliation(s)
- Stefan Deleuze
- Research Unit FARAH, Equine and Companion Animal Reproduction Pathologies Clinic, Veterinary Medicine Faculty, University of Liège, Liège, Belgium
| | - Fany Brotcorne
- Research Unit SPHERES, Department of Biology, Ecology and Evolution, Sciences Faculty, University of Liège, Liège, Belgium
| | - Roland Polet
- Research Unit SPHERES, Department of Biology, Ecology and Evolution, Sciences Faculty, University of Liège, Liège, Belgium
| | - Gede Soma
- Primate Research Center, Veterinary Medicine Faculty, Udayana University, Denpasar, Indonesia
| | | | - Gwennan Giraud
- Research Unit SPHERES, Department of Biology, Ecology and Evolution, Sciences Faculty, University of Liège, Liège, Belgium
| | - Fanny Cloutier
- Research Unit SPHERES, Department of Biology, Ecology and Evolution, Sciences Faculty, University of Liège, Liège, Belgium
| | - Pascal Poncin
- Research Unit FOCUS, Department of Biology, Ecology and Evolution, University of Liège, Liège, Belgium
| | - Nengah Wandia
- Primate Research Center, Veterinary Medicine Faculty, Udayana University, Denpasar, Indonesia
| | - Marie-Claude Huynen
- Research Unit SPHERES, Department of Biology, Ecology and Evolution, Sciences Faculty, University of Liège, Liège, Belgium
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Laparoscopic appendectomy with left lateral tilt in pregnant women in the second and third trimesters: A clinical case series in a single Vietnam centre. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Li C, Guo L, Luo M, Guo M, Li J, Zhang S, Liu G. Risk factors of uterine contraction after ureteroscopy in pregnant women with renal colic. Int Urol Nephrol 2021; 53:1987-1993. [PMID: 34227015 PMCID: PMC8463365 DOI: 10.1007/s11255-021-02932-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
Background Ureteroscopy is widely applied in pregnant women with renal colic, but such patients are easy to experience uterine contraction after surgery. There are many factors which may affect uterine contraction, this study aims to explore the risk factors of uterine contraction triggered by ureteroscopy in pregnant women with renal colic. Methods One hundred and one pregnant women were retrospectively analyzed, the patients were hospitalized because of severe renal colic. All patients received ureteroscopy during which double J catheters were inserted into ureters for drainage. Patients received other medical treatments individually according to their condition and uterine contractions were detected by EHG within 12 h after operation. Patients were classified as group A (uterine contraction) and group B (no uterine contraction) according to the presence or absence of continuously regular uterine contraction. Clinical characteristics were collected for further analysis, including history of childbirth, anesthesia method, application of phloroglucinol or not, operation time, Oxygen inhalation or not, pain relief or not after surgery, systemic inflammatory response syndrome (SIRS) occurred or not. A binary logistic regression analysis model was established to explore whether such clinical characteristics were relevant to uterine contraction after ureteroscopy. Results Continuously regular uterine contraction presented in 46 pregnant women within 12 h after ureteroscopy, making the incidence of uterine contraction as high as 45.54%. The presence of uterine contraction was related to the following factors(P < 0.05): history of childbirth (primipara versus multipara)(OR 6.593, 95% CI 2.231–19.490), operation time (each quarter additional) (OR 2.385, 95% CI 1.342–4.238), application of phloroglucinol (yes versus not) (OR 6.959, 95% CI 1.416–34.194), pain relief after surgery(yes versus not)(OR 6.707, 95% CI 1.978–22.738), SIRS occurred after surgery (yes versus not) (OR 0.099, 95% CI 0.014–0.713). Conclusion Continuously regular uterine contraction is easy to occur within 12 h after ureteroscopy in pregnant women. SIRS occurred after surgery is a risk factor for uterine contraction; on the contrary, no history of childbirth, shorter operation time, application of phloroglucinol, pain relief after surgery are protective factors.
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Affiliation(s)
- Chunjing Li
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China.
| | - Liwen Guo
- Department of Gynecology, Ningde Municipal Hospital, Fujian Medical University, Ningde, Fujian, 352100, People's Republic of China
| | - Mi Luo
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Mingjuan Guo
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Jierong Li
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Shilin Zhang
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Guoqing Liu
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China.
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Elci E. Prise en charge laparoscopique d'une torsion de masse annexielle au troisième trimestre de la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:337-338. [PMID: 34226139 DOI: 10.1016/j.jogc.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Erkan Elci
- University of Healty Umraniye Traning and Research Hospital Department of Obstetrics and Gynecology, Istanbul, Turkey.
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13
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Laparoscopic management of a torsioned adnexal mass in the third trimester of pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:335-336. [PMID: 34465550 DOI: 10.1016/j.jogc.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022]
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Association of laparoscopy and laparotomy with adverse fetal outcomes: a retrospective population-based case-control study. Surg Endosc 2020; 35:6048-6054. [PMID: 33048230 DOI: 10.1007/s00464-020-08094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to evaluate fetal adverse outcomes of laparoscopy and laparotomy in pregnant women to determine the safety of these surgical approaches. METHODS This was a retrospective nationwide case-control study of women who became pregnant for the first time between 2000 and 2012 in Taiwan. The case (with adverse fetal outcomes) and control groups comprised 208,604 and 417,124 participants, respectively. Participants who underwent appendectomy, cholecystectomy, ovarian cystectomy, or myomectomy were treated with either laparoscopy or laparotomy. A conditional logistic regression model was used to calculate the odds ratios (ORs) for adverse fetal outcomes. RESULTS The laparotomy and laparoscopy groups comprised 632 and 536 patients, respectively. Women who underwent laparoscopy had a significantly higher risk of adverse fetal outcomes (adjusted OR [AOR] = 2.33; 95% CI 1.66-2.99) than those who underwent laparotomy. Adverse fetal outcomes were found to be significantly associated with laparoscopy among women aged 20-39 years (AOR = 2.30; 95% CI 1.70-3.31). Regarding surgical indication, unlike laparotomy, laparoscopic cholecystectomy and appendectomy were not associated with adverse fetal outcomes. However, laparoscopic myomectomy and ovarian surgeries were associated with a higher incidence of adverse fetal outcomes than the laparotomy group (AOR = 2.29 [95% CI 1.57-3.35, p < 0.0001] and AOR = 2.52 [95% CI 1.58-4.04, p = 0.0001], respectively). CONCLUSIONS Pregnant women who underwent laparoscopic surgery experienced significantly more adverse fetal outcomes than those who underwent laparotomy. Therefore, pregnant women undergoing either laparotomy or laparoscopy should be informed of the risk of adverse fetal outcomes.
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Danawar NA, Mekaiel A, Raut S, Reddy I, Malik BH. How to Treat Hernias in Pregnant Women? Cureus 2020; 12:e8959. [PMID: 32766002 PMCID: PMC7398739 DOI: 10.7759/cureus.8959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022] Open
Abstract
A hernia is a common surgical problem. Although hernias during pregnancy are uncommon, they can be challenging for both the surgeon and the patient if present. To date, there is no consensus in the medical community regarding the elective repair of hernias in pregnant women. The debate mainly concerns three areas: the timing, the approach, and the surgical technique. This study aims to offer a clear pathway in this field based on the best available data. In this study, we collected reviews written in English and published in PubMed from 2010 to 2020 (the exception being three articles that were published before 2010, which we retained since they contained relevant information). We used regular and Medical Subject Headings (MeSH) keywords. Two of the authors screened the collected studies to select the best articles that would fit our inclusion criteria for the review. The articles considered for this review can be classified into retrospective studies, case reports, and reviews. No randomized controlled trials were found. The lack of an agreement about the treatment of ventral hernias in fertile women makes the decision to treat and the process challenging. The treatment significantly depends on two factors: the symptoms and the pregnancy status at diagnosis. If the hernia is incarcerated or strangulated at presentation, an emergency repair is obligatory. If the hernia is symptomatic, but not complicated, elective surgery should be offered. The timing of repair will depend on whether the patient is already pregnant or non-pregnant. In pregnant patients, if the hernia is small and asymptomatic, it may be better to delay the surgery until after delivery or after the last pregnancy. If the hernia is symptomatic and seems to affect the patient's quality of life, it may be better to postpone the repair until the second trimester or after delivery if complications do not occur. Internal herniation (IH) should be suspected as a cause of the abdominal pain in pregnant women who have undergone laparoscopic Roux-en-Y gastric bypass (LRYGB). In pre-pregnancy patients, if the hernia is large and symptomatic, it may be better to do an elective repair and then wait for one or two years before the next pregnancy. However, if the hernia is small or minimally symptomatic, it may be better to hold the repair until after delivery or after the last pregnancy. Pregnancy may be considered a significant risk factor for hernia recurrence. The laparoscopic mesh repair should be offered whenever possible, whereas the open approach may be preferred in complicated cases. The suture repair may be suitable for both small hernias and in cases of gross contamination.
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Affiliation(s)
- Nuaman A Danawar
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Andrew Mekaiel
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sumit Raut
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ishani Reddy
- Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Cohen SB, Watad H, Shapira M, Goldenberg M, Mashiach R. Urgent Laparoscopic Surgeries during the Third Trimester of Pregnancy: A Case Series. J Minim Invasive Gynecol 2019; 27:909-914. [PMID: 31271895 DOI: 10.1016/j.jmig.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE Laparoscopic management of nonobstetric acute abdominal pain in the third trimester of pregnancy remains controversial with limited data regarding procedure safety and feasibility. This study aimed to investigate the feasibility, immediate complications, and short-term outcomes of laparoscopic surgery at an advanced gestational age. DESIGN Case-series. SETTING Sheba Medical Center, a tertiary referral center. PATIENTS Pregnant women who underwent urgent laparoscopic surgery at 27 weeks of gestation and above. INTERVENTION Emergent laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS Clinical data were retrospectively collected and analyzed. A telephone questionnaire was administered in cases of missing data. Clinical information obtained included detailed medical and obstetric history; preoperative, intraoperative, and postoperative data; complications; and pregnancy outcomes. Between January 2010 and July 2017, 12 patients underwent emergent laparoscopic surgeries during the third trimester of pregnancy. The gestational age at the time of the surgery ranged between 27 and 38 weeks. All women had singleton pregnancies. Laparoscopic surgeries included 7 appendectomies, 4 adnexal surgeries, and 1 diagnostic laparoscopy. No complications related to the access route for any of the 12 laparoscopic surgeries occurred. The laparoscopic surgical procedure was successfully completed in 11 patients; only 1 laparoscopic appendectomy for perforated acute appendicitis with purulent peritonitis at 30 weeks of gestation was converted to laparotomy because of a limited operative field. Two patients had preterm labor at 35 and 36 weeks of gestation, respectively. None of the women was complicated with intrauterine fetal demise or low Apgar scores. CONCLUSION Our results demonstrate that urgent laparoscopic surgeries in the third trimester of pregnancy are feasible and can be safely performed with minimal risk for the patient and fetus. Larger prospective studies are required to validate these recommendations.
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Affiliation(s)
- Shlomo B Cohen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Hadel Watad
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors).
| | - Moran Shapira
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Mordechai Goldenberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
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