[Laparoscopic management of ectopic pregnancy about 166 cases]

The ectopic pregnancy [EP] is a frequent and serious pathology. It represents a medical and surgical emergency. To study the epidemiologic profile and to evaluate the laparoscopic management of ectopic pregnancy by comparing our results with those of the literature. Retrospective study of 166 cases of ectopic pregnancies treated by laparoscopy in the department of obstetric and gynaecology of the Charles Nicolle Hospital, over one period of five years [January 2002-December 2006]. The mean age of the patients was 32.07 years [21-41]. The mean parity was 1, 42 [27.71%when nulliparous]. 9.03%of our patients had a history of ER Clinical symptomatology was dominated by the pelvic pains and the bleeding in 90%of the cases. The amenorrhoea missed in 32 patients. The rate of beta HCG was superior to 1500 at 47.61%of the patients. The pelvic ultrasonography carried out in all the patients, objectified a pelvic mass in 81.92%of the cases. Serology of chlamydiaewas positive at 9.03%of the patients. The laparoscopy was initially indicated in 155 patients; a medical treatment with methotrexate was begun in the six other patients. A laparoconversion was indicated in 16 cases, 9 times for operational difficulties and 7 times for a hemorrhagic complication. A salpingectomy was practised in 79.72%of the cases. The treatment was conservative in 20.27%of the cases. The laparoscopic treatment at best conservative should be the gold standard in the treatment of EP in order to preserve the fertility of the patients. who are generally young

[Laparoscopic treatment of adnexal abscess - about 86 cases]

To Specify the epidemiological profile of the patients presenting an adnexal abscess the therapeutic modes and the ulterior fertility. Retrospective clinic survey about 86 cases of adnexal abscess collected in the Service A of the Center of Motherhood and Neonatology the Rabta Turns during a period of 7 years going from January 1996 to December 2002 A laparoscopic drainage has been achieved in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later. The clinic symptomatology was dominated by the pelvic pain [97% and the fever in 65% of cases A latero - uterine adnexal mass has been discerned m 56% of patients. The echography practiced in all cases evoked the diagnosis in 49 cases. The exclusive laparoscopy permitted a conservative treatment in 52% of the cases. No new immediate operation was necessary in the first two months after the initial surgery. At the time of the control laparoscopy an adhesiolysis was made in any case necessary. A distal tuboplasty has been achieved in 17 patients and 6 patients were sent in IVF. Thereafter, 12 patients out of 19 that didn't use a contraceptive mean had a spontaneous intra-uterine pregnancy [63%]. Conclusion this survey confirms that the laparoscopic surgery is a sure and efficient technique for the treatment of the adnexal abscesses The anatomical results observed at the time of the control suggests that this second surgical phase is essential for the patients who want a future pregnancy

[Complications of the diagnostic and operational coelioscopies in gynaecology, about 5049 cases]

To present and compare with the literature, the complications which have occurred during 10 years of coelioscopic experiment. Material and processes: 5049 diagnostic and operational coelioscopies were practiced between January 1990 and December 2003 in the obstetric service of gynaecology "A" of the center of maternity and neonatology of Tunis. The major or advanced acts accounted for 28.5% of the practiced ccelioscopies. The rate of complications related to the phase of installation of the coelioscopy was 6.45%. 93.6% of our complications occurred at the time of major or advanced coelioscopies. 32 complications having imposed the immediate or differed laparoconversion. The most frequent complications were in connection with difficulties of hemostase accounting for 59.4%. The digestive, urinary, anaesthetic and infectious complications respectively accounted for 21.8%, 9.4%, 6.25%, and 3.1% of the accidents. The respect of against indications, the preoperative digestive preparation, the vesical survey as well as the rigour in the operational gestures should reduce the risk of complications related to this technique