Laparoscopic management of ovarian endometriomas comparative study incision peeling versus incision coagulation

To compare the effect of incision-peeling versus incision coagulation of pelvic endometriomas. Prospective, blind, randomized controlled study was performed on 88 patients diagnosed as having bilateral ovarian endometriomas. All patients were subjected to three puncture operative laparoscopy. In each patient one endometrioma was randomly chosen for mechanical peeling of its wall [peeled group] while the lining of the other endometrioma was coagulated. The records were blind to the observers of the results. No statistically significant difference between the two groups was found regarding the recurrence rate. While coagulated group is statistically better than peeled group regarding ovarian volume, ovarian dominance and response to clomphine citrate and ovarian dominance and number of occytes retrived during IVF and ICSI. Also there was statistically significant difference between the two groups regarding periovarian adhesions and distal tubal affection. No difference of the rate of recurrence of endometriomas either treated by laparoscopic excision of cyst wall or by coagulation. Ovarian endometriomas treated by incision, evacuation and coagulation provides for a more favourable outcome than peeling of cyst wall, with regard to the ovarian volume, the ovarian dominance and yield of follicles and the ovarian dominance and yield of oocytes. Peeling causes more periovarian adhesions and fimbrial affection of the ipsilateral tube

Hysteroscopic division of uterine septum using a right-angled electrode

Sixteen cases of diagnosed uterine septum were selected among patients presenting with infertility or repeated mid-trimester abortion. Hysteroscopic septum division using a right-angled electrode was tried under laparoscopic guidance and after exclusion of other factors that can be responsible. The whole procedure consumed an average of 25 minutes with a range of 15 to 40 minutes. All the cases were discharged on the same day. The postoperative period was smooth in all cases and minimal bleeding was reported lasting from few hours to four days and ceasing spontaneously in all patients. Hysterosalpingograms done three months after the procedure showed that 12 cases had normal configuration of the resultant cavity, in two cases the cavity was heart-shaped and in one case the septum was incompletely divided. As an intraoperative complication, a non-bleeding fundal perforation occurred in one case and was safely managed conservatively

Incidence of adhesions formation following laparoscopic ovarian endocoagulation in polycystic ovarian disease

The aim of this study was to evaluate the incidence of adhesions following laparoscopic thermocoagulation of the ovaries in twenty patients with polycytic ovarian disease [PCOD]. A second look laparoscopic examination was done after an average duration of 5. 31 months and after exclusion of pregnancy. Five cases [2.5%] achieved pregnancy four to seven months following the procedure. Laparoscopic findings of ovulatory response were found in another five cases [25%]. The second look revealed on pelvic adhesions except in four cases [26.67%] in whom the adhesions were single thin vascular bands. Tubal patency was confirmed in 14 cases [93.33%] and one single case [6.67%] showed unilateral fimbrial obstruction following the procedure

Symphysiotomy in modern obstetrics

Four hundred and sixteen cases of symphysiotomy are presented and analysed. The results indicate that the operation is a safe procedure with minimal complications. It has relative and absolute indications in modern obstetrics. It has a special place in developing countries. For over two centuries symphysiotomy has aroused great dispute in obstetric practice. The operation has never been widely adopted by the majority of obstetricians yet small enthusiastic groups of doctors are doing symphysiotomy in conditions which they consider entirely justifying its use

Culdoscopic sterilization of 262 cases

The results of surgical sterilization of 292 women using the culdoseope are presented. The operation is done under general analgesia with local anaesthesia. The operation is done in a short time, the technique is simple and hospitalization is only for one day. The efficacy of the method is very reliable and no major complications were encountered in the series presented. The operation is recommended as an ideal method of permanent contraception for couples who completed their families

Basal narcosis: a thchnique for culdoscopy in an awkward position

Culdoscopy was performed for 249 cases underbasal narcosis. This technique was used to achieve analgesia and sedation in a patient who has to be conscious and aware to be put in an awkward knee-chest position. This method was compared with other techniques used which included general, local or regional blocks. The results and side effects were discussed

Acupuncture analgesia in obstetric surgery in Alexandria. A preliminary report on 19 cases of lower segment caesarean sections and one case of abdominal hysterotomy and stcrilizatoin

Acupuncture analgcsisa was tried in 19 cases of lower segment Caesorean sections and one case of abdominal hysterotomy and sterilization. The technique Proved to be simple, safe and reliable especially when traditional anaesthsia proves to be risk