Vaginal Cuff Dehiscence After Total Laparoscopic Hysterectomy: Prospective Comparison Of Two Types Of Suturing Techniques.

BACKGROUND: To compare the frequency of vaginal cuff dehiscence after total laparoscopic hysterectomy between two different suturing techniques. Place and duration of study: The study was conducted at three centers; postgraduate tertiary care hospital, university affiliated hospital and private multidisciplinary hospital. The studied duration was from January 2019 to June 2020. METHODS: All patients with indication of total laparoscopic hysterectomy during the study period were included. These were randomly divided in to two groups A and B. Group A was performed upon the conventional interrupted figure of 8 vault suturing and group B with continuous, running, double layered suturing. Keeping the demographics almost same the frequency of a known but rare complication of vaginal cuff dehiscence (VCD) was determined. RESULTS: A total of 195 patients were enrolled. Of these 87 were in group A and 108 in group B. The results were unequivocal as only one patient had the said complication. CONCLUSIONS: The morbid complication has no relation with the technique of vault suturing.

Endometriosis - A Crippling Illness: A Rare Case Of Bladder Endometrioma.

Endometriosis is a common gynaecological condition affecting 10-12% of general female population. It has variable clinical presentation commonly causing infertility, chronic pelvic pain, and dysmenorrhea. Rare presentation could be a tender cervical/rectal mass therefore should be considered in women of reproductive age group. A 30 years old woman with 1.5 years history of heavy menstrual bleeding with painful menstruation, painful coitus, urinary hesitancy and constipation reported after visiting multiple hospitals and failed medical treatment with pelvic scans showing fibroid uterus. MRI excluded fibroid uterus and laparoscopic exploration of pelvis and subsequent histopathology confirm the mass to be bladder endometrioma.

Outcome of Total Laparoscopic Hysterectomy.

OBJECTIVE: To determine the surgical outcomes of total laparoscopic hysterectomy performed. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Obstetrics and Gynecologic Endoscopic Unit of Patel Hospital, Karachi, from February 2013 till February 2016. METHODOLOGY: The study included all patients on whom total laparoscopic hysterectomy was performed during the study period. Patients with malignancy were excluded from the study, except those with suspected stage 1 and 2 endometrial carcinoma. The procedures were performed by two gynecologists keeping rest of the team constant, with similar technique. The reviewed outcome measures were duration of surgery, and intraoperative and postoperative complications. RESULTS: Out of 209 patients, majority were multiparous with median age and weight of 45 (50-40) years and 69 (80-60) Kgs, respectively. Previous history of abdominopelvic surgery was present in 33%. Heavy menstrual bleeding was the leading indication. Median and interquartile value of operative time was 175 (225-120) minutes. Total rate of intraoperative and postoperative complications was 12.9% and major complications were 3.8%. All postoperative complications were minor. Of all, 3.3% of patients were converted to open surgery; there was no vascular injury or re-operation. CONCLUSION: Total laparoscopic hysterectomy is safe, acceptable, and doable alternative to conventional standard hysterectomy.

Laparoscopically diagnosed invasive mole presenting as acute hemoperitoneum.

A young multipara presented with acute abdominal pain. She had history of dilatation and evacuation for a missed miscarriage 2 months back. The diagnosis of ectopic pregnancy was made on the basis of clinical presentation and laboratory investigations. Laparoscopy was performed which revealed features of invasive mole. The procedure was converted to laparotomy and hysterectomy was performed. Patient recovered well. Histopathology confirmed the diagnosis of invasive mole. Follow-up till 12 weeks reported return to normal ßhCG (beta subunit of human Chorionic Gonadotropin) levels.