An adhesion barrier may induce peritonitis and abscess after laparoscopy-assisted myomectomy with vaginal extraction: report of a case.

Following a myomectomy, postoperative adhesions occur in many patients. Although laparoscopy has been shown to decrease the development of adhesions compared to laparotomy, adhesions still occur. There are several commercially available adhesion barriers but these are not designed to be easily applied during laparoscopic surgery. In this study, we report a case involving a 34-year-old patient who developed pelvic peritonitis and abscess without an obvious etiology; this might have been related to the off-label use of a bioabsorbable membrane converted into a slurry during recent surgery. Surgeons should be aware of such complications, which might be attributed to this product.

Total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries (CUA) at their origin plus total laparoscopic hysterectomy (TLH) for the management of myoma and adenomyosis.

We tried to evaluate the relative feasibility, surgical duration and complications of total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries at their origin (CUA) plus total laparoscopic hysterectomy for the management of myoma and adenomyosis, and to compare the estimated blood loss for both procedures. A total of 123 patients underwent TLH or CUA plus TLH for the treatment of symptomatic myoma and adenomyosis. Sixty-four women underwent TLH, whilst 68 women underwent coagulation of uterine arteries at their origin plus TLH. The mean weight and volume of the uterus as determined following TLH was 288.1+/-102.4 gm (range 182.1 approximately 396.2 gm.) and 451+/-340.6 cm(3) (range 107.4 approximately 792), respectively. The mean weight of the uterus following CUA plus TLH was 269.1+/-151.7 gm (range 215.8 approximately 430.1) whilst the mean uterine volume was 472.7+/-377.8 cm(3) (range 93.7 approximately 851.2). No significant differences with respect to surgical duration (95 vs. 96.5 minutes TLH vs. CUA + TLH; p>0.05), blood loss (177.2+/-80.1 ml for TLH and 154.9+/-30.21 ml for CUA+TLH; p>0.05) and mean+/-SD preoperative (12.05+/-1.70 gm/dl for TLH and 12.14+/-1.38 gm/dl for CUA+TLH; p>0.05) and post-operative hemoglobin level (11+/-1.03 for TLH and 11+/-1.49 for CUA + TLH; p>0.05) were observed between the two study groups. The blood loss for TLH is comparable to that for the CUA plus TLH procedure.

Ovarian pregnancy torsion.

INTRODUCTION: Ovarian-cyst torsion is often seen in early pregnancy due to progesterone stimulation. It is the fifth-most-common gynecological emergency, with a reported incidence of 3%. An ectopic pregnancy implanted in the ovary is rare, occurring in only 0.5-1% of such pregnancies. CASE REPORT: We presented a case of ovarian pregnancy with concomitant ipsilateral side tubal torsion managed by laparoscopy. DISCUSSION AND CONCLUSIONS: Varying density distribution in the ovary can predispose to ovarian torsion. Emergency surgery may offer the possibility of avoiding the ablation of functional ovarian tissue. Early detection and prompt management can preserve fertility and ovarian function. The etiology, presenting syndrome and management are discussed.

Transvaginal three-dimensional ultrasonography combined with serum CA 125 level for the diagnosis of pelvic adhesions before laparoscopic surgery.

STUDY OBJECTIVE: To investigate the role of transvaginal three-dimensional ultrasonography combined with serum CA 125 level in diagnosing pelvic adhesions before scheduled laparoscopic surgery. DESIGN: Prospective study (Canadian Task Force classification II-1). SETTING: Tertiary care academic hospital. PATIENTS: Fifty-nine women with an adnexal mass diagnosed by two-dimensional transvaginal ultrasonography. INTERVENTION: Preoperative transvaginal three-dimensional ultrasonography and serum CA 125 level, followed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: Pelvic adhesions were correctly identified by transvaginal three-dimensional ultrasonography in 26 of 32 women in whom the lesions were confirmed at laparoscopy or laparotomy. Mean serum CA125 level in women with adhesions was 70 +/- 73.7 U/ml, which was significantly higher than that in women without adhesions (24 +/- 16.16 U/ml, p = 0.004). The sensitivity of combined transvaginal three-dimensional ultrasonography and serum CA 125 level was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89%. The two methods showed strong agreement with surgical results (kappa = 0.889). Eight scheduled laparoscopies (13.6%) were converted to laparotomy due to severe adhesions. One patient (1.7%) experienced colon injury during laparoscopic adhesiolysis. CONCLUSION: Transvaginal three-dimensional ultrasonography combined with serum CA 125 level is sensitive in detecting pelvic adhesions before laparoscopic surgery. Patients with suspected severe pelvic adhesions should have preoperative bowel preparation to reduce the risk of intraoperative injury.