ABSTRACT
BACKGROUND: Cesarean delivery adhesions, during laparoscopic hysterectomy, can present surgical challenges, including distortion of anatomy, prolonged operating time, and inadvertent injury to nearby structures. TECHNIQUE: At the time of laparoscopic hysterectomy, in patients with significant adhesions from prior cesarean deliveries, we use a reverse inferior to superior vesicouterine fold dissection to mobilize the scarred bladder. We use this as an alternative to the commonly practiced technique of mobilizing the bladder in a superior to inferior fashion at the time of laparoscopic hysterectomy. EXPERIENCE: Fifty-two patients with a median age of 42.5 years are presented. Forty-eight patients were discharged within 3-6 hours postoperatively. Sixteen patients were discharged with Foley catheters, because they were unable to void within the protocol for a fast-track discharge. The catheters were removed between postoperative days 1 and 5. There were no gastrointestinal or genitourinary complications. One patient experienced a delayed vaginal cuff abscess and bleeding, which were managed conservatively. CONCLUSION: Reverse vesicouterine fold dissection is a useful alternative technique for laparoscopic hysterectomy in women with a history of prior cesarean deliveries.
Subject(s)
Cystotomy/methods , Dissection/methods , Hysterectomy/methods , Urinary Bladder/surgery , Uterus/surgery , Adult , Cesarean Section/adverse effects , Female , Humans , Laparoscopy , Middle Aged , Tissue Adhesions/etiology , Tissue Adhesions/surgery , Urinary Bladder/pathology , Uterus/pathologyABSTRACT
Cyclooxygenase (COX)-2 is constitutively expressed in neurons of the hippocampus and neocortex. Therefore, non-steroidal anti-inflammatory drugs (NSAIDs) targeting inflammation-induced COX-2 in the periphery and the central nervous system may also affect cognitive function mediated by basal COX-2 activity. We report that systemic administration of the selective COX-2 inhibitor NS-398 6h prior to behavioral assessment does not influence spatial acquisition or retention in male C57BL/6J mice. However, we observed impaired spatial retention in female mice treated with NS-398, suggesting a sex-dependent role of COX-2 in spatial memory of mice.
