ABSTRACT
Objective: To describe the clinical characteristics and location of lesions in patients with deeply infiltrating endometriosis using the revised Enzian (rEnzian) classification. Material and Methods: The clinical records of 60 patients undergoing laparoscopy for deeply infiltrating endometriosis at Hospital Civil de Culiacán, Sinaloa and Hospital San Javier, Jalisco, Mexico, were reviewed. Age, body mass index (BMI), number of pregnancies, childbearing, previous abortions, laparoscopic suggestion (pelvic pain, bleeding, infertility), and size and location of the lesions were assessed according to the rEnzian classification. Results: The mean age of the patients was 30.5 years. The mean BMI was 25.6 kg/m2. Sixty-eight percent were nulliparous and 13% had at least one birth. Eighty-five percent had pelvic pain and 8.3% had infertility. Seventy percent (n=42) of the women had ovarian endometriomas (middle compartment); uterosacral and the torus uterinus ligaments were affected in 23.3%, rectum and sigmoid colon in 35% (posterior compartment), and the appendix and small intestine in 3.3%. According to the rEnzian classification, the most affected compartment was C2 (rectum and sigmoid colon with 1-3 cm lesions). Conclusion: Pelvic pain was the main symptom of patients with deeply infiltrating endometriosis, mainly in nulliparous women. According to the rEnzian classification, the C2 compartment was the most affected (rectum and sigmoid colon).
ABSTRACT
BACKGROUND: Total laparoscopic hysterectomy is a procedure that requires proper training so that implementation is safe and effective. OBJECTIVE: To describe the clinical outcomes of the teaching of total laparoscopic hysterectomy in a university program. PATIENTS AND METHODS: for a period of two years (2009-2010), 18 doctors enrolled in the diploma program in gynecological laparoscopy conducted at the Hospital Civil de Culiacán, Sinaloa, made 82 total laparoscopic hysterectomy. Were analyzed: age and gender of the participating physicians, exercise time of gynecology, general characteristics of the patients, indications, route of access to the pneumoperitoneum, duration of procedure, intraoperative and postoperative complications, size and weight of the uterus, closing time of the dome by laparoscopy and laparotomy conversion rate. RESULTS: The median age of physicians was 34 years (range 28 to 50 years), 69.2% were male, seven years on average for the exercise of gynecology (range 1 to 20 years). The mean procedure time was 121.5 minutes (95% CI 110.5-132.4), the mean uterine size was 12.1 cm (95% CI 11.3-12.8) and uterine weight of 229.6 g (95%: 182.5-276.7). The average intraoperative bleeding was 133.9 mL (95% CI 112.9-154.8), hospital stay was 24.8 hours (95% CI 23.1-26.4). Major complications occurred in 1.2% of patients (95% CI 0.6-5.8). Minor complications were demonstrated in 7.3% of procedures (95% CI 3.01-14.5). The frequency of conversion to abdominal hysterectomy was 1.2% (95% CI 0.6-5.8). CONCLUSION: Total laparoscopic hysterectomy was performed safely and efficiently by training students in university teaching program in gynecologic laparoscopy.