Evaluation of stress-related hormones after surgery by laparoscopy or laparotomy.

STUDY OBJECTIVE: To evaluate the stress hormone response after pelvic surgery performed by laparoscopy versus laparotomy. DESIGN: Prospective study. SETTING: A tertiary care university hospital. PATIENTS: Ten women were scheduled to undergo laparoscopic surgery and 10 laparotomy for either tubal disease or endometriosis. INTERVENTIONS: Surgical procedures were performed by laparoscopy or laparotomy for stage III-IV endometriosis, pelvic adhesions, or distal tubal occlusion. The following hormones were measured before the induction of anesthesia in the ward, 60 minutes after the beginning of surgery, at the end of surgery after extubation, and 2 hours and 6 hours after the end of the operation: norepinephrine (NE), epinephrine (E), dopamine (D), adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL), and GH. MEASUREMENTS AND MAIN RESULTS: The mean duration of surgery was not significantly different between the two groups. Surgery-related adrenergic activation (E, NE, D) appears more pronounced in the laparotomy group (p<0.005) during surgery and in the postoperative period. More elevated values for laparotomy were observed also for the other stress hormones (ACTH, cortisol, PRL, GH), even though statistical significance was not always reached. CONCLUSIONS: Compared with laparotomy, activation of stress-related factors during laparoscopy seems to be less intense and of shorter duration.

GnRH analogs versus expectant management in minimal and mild endometriosis-associated infertility.

The aim of the present study is to compare the outcome of GnRH analog treatment versus expectant management in infertile patients with minimal and mild endometriosis. From January 1987 to December 1990, 14 patients with stage I and II endometriosis underwent a six-month course of the GnRH analog buserelin, whereas 38 patients underwent expectant management. The two groups were comparable as to mean age of the patients, mean length of infertility prior to diagnosis and mean scores of endometriosis. No major tubal or male factor of infertility was present in any patient. Cumulative pregnancy rates at 12 months were comparable in the two groups (48% for GnRH analog treatment and 42% for expectant management). Expectant management should therefore be considered the most cost-effective option in the management of mild endometriosis-associated infertility.

[The role of laparoscopy in the evaluation of chronic pelvic pain]. / Il ruolo della laparoscopia nella valutazione del dolore pelvico cronico.

Chronic pelvic pain, defined as cyclic or acyclic pain reported for a minimum of six months, is one of the most common gynecological symptoms and one of the most important in terms of social costs. From January 1987 to December 1991, 127 patients suffering from chronic pelvic pain were submitted to diagnostic laparoscopy at the Department of Obstetrics and Gynecology of the Università Cattolica del Sacro Cuore in Rome. The mean age of the patients was 30 years, ranging from 14 to 46. All patients were submitted to bimanual pelvic examination upon hospital admission, and most of them (No. = 99, 78%) to pelvic ultrasonographic examination. In 117 patients (92%) samples for the isolation of Chlamydia trachomatis in 5-iodo-2-deoxiuridine treated McCoy cell cultures were obtained from the cervix, the endometrium and the cul-de-sac peritoneal fluid. At laparoscopy, in 25 patients (20%) the exam showed normal pelvic anatomy, whereas in 102 patients (80%) some pelvic pathology was found. The most frequent conditions observed were: pelvic adhesions in 55% (No. = 70), endometriosis in 29% of the cases (No. = 37), and other pathologies (non-endometriotic ovarian cysts, hydrosalpinges, myomas, etc.) in 25% of the cases (No. = 32). At the comparison of bimanual examination and laparoscopic findings, out of 71 patients with normal findings at bimanual examination, 75% (No. = 53) were found to have abnormal findings at laparoscopy; out of 55 patients with abnormal bimanual examination, 11% (No. = 6) were found to have normal laparoscopic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Reproductive outcome after ovarian surgery: microsurgery versus CO 2 laser.

The present study was undertaken to compare CO 2 laser vs microsurgery in ovarian surgery, evaluating both postoperative adhesion formation and reproductive outcome. Eighteen female white New Zealand rabbits were anesthetized, and the ovaries were exposed. At random, one ovary was longitudinally bivalved with a scalpel and then reconstructed by microsurgery. The contralateral ovary was similarly cut, but with a CO 2 laser set at a superpulsed mode. Four weeks after surgery, the rabbits were mated, and two weeks later, the animals were evaluated for extent of postoperative adhesion formation, number of corpora lutea in each ovary, and number of embryos in each uterine horn. The nidation index was calculated. The present study shows no difference in postoperative adhesion formation or reproductive function following ovarian surgery by microsurgery or CO 2 laser.

Reproductive outcome after ovarian surgery: suturing versus nonsuturing of the ovarian cortex.

The purpose of this study was to ascertain if microsurgical approximation of the ovarian edges after ovarian surgery alters postoperative results, as determined by both adhesion formation and reproductive outcome. Sixteen female white New Zealand rabbits were anesthetized, and the ovaries were exposed. Each ovary was longitudinally bivalved with a scalpel, but only one ovary was reconstructed microsurgically, whereas the contralateral ovary was left open. Four weeks after surgery, the rabbits were mated, and two weeks later, a laparotomy was performed to evaluate postoperative adhesions, the number of corpora lutea in each ovary, and the number of embryos in each uterine horn. The nidation index was calculated. No significant differences were found between the microsurgically sutured and the nonsutured ovaries for all the parameters evaluated. Our data suggest that not closing the ovarian incision does not alter either postoperative adhesion formation or reproductive outcome.