Colouterine Fistula Treated by a Double Endoscopic Approach.

Colouterine fistula associated with the use of an intrauterine device (IUD) is extremely rare. Clinical presentation may vary; however, to our knowledge, only 1 paper has previously reported menochezia as the main symptom of an utero-intestinal fistula as a complication of IUD use. Surgery is generally needed for definitive resolution of the fistula. Various surgical approaches have been proposed, mainly using open approaches owing to the presence of severe pelvic adhesions. Reports of laparoscopic treatment have been rarely described. We performed a successful conservative double endoscopic repair, with hysteroscopy followed by laparoscopy. Follow-up of IUD users is important, as complications may appear at any time. Unusual signs or symptoms warrant attention. Imaging tests aid in diagnosis and treatment selection, which in the majority of cases means planning for surgery. An endoscopic approached is preferred because of its lower risk of complications and shorter postoperative recovery period.

Transperitoneal Laparoscopic Para-Aortic Lymphadenectomy and Body Mass Index: Is It Really a Limiting Factor for the Procedure?

Objective: To explore if obesity measured by body mass index (BMI) ≥30 kg/m2 represents a limiting factor for para-aortic lymphadenectomy done with a transperitoneal laparoscopic approach. Materials and Methods: Retrospective observational study with 146 consecutive patients, diagnosed with a gynecological cancer submitted to para-aortic surgical staging between January 2010 and December 2018. The mean age was 52 years and the mean BMI was 27 kg/m2. 72.6% (106 patients) had BMI <30 kg/m2 and 27.4% (40 patients) had BMI ≥30 kg/m2. Half of the patients did not have prior abdominal surgeries. Results: The statistical analysis showed that there were no significant differences between two groups depending on their BMI in the lymph node count: BMI <30 kg/m2 14 nodes versus BMI ≥30 kg/m2 10 nodes (P = .122); rate of intraoperative complications: BMI <30: 6.3% versus BMI ≥30: 0% (P = .180), postoperative complications: BMI <30: 6.6% versus BMI ≥30: 5% (P = .723); feasibility rate: BMI <30: 97.1% versus BMI ≥30: 95.6% (P = .063) or the mean hospital stay BMI <30: 2.47 ± 2.05 days (standard deviation [SD]), BMI ≥30: 2.64 ± 0.93 days (SD) (P = .171). The only significant difference observed was due to the operating time: BMI <30: 103.1 ± 60.8 (SD) versus BMI ≥30: 146.9 ± 82.5 (SD) (P = .019), being longer in obese patients. Conclusions: Obesity, estimated by BMI, does not seem to represent a limiting factor for this surgical procedure in our series. We feel it is a feasible and justified approach in obese patients when other surgical procedures have to be carried out in the same surgical act. Probably, other factors and anthropometric measurements are more accurate to select patients in which this approach is feasible.

Transperitoneal laparoscopic para-aortic lymphadenectomy and body mass index / Linfadenectomía para-aórtica laparoscópica transperitoneal e índice de masa corporal

Objective: To determine whether obesity (BMI ≥ 30 kg/m2) is a limiting factor for para-aortic lymphadenectomy performed using transperitoneal laparoscopy in a series of 146 consecutive cases. Patients and methods: We performed a retrospective observational study of 146 consecutive patients diagnosed with gynecologic cancer who underwent para-aortic surgical staging by transperitoneal laparoscopy. The study sample included 45 cases (30.8%) for staging of apparent stage I ovarian carcinoma I, 56 cases (38.4%) of locally advanced cervical carcinoma and/or positive pelvic nodes, 34 cases (23.3%) of endometrial carcinoma with a poor prognosis and high risk of locoregional recurrence, 4 cases (2.7%) of carcino-sarcoma, and 7 cases (4.8%) of local recurrence of previously treated cervical carcinoma. Statistical significance was set at p < 0.05. Results: The feasibility rate was 93.2%. The intraoperative complication rate was 5.4% (6 cases). The postoperative complication rate was 8.9% (13 cases); if we include those patients who required a blood transfusion (6.8%), then complications were recorded in 23 cases. Mean (SD) operative time was 122.4 (72.9) minutes. The mean number of lymph nodes removed was 13 (8-17). The mean hospital stay was 2.5 (1.7) days. Patients were divided into 2 groups according to their BMI: < 30 kg/m2 and ≥ 30 kg/m2. The statistical analysis revealed no significant differences between the groups for lymph node count (p = 0.122), percentage of complications (p = 0.459), feasibility rate (p = 0.063), or mean hospital stay (p = 0.171). Differences were found with respect to operative time (p = 0.019), which was greater in obese patients. Conclusions: In our series, obesity did not appear to be a limiting factor for surgery in terms of lymph node count and rate of complications although it continues to affect operative time. The surgical feasibility rate was adequate. We believe that surgery is both feasible and justified in obese patients when other procedures are necessary during surgery

Objetivo: explorar si la obesidad (índice de masa corporal ≥ 30 kg/m2) representa un factor limitante para la linfadenectomía para-aórtica mediante abordaje laparoscópico transperitoneal en una serie de 146 casos consecutivos. Material y métodos: estudio observacional retrospectivo constituido por 146 pacientes consecutivas con diagnóstico de cáncer ginecológico, sometidas a estadificación quirúrgica para-aórtica mediante abordaje laparoscópico transperitoneal. Se incluyeron 45 casos (30,8%) para la estadificación del carcinoma ovárico aparentemente en estadio clínico I, 56 casos (38,4%) para el carcinoma cervical en formas localmente avanzadas y/o ganglios pélvicos positivos, 34 casos (23,3%) de estadificación del carcinoma endometrial en los casos de mal pronóstico y alto riesgo de recidiva locorregional, 4 casos (2,7%) de carcinosarcoma y 7 casos (4,8%) de recidiva local de carcinoma de cérvix inicialmente tratado. Para el análisis estadístico se consideró P < 0,05 como significativo. Resultados: la tasa de factibilidad fue del 93,2%. La tasa de complicaciones intraoperatorias fue del 5,4 % (6 casos). La tasa de complicaciones posoperatorias se situó en 8.9 % registrándose 13 casos; 23 casos si incluimos a aquellas pacientes que requirieron la realización de una transfusión sanguínea, con una tasa de la misma del 6,8%. El tiempo medio quirúrgico fue 122,4 +/- 72,9 (DE) minutos. Se registró un número medio de ganglios extraídos del 13 (8-17). La estancia media hospitalaria se situó en 2,5 +/- 1,7 (DE) días. Se dividió a las pacientes en 2 grupos en función de su índice de masa corporal: < 30 kg/m2 y ≥ 30 kg/m2, el análisis estadístico demostró que no existen diferencias significativas en el recuento ganglionar (p = 0,122) entre ambos grupos; tampoco se hallaron diferencias en cuanto al porcentaje de complicaciones (p = 0,459) o la tasa de factibilidad (p = 0,063) ni en la estancia media hospitalaria (p = 0,171). Sí se establecieron diferencias en cuanto a tiempo operatorio (p = 0,019), siendo mayor en aquellas pacientes obesas. Conclusiones: la obesidad parece no representar un factor limitante para la técnica quirúrgica en nuestra serie en cuanto a recuento ganglionar y tasa de complicaciones, con una tasa de factibilidad adecuada. Por el contrario, se sigue estableciendo como factor condicionante del tiempo operatorio. A pesar de ello, creemos factible y justificado este abordaje en pacientes obesas, cuando se requieran otros procedimientos en el mismo acto quirúrgico

Microinvasive squamous carcinoma of neovagina created with peritoneal flap (Davidov): Case report and literature review.

Carcinoma of the vagina is a rare disease, and it is even more rare when it appears in a neovagina, having its incidence and optimum treatment constantly discussed. The aim of this article was to review the cases described in the currently available literature and describe the second documented case of carcinoma in a neovagina created with peritoneal flaps, and also list the possible pathways and risk factors for its development. The case we present is a 49-year-old female who after undergoing a laparoscopic colpectomy of the upper two-thirds of the vagina, with an immediate reconstruction with peritoneal flaps by laparoscopy, at a 4 months follow up presented a focal microinvasive squamous carcinoma in the vault of the neovagina. After reviewing the literature, we conclude that excisional treatment is the preferable option to avoid the progression to an invasive carcinoma. However, this case demonstrates the importance of the necessity to do regular cito-vulvovaginoscopic examinations after the complete surgical treatment because of the chance of persistent or recurrent lesions on the transplanted tissue.