Abnormal menstruation after radical trachelectomy and its effects on fertility.

AIM: To evaluate and identify the risk factors for abnormal menstruation after radical trachelectomy. METHODS: This study included 58 patients who underwent radical trachelectomy at our hospital between April 2005 and January 2018. Patients were divided into groups of those with no change in postoperative menstruation (regular [R] group; n = 46) and those with abnormal menstruation such as amenorrhea or hypomenorrhea (irregular [I] group; n = 12). The perioperative characteristics and fertility of the groups were compared retrospectively. The data were statistically analyzed using Student's t-test, Fisher's exact test and Mann-Whitney U test for univariate analysis and logistic regression analysis for multivariate analysis, with the level of statistical significance set at P < 0.05. RESULTS: Based on Federation of Gynecology and Obstetrics staging, 54 patients had stage IB1, 2 had stage IB2 and 2 had stage IIA1 cervical cancer. Eight patients received neoadjuvant chemotherapy. Pretreatment tumor size, residual uterine cavity length and neoadjuvant and postoperative chemotherapy use were not significantly different between the groups. Abnormal menstruation was significantly more common in patients with postoperative pelvic infection (R group, 13.0%; I group, 58.3%) and cervical stenosis (R group, 15.2%; I group, 58.3%). CONCLUSION: To maintain healthy menstruation even after radical trachelectomy, it is important to prevent postoperative pelvic infection and cervical stenosis.

A case of laparoscopy-assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy.

INTRODUCTION: Vaginal cuff dehiscence after hysterectomy is a rare complication and occurs in less than 1% of patients. It can present with serious complications, such as bowel evisceration and peritonitis. PRESENTATION OF CASE: A 51-year-old multigravida Korean woman underwent total laparoscopic hysterectomy for leiomyoma. Six months later, she reported lower abdominal pain and vaginal bleeding. Physical examination revealed rebound tenderness in the lower abdomen, and pelvic examination showed a small amount of vaginal bleeding with an evisceration of the small intestine through the vagina that exhibited healthy peristalsis. The eviscerated bowel, which seemed to be a part of the ileum, was carefully manually reduced transvaginally into the abdominal cavity. Laparoscopic observation revealed adhesions between the omentum, small intestine, and the peritoneum. Specifically, the small intestine was adhered around the vaginal cuff. An abdominal abscess was found in the left lower abdominal cavity. An adhesiotomy was performed and the abdominal abscess was removed and irrigated. Complete separation of the anterior and posterior vaginal cuff edges was obtained. The vaginal cuff was closed with interrupted 0-polydioxanone absorbable sutures without bowel injury. A 6-month follow-up examination revealed complete healing of the vaginal cuff. DISCUSSION: In this case, we were able to make use of both laparoscopic and transvaginal methods to perform a successful repair with a minimally invasive and safe technique. CONCLUSION: Laparoscopically assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy was found to be effective, safe, and minimally invasive.

Abdominal radical trachelectomy for vaginal cancer - A case report.

•Vaginal cancer is most common in elderly woman and very rare in young woman.•Stage I vaginal cancer is treated with surgery and radiotherapy.•Vaginal cancer in a young patient was treated by intra-arterial chemotherapy followed by abdominal radical trachelectomy.

Successful delivery after abdominal radical trachelectomy followed by adjuvant chemotherapy for advanced invasive uterine cervical cancer: a case report and literature review.

Uterine cervical cancer is increasingly prevalent among young Japanese women who are eager to preserve their fertility, and abdominal radical trachelectomy (ART) is often performed in patients with early-stage invasive lesions. Herein we present details of a 27-year-old woman with stage IB1 cervical cancer. Although the patient received ART, histopathological findings revealed a parametrial invasion. Hence, 3 courses of adjuvant chemotherapy with paclitaxel and carboplatin (TC) were administered, and the patient conceived spontaneously 44 months later. Rupture of the membrane occurred at 32 weeks and 4 days, and a 1822 g female baby was delivered by emergency cesarean section. The patient is alive without disease and her child is growing favorably. This case demonstrates the balance between preservation of fertility and curative adjuvant chemotherapy after ART.

Massive subchorionic thrombosis followed by magnetic resonance imaging.

Massive subchorionic thrombosis is a rare condition, defined as a large thrombus confined to the subchorionic space. It is associated with poor perinatal prognosis. However, prenatal diagnosis by ultrasonography is often difficult. We report a case of massive subchorionic thrombosis developing dermatomyositis after the delivery, followed by magnetic resonance imaging. Moreover, we review other 4 cases assessed with magnetic resonance imaging. Magnetic resonance imaging is very useful for confirmation of diagnosis and follow-up in combination with ultrasonography.

Pregnancy after neoadjuvant chemotherapy followed by abdominal radical trachelectomy in stage IB2 cervical cancer: A case report.

► Huge cervical cancer was treated by intra-arterial chemotherapy followed by radical trachelectomy. ► The patient conceived after abdominal radical trachelectomy and had a baby by Cesarean section.