A review of the open laparoscopic Hasson technique and retrieval of adnexal specimen via umbilicus.

Laparoscopic entry techniques vary amongst surgeons and gynaecologists, with gynaecologists favouring Veress needle entry. Recent RCOG/BSGE recommendations have recommended retrieval of ovarian masses via the umbilical port with resultant less postoperative pain and a faster retrieval time than with retrieval through lateral ports of the same size. This is a prospective observational study reviewing the Hasson entry technique and the introduction of retrieval of specimens via the umbilicus in patients scheduled for a laparoscopy procedure at our day surgery unit. We found no immediate or major surgical complications and all specimens were successfully retrieved through the umbilicus. Pain scores were low. We recommend the technique for extirpative gynaecological surgery. Impact Statement This study confirms that conversion from the closed Veress to the open Hasson technique is achievable in a university hospital setting. Operator confidence during the learning phase is enhanced by the use of ultrasound to locate and measure the depth of the umbilical ligament. Retrieval of benign adnexal specimens through the umbilicus was very satisfactory.

Appendectomy with cytoreductive surgery for ovarian and type 2 endometrial carcinoma.

UNLABELLED: There is considerable variation within and between cancer centers in the practice of appendectomy as part of cytoreductive surgery for ovarian carcinoma and in the surgical staging of endometrial carcinoma. The purpose of this study was to determine the prevalence and the type of appendiceal pathology, the morbidity associated with appendectomy in gynaecologic cancer surgery. MATERIALS AND METHODS: This is a retrospective review of all cytoreductive surgery for ovarian carcinoma and surgical staging for endometrial carcinoma with appendectomy over a four year period. RESULTS: Two hundred and fifty-one patients (38 patients for endometrial carcinoma surgery and 213 patients for ovarian cytoreduction) had an appendectomy performed. Metastases to the appendix was present in 46 (23.2%) of primary ovarian carcinoma and one (2.6%) primary endometrial carcinosarcoma. The appendix was more likely to be involved in advanced stage ovarian cancer with positive peritoneal washings, omental deposits, grade 3 differentiation, and papillary serous histology. Sixteen (6.4%) co-incidental primary appendiceal tumours were detected. No postoperative morbidity specific to appendectomy was identified. One case of ovarian carcinoma was upstaged from IC to IIIA by the appendiceal metastases. There was no upstaging of disease in the endometrial carcinoma group. DISCUSSION: Appendectomy is an integral part of ovarian cytoreductive surgery but the authors found it did not upstage the disease in a clinically significant manner. The incidence of co-incidental appendiceal primary tumours was high in this series and may add value to the procedure in preventing further surgeries. The absence of procedure related morbidity is reassuring. The authors recommend appendectomy for all ovarian staging surgery and its consideration in type 2 endometrial cancer.

Listeria awareness among recently delivered mothers.

The level of knowledge of Listeria among mothers in Ireland is unknown. This prospective questionnaire study aims to evaluate the level of knowledge of recently delivered mothers regarding Listeria infection and its potential prevention. A response rate of 98% was achieved. A total of 271 (43.9%) mothers had heard about Listeria infection but only 187 (30.3%) knew that it was a food-borne pathogen. In total, 83 (13.5%) mothers recalled being told about Listeria infection by a midwife or doctor and 33 (5.3%) recalled receiving written information. A total of 224 (36.3%) of mothers were aware of the increased risk of listeriosis during pregnancy, while 250 (40.5%) knew the potential complications to the unborn fetus. A grand total of 505 (81.8%) mothers knew that they should avoid certain high-risk foods during pregnancy but 342 (55.4%) admitted to having consumed high-risk foods during their pregnancy. In conclusion, mothers' knowledge about listeriosis and its prevention was limited. Many mothers ate high-risk food during pregnancy. Antenatal advice regarding Listeria prevention needs to be improved.

Myomectomy: a suturing technique for the open procedure.

Uterine fibroids are common among women of reproductive age. In women who have not completed their family, a myomectomy is often suggested to preserve and improve fertility. Here, we would like to describe our technique of myomectomy in an open laparotomy procedure.

Pre-operative testing for pregnancy in Dublin day surgery units.

BACKGROUND: The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients' pregnancy status prior to elective surgery. AIMS: This study aims to evaluate practices in Ireland with regard to methods used to exclude pregnancy in premenopausal women attending for day surgery. METHODS: Postal questionnaires were sent to all consultants in Gynaecology and General Surgery. E-mail questionnaires were sent to all registrar trainees in both specialties. Letters were sent to nine Dublin teaching hospital day surgery units and followed up by telephone consultations. RESULTS: The overall response rate was poor at 34.3 %. Eighty per cent of respondents in the gynaecology specialty have encountered a preoperative patient with a positive pregnancy test at least once during their career versus 28.6 % in the surgical specialty. Only 35 % of gynaecology respondents would routinely inform female reproductive age patients of the need to avoid pregnancy prior to surgery versus 14.3 % in the surgical specialty. On the day of elective surgery, 90 % of gynaecologists would determine the LMP (last menstrual period) versus 35.7 % of surgeons. The policy at all nine Dublin teaching hospitals is to perform a urinary HCG preoperatively but, their policies vary as to whether the patient's LMP, age and medical history are considered when performing a urinary HCG test. CONCLUSION: It is important that, female patients are counselled appropriately regarding the importance of using adequate contraception or, abstinence in order to avoid pregnancy prior to elective surgical procedures. Our survey shows that, gynaecologists are more likely to give this advice compared to our surgical colleagues. Nevertheless, the number of gynaecologists who do this is surprisingly low (35 %). Urinary HCG is still the standard test used in most units to exclude pregnancy.

Piriformis pyomyositis, an unusual presentation of leg pain post partum--case report and review of literature.

Piriformis pyomyositis is defined as a subacute infection of skeletal muscles associated with systemic infectious symptoms. In the literature it rarely occurs postpartum. We report a case of piriformis pyomyositis involving a parturient and review the published cases available in the literature.

Comparative study on the outcome of obstetric cholestasis.

OBJECTIVES: The aim of this study was to determine the characteristics and outcomes of obstetric cholestasis (OC) and the significance of measuring total bile acid (TBA) to aid diagnosis. METHODS: This study was conducted over a 27-month period at a tertiary referral maternity hospital (>8000 deliveries annually). In the study period, 753 women presented with pruritus of no specific origin. This group was divided into OC (TBA > or =6 micromol/L, N=151) and idiopathic pruritus of pregnancy (TBA <6 micromol/L, N=602). The latter group served as controls. Data were collected retrospectively and analyzed using SPSS 11.4 for Windows (SPSS Inc., Chicago, IL, USA). RESULTS: Patients were matched for age, ethnicity, parity, and smoking status, sex of baby, and Apgar scores at 1 and 5 minutes. OC was noted to be higher in twin pregnancies. Twice as many mothers in the OC group were induced compared to controls. Of the OC group, 18.0% delivered preterm versus 7.7% of controls. Of the mothers with OC, 48.3% had a TBA in the range of 11-39.9 micromol/L, 21.2% had a TBA >40 micromol/L, and the remaining 30.5% had a TBA between 6 and 10.9 micromol/L. Of the OC group with preterm delivery, all had a raised TBA >11 micromol/L. CONCLUSIONS: The presence of OC increases preterm delivery, both idiopathic and iatrogenic. Increasing induction, admission to the neonatal intensive care unit, and low birth weight were also noted. A TBA cut-off value of >11 micromol/L will more accurately aid the diagnosis of OC in the absence of raised liver function test results, reducing the over-diagnosis of this condition.

A review of neonatal attendances out of hours in a Dublin maternity hospital.

UNLABELLED: BACKGROUND All neonates have free open access to the Baby Clinic at the maternity hospitals in Dublin for assessment of neonatal health issues. Through observation, however there is an increase in number of neonates attending the hospital outside the Baby Clinic hours. AIMS: To determine the number of neonates attending the acute neonatal service out of hours and to identify the percentage of neonates treated as true emergency. METHODS: Retrospective chart review over a twelve-month period. RESULTS: Seven hundred and thirty-two neonates attended the hospital out of hours. The majority were diagnosed with gastrointestinal problems (228/31%), jaundice (101/13.7%), respiratory problems (82/11.1%) and skin disorders (79/10.7%). Only 106 (14.4%) attendances warranted admissions. CONCLUSIONS: A large number of neonatal attendances did not require acute assessment out of hours and were managed by reassurance and maternal education. A centralized phone-in-triage system was suggested to relieve the strain on the acute neonatal service.