Glue mesh fixation: Feasibility, tolerance and complication assessment. Results 24months after laparoscopic sacrocolpopexy.

AIM: This study aims to assess short- and mid-term feasibility, strength and tolerance of glue mesh fixation for laparoscopic sacrocolpopexy, as well as postoperative quality of sexual activity. PATIENTS AND METHODS: This original prospective clinical study was carried out in multiple university surgical centres between 2012 and 2013. Data were obtained during immediate postoperative hospitalisation, at 3 and at 24 months postoperatively. For a total of 42 patients subjected to laparoscopic sacrocolpopexy, bladder catheterization and hospitalisation times, pain score, early and late postoperative complications, prolapse staging according to POP-Q classification, and quality of sexual activity were registered. RESULTS: Mean operative time was 120minutes and patients were hospitalised for a mean of 3days. Four complications (9.52%) occurred on the immediate postoperative period, whilst 2 patients (4.76%) complained of pain on day 3 (VAS 1). At the end of the follow-up period (24 months), one patient had a prosthetic exposure, 4 patients (9.52%) complained of stress urinary incontinence (10.81%). Simultaneously, 6 patients (14.29%) experienced dyschezia (2 improved, 1 similar, 1 de novo, 2 worsened), and there was no report of dyspareunia. All anterior and posterior floor prolapses were staged between 0 and 1. All superior floor prolapses were staged between 0 and 2. Concerning sexual impairment, there was no report of dyspareunia, urinary leaks or other problems associated with intercourse, and quality of sexual activity improved. CONCLUSION: Minimally invasive sacrocolpopexy with the use of glue fixation does not lead to increased mid-term morbidity, simultaneously allowing for significant prolapse improvement, and providing global patient satisfaction and overall quality of life.

[Stress urinary incontinence treatment using Surgimesh® Sling, evolution on patient quality of life and sexual activity during 12 months follow-up]. / Traitement de l'incontinence urinaire d'effort par Surgimesh(®) Sling, évolution de la qualité de vie et de la qualité de la sexualité des patientes sur une période de 12 mois.

INTRODUCTION: Evaluation of quality of life (QOL) and sexual activity after using sub-urethral Surgimesh® Sling for female stress urinary incontinence (SUI). METHODS: Study with a total duration of 12 months. One hundred and sixty-eight patients presenting a SUI underwent surgery for a Surgimesh® Sling implantation. RESULTS: QOL was significantly improved on the International Consultation Continence Questionnaire (ICIQ) scale with an increase of the average score from 2.79±1.75 to 8.48±1.7 at 12 months (P<0.05). The percentage of patients undergoing sexual intercourses remains at a high level during the study (76.87% versus 78.33%). The number of patients with pain during sexual intercourse significantly decreased (15% versus 2.1%). The QOL score is significantly better in post-operation conditions (7.84 versus 9.20; P=0.001). In terms of continence at 12 months, 75.6% of women declared recovery and 23.53% observed improvements. CONCLUSION: SUI correction using Surgimesh® Sling induces a very significant improvement in patients' QOL and sexual activity.

[Ambulatory Essure implant placement sterilization procedure for women: prospective study comparing general anesthesia versus hypnosis combined with sedation]. / Étude prospective comparant l'hypnosédation et l'anesthésie générale pour la pose de dispositif de stérilisation intratubaire en ambulatoire.

OBJECTIVE: implant placement Essure, sterilization procedure for women, were performed under hypnosedation (HYP) and compared to the operative anxiety and analgesia of 12 patients operated-on under general anesthesia (GA). STUDY DESIGN: prospective and comparative group study. PATIENTS AND METHODS: two groups of twelve patients were matched and compared based on the choice of anesthetic technique: hypnotics (HYP) with possible additional sedation by propofol and remifentanil or GA involving propofol, sevoflurane and remifentanil. The assessment of anxiety and pain based on a visual analogy scale (0-10) and use of analgesics were studied in the recovery room and at discharge of hospital. The statistical analysis relies on nonparametric tests for paired data (Wilcoxon test). RESULTS: all patients were operated. The two groups are statistically comparable. The preoperative anxiety before premedication is lower in the HYP group (p<0.05). No conversion to general anaesthesia is necessary in the HYP group, but five patients were using sedatives drugs but doses are very low compared to general anaesthesia. The analgesic consumption was equivalent in both groups. CONCLUSION: we conclude that hypnosedation is a valuable alternative to traditional anesthetic techniques for ambulatory Essure implant. The use of hypnotic tool is an interesting alternative for the management of patients during invasive medical procedures or surgical, providing psychological benefits to the patient.

[Primary seropapillary peritoneal carcinoma. 16 case reports. Review of the literature]. / Carcinome séropapillaire primitif du péritoine. A propos de 16 observations. Revue de la littérature.

OBJECTIVE: Review of primary seropapillary carcinoma of the peritoneum. TYPE OF STUDY: Retrospective. PLACE: Department of Gynaecology and Oncology, University Hospital, Rennes. SUBJECT: 16 patients who underwent chemotherapy and surgery. RESULTS: Mean age at onset was 62 years with a late clinical diagnosis at an advanced stage. Macroscopically, peritoneal miliary was often associated with a predominant tumoural formation on the epiploon. Treatment included surgical exeresis with endoxan-cisplatin chemotherapy. The prognosis was equivalent to ovarian tumours at similar stages. CONCLUSION: Primary seropapillary carcinosis of the peritoneum is a separate group of peritoneal carcinosis distinguishable from peritoneal mesotheliomas and which have a prognosis similar to ovarian tumours. These tumours should be classed as part of the large group of mullerian tumours.