Barbed Suture versus Conventional Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy: Randomized Controlled Clinical Trial.

STUDY OBJECTIVE: To determine the surgical time, suture time, presence of postoperative dyspareunia, and complications that occur after closing the vaginal cuff with a barbed suture compared with conventional suture. DESIGN: A randomized, controlled clinical trial (Canadian Task Force classification I). SETTING: Private gynecologic clinic in Medellin, Colombia. PATIENTS: One hundred fifty women who underwent total laparoscopic hysterectomy for benign pathology. INTERVENTIONS: The patients underwent total laparoscopic hysterectomy with intracorporeal closure of the vaginal cuff and were randomized to 2 groups, 1 using a barbed suture (V-Loc 90; Medtronic/Covidien, New Haven, CT) and 1 using polyglactin 910 (coated Vicryl suture; Ethicon/Johnson & Johnson, New Brunswick, NJ). MEASUREMENTS AND MAIN RESULTS: The total operative time, closing time of the vaginal vault, presence of complications in the cuff, and incidence of postoperative dyspareunia were recorded. The patients were evaluated at a postoperative office visit 2 weeks after the procedure and by telephone interview at 24 weeks. Seventy-five patients were included in the barbed suture group and 75 patients in the polyglactin 910 group. The average time to complete the suture of the vaginal cuff was 12.01 minutes (± 5.37 standard deviation) for the barbed suture group versus 13.49 minutes (± 6.48) in the polyglactin 910 group (95% confidence interval, -.44 to 3.4; p = .130). Blood loss was 31.56 ± 22.93 mL in the barbed suture group versus 30.82 ± 21.75 mL in the polyglactin 910 group (95% confidence interval, -7.95 to 6.47; p = .840). The frequency of postoperative events such as hematoma, cellulitis, cuff dehiscence, fever, emergency consultation, and hospitalization was not statistically significant between groups. No statistically significant difference was found regarding deep dyspareunia at 24 postoperative weeks. CONCLUSION: No differences were found in surgical time or frequency of adverse events when comparing patients after vaginal cuff closure with barbed suture versus polyglactin 910.

Transversus abdominis plane block after ambulatory total laparoscopic hysterectomy: randomized controlled trial.

OBJECTIVE: To determine if transversus abdominis plane anesthetic blockage (TAP block) diminishes early postoperative pain scores and facilitates ambulatory management following total laparoscopic hysterectomy. DESIGN: Randomized triple blind trial. SETTING: Gynecological endoscopy unit at a referral center for laparoscopic surgery. POPULATION: A total of 197 patients. METHODS: Comparison of a treatment group receiving TAP block with bupivacaine 0.25% and placebo group with comparably placed bilateral injection of sterile saline solution. MAIN OUTCOME MEASURES: Pain scores at discharge 24, 48 and 72 h after surgery, opioid requirement after procedure. RESULTS: Patients who had TAP block had a significant reduction in their pain score at discharge compared with the placebo group (p = 0.017). There were no significant differences in the pain scores between groups at 24 h (95% CI 1.36-0.133, p = 0.237), 48 h (95% CI 0.689-0.465, p = 0.702) and 72 h (95% CI -0.631 to 0.223, p = 0.347). No differences were found between the groups regarding opioid requirements following the procedure (χ(2)  = 3.62, p = 0.46). CONCLUSION: Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.

[Sciatic hernia as a cause of chronic pelvic pain]. / Hernia ciática como causa de dolor pélvico crónico.

Sciatic hernia constitutes the scarcest group of hernias of pelvic floor; however, they should be considered in the origin of chronic pelvic pain. The proper diagnosis of sciatic hernias has allowed to surgeons treating successfully patients with acute or chronic pelvic pain, with intestinal or ureteral obstruction and with urinary or gluteus sepsis. It has to be considered as differential diagnosis before the finding of a congenital or acquired gluteus mass. Laparoscopist gynecologist should know the existence of this defect, to be familiar with its aspect in laparoscopic view and to know the laparoscopic treatment of this disease.

Histerosacropexia laparoscópica para tratamiento conservador en pacientes con prolapso apical puro: reporte de 4 casos en Medellín, Colombia, 2006 / Laparoscopic hysterosacropexy for uterine conservation in patients having pure apical defects: a report of 4 cases from Medellín, Colombia, during 2006

Objetivo: describir la histerosacropexia por laparoscopia y sus resultados a corto plazo, en una serie de pacientes con prolapso apical puro y contraindicación para histerectomía. Institución: Unidad de Cirugía Endoscópica Ginecológica, Clínica del Prado, Medellín, Colombia. Diseño: reporte de cuatro pacientes con prolapso apical puro y deseo de conservación uterina. Variables para medir: edad, indicación de cirugía, tiempo quirúrgico, sangrado estimado, complicaciones intraoperatorias, tiempo de hospitalización, incidencia de disfunción urinaria, defecatoria o sexual, aparición de incontinencia urinaria posoperatoria, complicaciones atribuibles a la malla, incidencia de recaídas, tasa de curación subjetiva, tasa de curación objetiva, satisfacción con el procedimiento, incidencia de embarazos después de cirugía. Resultados: edad promedio: 53 años; tiempo quirúrgico: 67 minutos (60-75); pérdida sanguínea: 30 cc (10-50); tiempo promedio de hospitalización: 15 horas (6-24); no hubo complicaciones intraoperatorias. En el seguimiento durante 12 meses en promedio (8-17) no hay recidivas ni signos de disfunción urinaria, defecatoria o coital en las pacientes sexualmente activas. No hay casos de incontinencia urinaria posoperatoria. Las pacientes están satisfechas con la intervención realizada. Aún no hay ningún embarazo. Conclusiones: la histerosacropexia laparoscópica podría ser una alternativa viable en nuestro medio para el tratamiento de pacientes con prolapso apical puro y contraindicación para histerectomía. Se requieren series mayores para determinar su papel en la práctica clínica.

Bilateral ectopic pregnancy.

Bilateral simultaneous ectopic pregnancy is a very rare clinical condition. Two different subsets of patients can be distinguished: women presenting with the disease as a result of spontaneous conception and those with the condition after undergoing assisted reproduction procedures. This article reviews and analyzes 42 cases of bilateral ectopic pregnancies reported in the last 10 years, proposes a new classification of the disease, and presents some data that should be useful for the clinician who confronts this difficult entity.

Resección laparoscópica de 13 teratomas ováricos y un quiste simple en una misma paciente: reporte de caso / Laparoscopic resection of 13 ovarian teratomas and a simple cyst in the same patient: a case report

Se describe el caso de una mujer que consultó por dolor pélvico. Tenía una ecografía transvaginal que reportaba teratomas bilaterales de ovario. Fue llevada a cirugía laparoscópica durante la cual se extirparon 7 teratomas y 1 quiste folicular simple del ovario derecho y se realizó salpingooforectomía izquierda, encontrando 6 teratomas intraováricos. Los objetivos de esta publicación son reportar un caso atípico de múltiples lesiones ováricas sincrónicas y discutir algunos aspectos controversiales del manejo de los teratomas por laparoscopia

Salpingostomía lineal por laparoscopia para el tratamiento de un embarazo ectópico bilateral espontáneo: reporte de caso / Lineal laparoscopic salpingostomy for treating spontaneous bilateral ectopic pregnancy: a case report

El embarazo ectópico bilateral espontáneo es una condición clínica infrecuente que ocurre en 1 de cada 1.580 embarazos ectópicos. En los últimos 25 años se han reportado 72 casos de embarazo ectópico bilateral, 31 de los cuales han sido espontáneos y en ninguno de ellos se ha logrado hacer un correcto diagnóstico preoperatorio. Su tratamiento, al igual que en los ectópicos unilaterales depende de la expectativa reproductiva de la paciente y del estado de las trompas. Existen seis reportes en la literatura de salpingostomía lineal por laparoscopia en pacientes con embarazo ectópico tubárico bilateral. Sólo uno de ellos informa el estado de ambas trompas después de este tipo de intervención. En este trabajo se reporta el primer caso descrito en la literatura colombiana de un embarazo ectópico bilteral espontáneo, en el que se practica manejo conservador por laparoscopia y además, cuatro meses después, se confirma la permeabilidad de ambas trompas por medio de una sonohisterosalpingografía.