Colpotomizer-assisted Total Abdominal Hysterectomy (CATAH Technique): A New Technique for Uterine Removal in Benign Pathologies.

OBJECTIVES: The aim of this study is to evaluate the applicability and feasibility of Colpotomizer-assisted total abdominal hysterectomy (CATAH), a new technique for uterine removal in benign uterine pathologies. MATERIALS AND METHODS: This study is a prospective cohort study conducted at a tertiary University hospital in Egypt. Eligible patients (n = 88) for total abdominal hysterectomy (TAH) were divided into two groups; the study group who underwent TAH by the CATAH technique and the control group who underwent TAH by the conventional technique. Demographic data, operative time, blood loss, and operative complications were recorded. RESULTS: The mean operative time was significantly reduced (64.47 ± 3.60 min) in the study group than in the control group (86.42 ± 5.54 min, P < 0.001). The mean time for cervical removal was significantly less (8.60 ± 1.39 min) in the study group than (17.77 ± 2.62 min) in the control group (P < 0.001). The mean volume of blood loss was less (197.38 ± 39.42 ml) in the study group than in the control group (462.69 ± 167.96 ml). Complications were fewer in the study group than in the control group. CONCLUSION: The CATAH technique was feasible, quicker with less intraoperative and postoperative complications than the conventional technique for TAH in benign uterine pathologies.

Evaluation of three-step procedure (Shehata's technique) as a conservative management for placenta accreta at a tertiary care hospital in Egypt.

OBJECTIVE: To evaluate the benefits and risks of three-step technique as a conservative treatment for women with placenta accreta and desiring future fertility. STUDY DESIGN: This study is a retrospective study where the files of 91 cases of placenta accreta managed by three-step technique were reviewed. This study was conducted at Tanta University Hospitals in the period from June 1, 2015 to May 31, 2017. All demographic and operative data were extracted and recorded. RESULTS: The mean age was 32.44±2.72 years; the mean operative time was 81.65±15.68min. The mean gestational age at operation was 35.67±1.19 weeks. The technique succeeded to preserve the uterus in 86 cases and failed in 5 cases. There was no cases required ICU admission with mean hospital stay of 3.065±1.04 days. The postoperative morbidities were mild and in the form of fever (n=9) and wound sepsis (n=4), pyometra (n=1) and secondary hemorrhage (n=1). CONCLUSION: The three-step procedure is effective as a uterine sparing technique in management of placenta accreta with success rate of 94.5%. The operative and postoperative complications were minimal and expected in such case.

Incidence and sites of pelvic adhesions in women with post-caesarean infertility.

This cross-sectional study was designed to evaluate the incidences and sites of pelvic adhesions in women with post-caesarean unexplained infertility. This study was conducted at the Tanta University Hospitals in the period from August 1 2015 to July 31 2016. The enrolled patients were assessed by a diagnostic laparoscopy for the presence and sites of abdominal and pelvic adhesions. Pelvic adhesions were found in 98 cases (73.13%) and the remaining 36 cases (26.87%) were free of adhesions. Adhesions were tubal in 55.10%, ovarian in 20.40%, combined tubo-ovarian and omental adhesions in 11.22%, uterine adhesions in 6.12% and a frozen pelvis was found in 7.14%. There was no correlation between the severity of the adhesions and the number of previous caesarean sections (CS). The data of this study led us to conclude that pelvic adhesions are common in patients with unexplained infertility following a caesarean delivery. Tubal and ovarian adhesions to the lateral pelvic wall represent a pathognomonic feature in post-caesarean infertility. Impact Statement What is already known on this subject? Adhesions following a caesarean delivery have been assessed by many studies at the time of the next caesarean delivery. These adhesions have not been studied well in the patients with unexplained infertility. What the results of this study add? The results of this study specify the incidences and the sites of the adhesions which are considered to be pathognomonic for caesarean section. What the implications are of these findings for clinical practice and/or further research? These findings should be applied when the cases of post-caesarean infertility are evaluated in order to shorten the duration and burdens of infertility.