Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients.

PURPOSE: Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery. METHODS: We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics. RESULTS: 164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43-159.18); p = 0.005]. CONCLUSION: The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.

[Lipofilling in breast reconstruction: is there any population with higher risk of local recurrence? Literature systematic review]. / Transfert de tissu adipeux en reconstruction mammaire: y a-t-il des populations à risque? Revue systématique de la littérature.

Safety of the autologous fat grafting (AFG) in the breast parenchyma remains a debated topic, particularly in reconstruction following breast cancer. This procedure still raises many questions, especially considering recent in vitro studies warning about the fact that lipofilling could promote tumor recurrence through increased neoangiogenesis, or facilitate metastasis. Through a systematic literature review on oncological risk and radiological follow-up, conducted from January 2010 to August 2014, we tried to identify populations at risk of recurrence after AFG. The study selection process was adapted from the Prisma statement. Out of the seven analysed patients cohorts, i.e. approximately 1500 AFG procedures, results on the risk of local recurrence appear reassuring after an average follow-up of 42 months. These results should be cautiously interpreted because of the heterogeneity of the studies. However, recurrences have been analysed based on the characteristics of the original tumor and many of them warn about population that seem more at risk of recurrence. Studies on radiological modifications after AFG emphasize the need for the radiologists to know the importance of radiological images induced by this procedure, however, AFG does not seem to interfere with radiological screening of local recurrence. In order to deliver clear information to patients receiving breast reconstruction by lipofilling, prospective studies focused on populations that seem to be most at risk of recurrence are required.

[Use of local estrogenotherapy in urology and pelviperineology: A systematic review]. / Œstrogénothérapie locale en urologie et pelvi-périnéologie. Revue de littérature.

OBJECTIVE: To conduct a literature review of the efficiency of vaginal local estrogenotherapy (LE) on genitourinary disorders related to menopause and those side effects. MATERIALS: A literature review was conducted using Pubmed database using the keywords vaginal estrogen, urinary incontinence, urgency, urinary tract infection, vulvar and vaginal atrophy, dyspareunia, breast cancer, endometrial cancer, thrombosis. The most relevant articles were selected and analyzed. RESULTS: The LE demonstrates its efficiency on preventing urinary tract infections, treatment of overactive bladder and vaginal disorders of postmenopausal women in controlled studies or meta-analysis level of evidence 1. Local side effects (discharge, erythema, vaginal bleeding, etc.) are rare. The systemic diffusion of low dose LE is limited and allowed to prescribe it to postmenopausal women without special supervision. However, using LE might be avoided in women with a history of oncological breast due to the lack of controlled studies evaluating the risk of developing breast cancer under LE. Except for high-risk women, LE does not increase the risk of thrombosis. CONCLUSION: Vaginal administration of low dose of estrogen is an effective and safe treatment in the management of postmenopausal genitourinary disorders. However, using LE for women with history of breast cancer or high risk of thrombisis should be avoided.

[Robotic-assisted laparoscopy for deep infiltrating endometriosis: the Register of the Society of European Robotic Gynaecological Surgery]. / Place de la robotique dans l'endométriose pelvienne profonde : à propos du registre de la SERGS.

OBJECTIVES: To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results. PATIENTS AND METHODS: From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum (n=88), bladder (n=23), ureter and uterosacral ligaments (n=115) et hysterectomy (n=28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility. RESULTS: In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group. DISCUSSION AND CONCLUSION: This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed.

[Sexual function and quality of life in locally advanced cervical cancer]. / Qualité de vie sexuelle et cancer du col localement avancé

OBJECTIVES: Sexual dysfunction is currently the most common complication of cancer. Most of the time, patients who are concerned by locally advanced cervical cancer are in a period of sexual activity. The primary objective of this study was to assess the quality of life and sexual function of patients with locally advanced cervical cancer who were in remission. The secondary objective was to correlate the prognostic factor with sexual dysfunction. PATIENTS AND METHODS: This multicentric and prospective study included the patients with locally advanced cervical cancer diagnosis from three centres. Thirty-one patients with diagnosis of locally advanced cervical cancer were enrolled from February 2007 to October 2008. The mean age was 49years old. Inclusion criteria were to have received the standard therapy by chemoradiotherapy and have been in remission for 2years. Both self-administered questionnaires BISF-W and EORTC QLQ-CX24 allowed scoring quality of life and sexual function. RESULTS: The rate of completion was 42%. The results confirmed that sexual function was impaired in accordance with sexual satisfaction. After therapy, the frequency of sexual activity was decreased. The functional quality of life was significantly correlated with sexual function. Marital status was a significant prognostic factor. Age, stage and the type of centre were not. DISCUSSION AND CONCLUSION: This preliminary study suggests that after 2years of remission of the disease after treatment, patients and their partners need to be helped as regards their sexual function. We propose to perform a prospective study on a larger cohort.

[Solitary fibrous tumor of the vulva: a case report]. / Tumeur fibreuse solitaire de la vulve : à propos d'un cas.

Solitary fibrous tumors of the genital tract female are extremely rare. We reported a case of solitary fibrous tumor originating in the vulva of a 37-year-old woman. The histological analysis revealed a conjunctiva tumourous proliferation, with variable cellularity, the morphology feature and the immunohistochemistry profile of which entailed us to infer on a solitary fibrous tumor. No recurrence was observed 16 months after surgery with flap reconstruction. Because of their possible pejorative evolution, it is very important to know these tumors. A long term follow-up must be advised.

[The adipose tissue transfer in the mammary parenchyma (part II): Review of the literature on the carcinologic risks]. / Transfert de tissu adipeux dans le parenchyme mammaire (2e partie) : y a-t-il un risque carcinologique ? Revue de la littérature.

The adipose tissue transfer in the mammary parenchyma is a controversial area that generates passionate debates both in France and abroad. This second article presents a review of the literature on the interactions of fat transfer and the risk of developing breast cancer. Analysis of the results of the fundamental literature on the effects of adipose tissue in breast cancer development is troubling. At this stage, these results can not be transposed to humans as there are no studies showing a clinical correlation with suspected factors. It is difficult today to propose a pragmatic attitude on the transfer fat tissue into the breast. Given the results of the literature, we believe that the recommendations of caution of various scientific societies is well justified. The development of prospective study seems necessary to address this controversial issue.

[Hurt eczematiforme column (chronicle) of the breast after implementation of a surgical clip]. / Lésion eczématiforme chronique du sein après mise en place d'un clip chirurgical.

We report a case of atopic dermatitis in relation with a surgical titanium clip. Such a complication has only been reported once in the literature. We advocate to ask the patients about query atopic manifestations especially contact dermatitis to metal before any procedure involving metallic implants.

[Voluminous juvenile papillomatosis: Diagnostic, therapeutic and prognostic difficulties - a case report]. / Volumineuse papillomatose juvénile : difficultés diagnostiques, thérapeutiques et pronostiques - à propos d'un cas.

The juvenile papillomatosis is a rare entity. We shall systematically check for a cancer. A 20-year-old woman patient without any familial medical history of breast carcinoma, was presenting a voluminous nodule of the left breast. A core needle biopsy allowed to diagnose papilloma. A conservative surgical treatment was proposed and realized despite any possibility of complete resection. Histological examination of the surgical specimen concluded to a juvenile papillomatosis. A closed follow-up was proposed to the patient. This case illustrates the difficulty of a voluminous tumor surgery on a young woman. The main problem is to combine the cosmetic constraints with oncology risk.

[The adipose tissue transfer in the mammary parenchyma (part I): Review of the literature on modifications of the radiological images]. / Transfert de tissu adipeux dans le parenchyme mammaire (première partie) : les modifications des images radiologiques. Revue de la littérature.

The adipose tissue transfer (ATT) in the mammary parenchyma is a subject of controversy and generates passionate debates in scientific meetings. So far, many phenomena remain unexplained. Among these phenomena, changes in mammogram images generated by the grafted adipose tissue and the interactions between the grafted adipose tissue and a clinically undetectable breast cancer are the most important. We will present a series of articles with a critical analysis of the scientific literature on each of these phenomena. This first article presents the review of the literature on modifications of the radiological images after ATT. Two types of images are most common in mammograms after ATT. These are oil cysts and microcalcifications. Regarding to the presented review of literature, there is not yet sufficient evidence to prove a similarity or not between these images generated by the ATT and those from a breast malignancy. Therefore, clinically, patients must be included in a prospective clinical trial and in terms of research, the first step should be an exhaustive description of radiological images after ATT and a comparison of these images to images of malignancy. So, it's important to include these patients in prospective protocols with close and long term follow-up.

Predictors of recurrence in high-grade cervical lesions and a plan of management.

UNLABELLED: PRÉCIS: Positive endocervical margins are an important predictor of recurrence in high-grade cervical lesions, and though they do not always warrant retreatment, closer surveillance is recommended. OBJECTIVE: To identify predictors of recurrence and persistence of high-grade cervical dysplasia and to determine appropriate follow-up. DESIGN: prospective pilot study. SETTING: Gynaecological surgical center. POPULATION: Three hundred fifty-two patients were treated between 1999 and 2002 for high-grade lesions. METHODS: According to the accessibility of the transformation zone and the degree of dysplasia, patients were treated either by conization or by loop electrosurgical excision procedure (LEEP). Follow-up comprised colposcopy and Pap-smear screening 4-6 months after treatment as well as high-risk human papillomavirus (HR-HPV) testing before and after treatment. MAIN OUTCOME MEASURES: underscore predictors of recurrence and propose a treatment flowchart for both management and follow-up. RESULTS: Of the 352 patients, 37 (10.5%) had true recurrence 6 months after initial surgical treatment and 6 patients (1.7%) had persistent lesions. Overall, 43 patients (12.2%) were considered as having recurrent disease. Patients were followed up for 5 years with a mean of 73 months. The most important predictor of recurrence was a positive HR-HPV test at 6 months postoperatively (odds ratio 38.8, 95% confidence interval 14.09, 107.05). The second significant predictor was positive endocervical margins and the third was positive pre-treatment HPV typing. A positive post-treatment HPV test had a more significant influence on risk than a positive test before treatment. CONCLUSION: In agreement with recent findings, our study supports the usefulness of the HR-HPV test in the follow-up of treated high-grade lesions, especially when excision margins were positive.

[Construction of a neo-vagina by sigmoidocolpoplasty]. / Reconstruction vaginale par sigmoïdoplastie pour aplasie utérovaginale: Technique chirurgicale et avantages.

Construction of a neo-vagina by sigmoidocolpoplasty has been effective in the treatment of vaginal aplasia, a condition most commonly seen with the Mayer Rokitansky Syndrome. This article describes the surgical technique and principal complications, and reviews the literature to compare this technique with other methods of repair, particularly the Davydov technique.